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She is currently working on \u003cem>Dreams of Dust\u003c/em>, @dreamsofdust, a multimedia project that documents stories of climate migration in California’s Central Valley, previously funded by the California Humanities. Her completed projects include \u003cem>\u003ca href=\"http://www.facesoffracking.org/\" target=\"_blank\" rel=\"nofollow noopener noreferrer\">Faces of Fracking\u003c/a>,\u003c/em> an investigation into the impact of fracking on the people and places of California, and \u003cem>\u003ca href=\"http://sarahcraig.visura.co/gulf-disaster-2\" target=\"_blank\" rel=\"nofollow noopener noreferrer\">The Gulf Disaster\u003c/a>,\u003c/em> stories on the lives of fishermen in the aftermath of the BP spill. Her work has been published by Marketplace, KQED's Bay Curious and Q'ed Up podcasts, KQED's California Report Magazine, KALW's Crosscurrents, Grist.org, High Country News, Earth Island Journal, and others. Sarah received a B.A. in Geography at Vassar College and attended the \u003ca href=\"http://www.salt.edu/\" target=\"_blank\" rel=\"nofollow noopener noreferrer\">Salt Institute of Documentary Studies\u003c/a> in Portland, ME. She recently received an Excellence in Journalism Award from the NorCal Society of Professional Journalists for her documentary radio piece, \u003ca href=\"http://kalw.org/post/215-will-water-come#stream/0\">\"Will the Water Come.\"\u003c/a> Email: scraig@kqed.org Twitter: @sarahcraigmedia Website: sarahcraigmedia.com","avatar":"https://secure.gravatar.com/avatar/97f17950c828429d3df9f2907412a50b?s=600&d=blank&r=g","twitter":null,"facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"news","roles":["subscriber"]},{"site":"science","roles":["editor"]}],"headData":{"title":"Sarah Craig | KQED","description":"KQED Contributor","ogImgSrc":"https://secure.gravatar.com/avatar/97f17950c828429d3df9f2907412a50b?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/97f17950c828429d3df9f2907412a50b?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/scraig"}},"breakingNewsReducer":{},"campaignFinanceReducer":{},"firebase":{"requesting":{},"requested":{},"timestamps":{},"data":{},"ordered":{},"auth":{"isLoaded":false,"isEmpty":true},"authError":null,"profile":{"isLoaded":false,"isEmpty":true},"listeners":{"byId":{},"allIds":[]},"isInitializing":false,"errors":[]},"navBarReducer":{"navBarId":"home","fullView":true,"showPlayer":false},"navMenuReducer":{"menus":[{"key":"menu1","items":[{"name":"News","link":"/","type":"title"},{"name":"Politics","link":"/politics"},{"name":"Science","link":"/science"},{"name":"Education","link":"/educationnews"},{"name":"Housing","link":"/housing"},{"name":"Immigration","link":"/immigration"},{"name":"Criminal Justice","link":"/criminaljustice"},{"name":"Silicon Valley","link":"/siliconvalley"},{"name":"Forum","link":"/forum"},{"name":"The California Report","link":"/californiareport"}]},{"key":"menu2","items":[{"name":"Arts & Culture","link":"/arts","type":"title"},{"name":"Critics’ Picks","link":"/thedolist"},{"name":"Cultural Commentary","link":"/artscommentary"},{"name":"Food & Drink","link":"/food"},{"name":"Bay Area Hip-Hop","link":"/bayareahiphop"},{"name":"Rebel Girls","link":"/rebelgirls"},{"name":"Arts Video","link":"/artsvideos"}]},{"key":"menu3","items":[{"name":"Podcasts","link":"/podcasts","type":"title"},{"name":"Bay Curious","link":"/podcasts/baycurious"},{"name":"Rightnowish","link":"/podcasts/rightnowish"},{"name":"The Bay","link":"/podcasts/thebay"},{"name":"On Our Watch","link":"/podcasts/onourwatch"},{"name":"Mindshift","link":"/podcasts/mindshift"},{"name":"Consider This","link":"/podcasts/considerthis"},{"name":"Political Breakdown","link":"/podcasts/politicalbreakdown"}]},{"key":"menu4","items":[{"name":"Live Radio","link":"/radio","type":"title"},{"name":"TV","link":"/tv","type":"title"},{"name":"Events","link":"/events","type":"title"},{"name":"For Educators","link":"/education","type":"title"},{"name":"Support KQED","link":"/support","type":"title"},{"name":"About","link":"/about","type":"title"},{"name":"Help Center","link":"https://kqed-helpcenter.kqed.org/s","type":"title"}]}]},"pagesReducer":{},"postsReducer":{"stream_live":{"type":"live","id":"stream_live","audioUrl":"https://streams.kqed.org/kqedradio","title":"Live Stream","excerpt":"Live Stream information currently unavailable.","link":"/radio","featImg":"","label":{"name":"KQED Live","link":"/"}},"stream_kqedNewscast":{"type":"posts","id":"stream_kqedNewscast","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/newscast.mp3?_=1","title":"KQED Newscast","featImg":"","label":{"name":"88.5 FM","link":"/"}},"news_11498766":{"type":"posts","id":"news_11498766","meta":{"index":"posts_1591205157","site":"news","id":"11498766","score":null,"sort":[1501284820000]},"guestAuthors":[],"slug":"healing-americas-forgotten-nuclear-refugees-is-one-womans-mission","title":"Healing America’s Forgotten Nuclear Refugees Is One Woman's Mission","publishDate":1501284820,"format":"image","headTitle":"The California Report | KQED News","labelTerm":{"term":72,"site":"news"},"content":"\u003cp>Nestled in Orange County, among the Starbucks, strip malls and highways, there’s a tiny immigrant community with an enormous historical burden.\u003c/p>\n\u003cp>They come from the Marshall Islands, an archipelago in the South Pacific made up of 2,000 small tropical atolls. And they have the unfortunate distinction of having the\u003ca href=\"https://assets.documentcloud.org/documents/3902548/A-Community-of-Contrasts-NHPI-US-2014.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"> lowest per capita income of any racial and ethnic group \u003c/a>in the entire United States.\u003c/p>\n\u003cp>In Southern California, the Marshallese settled in Costa Mesa. Some of the adults work as baggage handlers at nearby airports. Others work at a medical device company, sewing pig valves onto heart stents. Although poor, they are knit together by their faith and their history.\u003c/p>\n\u003cp>Greta Briand is the pastor’s wife, a volunteer health educator and a respected elder among the Marshallese. The children call her “bubu\" -- Marshallese for “grandmother.\"\u003c/p>\n\u003cp>[audio src=\"http://www.kqed.org/.stream/anon/radio/tcrmag/2017/07/Marshallese.mp3\" Image=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/07/BriandTalking-800x576.jpg\" Title=\"Healing America’s Forgotten Nuclear Refugees Is One Woman's Mission\" program=\"The California Report\"]\u003c/p>\n\u003cp>Briand started training as a health educator 12 years ago. She wanted to help her community deal with \u003ca href=\"http://www.migrationpolicy.org/article/marshall-islanders-migration-patterns-and-health-care-challenges\" target=\"_blank\" rel=\"noopener noreferrer\">alarming rates \u003c/a>of cancer, heart disease and diabetes. Marshall Islanders have the \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4358182/\" target=\"_blank\" rel=\"noopener noreferrer\">second-highest rate of diabetes\u003c/a> in the world, and they also suffer from thyroid cancer, breast cancer, and cancers of the blood, stomach and colon.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>These illnesses, Briand says, can be traced back 70 years, to the immediate aftermath of World War II, when the U.S. occupied the atolls of the Marshall Islands and used them as a nuclear proving ground.\u003c/p>\n\u003cp>Over the course of 12 years, the U.S. detonated 67 nuclear bombs there.\u003c/p>\n\u003cp>\"I always call it nuke. They nuke us!\" she says. \"And we never had these kind of diseases before. And I do believe it was because we were exposed to radiation. It was too strong.\"\u003c/p>\n\u003cp>Briand’s own family has suffered. Her older and younger sisters are cancer survivors, of breast and thyroid, respectively. Both these cancers are on an official list from the Nuclear Claims Tribunal of \u003ca href=\"https://assets.documentcloud.org/documents/3902551/Humanitarian-Impacts-of-Nuclear-War.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">37 cancers and diseases linked to nuclear weapons testing\u003c/a>.\u003c/p>\n\u003cfigure id=\"attachment_11599022\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11599022\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/07/GretaFlower800-800x905.jpg\" alt=\"Greta Briand wears a traditional blossom in her hair. It’s woven together with the leaves of palm fronds.\" width=\"800\" height=\"905\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2017/07/GretaFlower800.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/GretaFlower800-160x181.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/GretaFlower800-240x272.jpg 240w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/GretaFlower800-375x424.jpg 375w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/GretaFlower800-520x588.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Greta Briand wears a traditional blossom in her hair. It’s woven together with the leaves of palm fronds. \u003ccite>(Courtesy of Melody Seanoa)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>Nuclear Refugees in California\u003c/h3>\n\u003cp>Greta Briand, now almost 70, came to California when she was a teenager, to work and to go to college. She was among the first group who came to Costa Mesa, which became the first Marshallese community in the U.S. Over the years, thousands of Marshallese followed her to America, uprooted and displaced by the U.S. nuclear testing.\u003c/p>\n\u003cp>Today, there are more than 23,000 Marshallese living in the U.S., \u003ca href=\"https://assets.documentcloud.org/documents/3902543/A-Community-of-Contrasts-NHPI-CA-2014.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">and about 2,000 in California.\u003c/a> They were able to come because of an agreement made between the Marshall Islands and the U.S. -- the \u003ca href=\"http://uscompact.org/about/cofa.php\">Compact of Free Association\u003c/a>. The Compact allows Marshallese to work and live freely on U.S. soil for as long as they want, but does not convey citizenship.\u003c/p>\n\u003cp>Briand originally planned to return to the Marshall Islands after she got her degree. But one reason she stayed was the health issues in her community. She wanted to help.\u003c/p>\n\u003cp>\"You go to everybody's home, every home has a person sick -- or two -- with diabetes, cancer, heart disease,\" she says.\u003c/p>\n\u003cp>But the effects of the radiation and fallout may extend even farther. According to researchers, it’s possible that the radiation from the nuclear weapons tests \u003ca href=\"http://dels.nas.edu/resources/static-assets/materials-based-on-reports/reports-in-brief/beir_vii_final.pdf\">can cause genetic damage\u003c/a> that can be inherited. The possibility haunts Greta.\u003c/p>\n\u003cp>“If I don’t have it, my grandkids ...,” she breaks off tearfully. “My grandkids -- or my great-grandkids -- might have cancer. And it just breaks my heart. But that's why we got to live each day, because you know we don't know what will happen tomorrow.”\u003c/p>\n\u003cfigure id=\"attachment_11599024\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11599024\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/07/BriandFuneral-800x975.jpg\" alt=\"Greta Briand attends a Marshallese funeral and scatters dirt over a grave. Her younger sister, Delta Garstang, far right, is a thyroid cancer survivor.\" width=\"800\" height=\"975\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2017/07/BriandFuneral-800x975.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/BriandFuneral-160x195.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/BriandFuneral-1020x1243.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/BriandFuneral.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/BriandFuneral-1180x1438.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/BriandFuneral-960x1170.jpg 960w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/BriandFuneral-240x293.jpg 240w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/BriandFuneral-375x457.jpg 375w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/BriandFuneral-520x634.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Greta Briand attends a Marshallese funeral and scatters dirt over a grave. Her younger sister, Delta Garstang, far right, is a thyroid cancer survivor. \u003ccite>(Courtesty of Melody Seanoa)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>One Voice for Many Needs\u003c/h3>\n\u003cp>Jane Pang, an advocate at the\u003ca href=\"http://www.pacifichealthpartners.org/\" target=\"_blank\" rel=\"noopener noreferrer\"> Pacific Islander Health Partnership\u003c/a> in Orange County, trained Briand to recognize and combat the barriers that prevent many Marshallese from getting treatment.\u003c/p>\n\u003cp>\"They don't understand the medical challenges. They don't understand the symptoms,” Pang said of the Marshallese. “It’s difficult for them to understand, because they have very little education in terms of health. They personally will not know what to ask for, and that's why Greta was so valuable. She was such an excellent voice.\"\u003c/p>\n\u003cp>Greta holds health classes in women’s homes, or at the church, to teach women how to do breast self-exams. She also encourages them to go to the doctor regularly, because of the health risks posed by the nuclear tests.\u003c/p>\n\u003cp>\"I was thinking about what happened to us, and I know if I don't say anything, nobody will.\"\u003c/p>\n\u003cp>Briand is the only Marshallese resident in Costa Mesa who is trying to help her peers navigate the U.S. health system. She’s up against a lot. Aside from severe poverty, there’s a language barrier. One in four Marshallese households don’t speak English.\u003c/p>\n\u003cp>Marshallese culture also stigmatizes illness. Briand says this applies to any sickness: “You don't tell anybody,” she says. “Whenever a person is sick, they always think that they did something wrong and God is punishing them.\"\u003c/p>\n\u003cfigure id=\"attachment_11599138\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11599138\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/07/CastleBravo800-800x815.jpg\" alt=\"This is an archival photo of Castle Bravo, 3.5 seconds after detonation. at a a distance of 75 nautical miles from ground zero. This bomb was the largest and dirtiest bomb ever detonated by the U.S. It was so large you can still see the crater from space. \" width=\"800\" height=\"815\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2017/07/CastleBravo800.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/CastleBravo800-160x163.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/CastleBravo800-240x245.jpg 240w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/CastleBravo800-375x382.jpg 375w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/CastleBravo800-520x530.jpg 520w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/CastleBravo800-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/CastleBravo800-50x50.jpg 50w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/CastleBravo800-64x64.jpg 64w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">This is an archival photo of Castle Bravo, 3.5 seconds after detonation. at a a distance of 75 nautical miles from ground zero. This bomb was the largest and dirtiest bomb ever detonated by the U.S. It was so large you can still see the crater from space. \u003ccite>(National Security Archive)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>A Childhood Among the Bombs\u003c/h3>\n\u003cp>To understand the root of the Marshallese health problems today, it’s important to go back to the late 1940s, when the Cold War began. At that time, the nuclear arms race was heating up and the U.S. needed a place, far from the populated mainland, to test bigger and more destructive nuclear weapons. Some of the 67 nuclear weapons tested in the Marshall Islands were detonated underwater, and some were dropped from airplanes. Some of the islands were completely destroyed.\u003c/p>\n\u003cp>When Briand was 5, she witnessed the largest and most radioactive of these bombs from her home island of Likiep. It was called \u003ca href=\"http://nsarchive.gwu.edu/nukevault/ebb459/\" target=\"_blank\" rel=\"noopener noreferrer\">Castle Bravo \u003c/a>and it had a nuclear force equivalent to 1,000 times the force of the bomb dropped on Hiroshima.\u003c/p>\n\u003cp>[contextly_sidebar id=\"lNX7qsQ8QEPRGkn5Tily0XyQahdDkc3H\"]\u003c/p>\n\u003cp>\"It was like, the sky was beautiful with orange color,\" Briand says. “And we thought it was something beautiful. We didn't know it was poison!\"\u003c/p>\n\u003cp>After the detonation, dangerous clouds of radioactive, pulverized coral dust drifted across her island, coating homes and people.\u003c/p>\n\u003cp>Briand isn’t alone. Castle Bravo remains the most remembered bomb test on the islands -- and everyone received documented levels of fallout from the blast.\u003c/p>\n\u003cp>Kon Kon Wasay, 82, was a teenager when she saw the bomb. She remembers that she was outside playing with six other girls and one boy. “All of a sudden, we hear this loud noise and it looked like something evaporating.”\u003c/p>\n\u003cp>Afterward, her friends all got sick. They have all passed away from thyroid cancers and other diseases.\u003c/p>\n\u003cfigure id=\"attachment_11498781\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11498781\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/06/bikini-800x612.jpg\" alt=\"\" width=\"800\" height=\"612\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2017/06/bikini-800x612.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2017/06/bikini-160x122.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2017/06/bikini-1020x780.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2017/06/bikini-1180x902.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/10/2017/06/bikini-960x734.jpg 960w, https://ww2.kqed.org/app/uploads/sites/10/2017/06/bikini-240x183.jpg 240w, https://ww2.kqed.org/app/uploads/sites/10/2017/06/bikini-375x287.jpg 375w, https://ww2.kqed.org/app/uploads/sites/10/2017/06/bikini-520x398.jpg 520w, https://ww2.kqed.org/app/uploads/sites/10/2017/06/bikini.jpg 1800w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">The U.S. Navy filming Commodore Wyatt “consulting” the Bikinians about their evacuation on March 6, 1946. \u003ccite>(National Security Archive)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>'Something Good for Mankind'\u003c/h3>\n\u003cp>The U.S. was able to conduct these nuclear tests because it had occupied the Marshall Islands since World War II. After defeating the Japanese, who had previously occupied the archipelago, the U.S. military moved in, permanently.\u003c/p>\n\u003cp>Before the tests began, military governor Commodore Ben H. Wyatt took a sea plane to Bikini Island to talk to the islanders. \u003ca href=\"https://www.youtube.com/watch?v=zri2knpOSqo\" target=\"_blank\" rel=\"noopener noreferrer\">Footage from a Navy propaganda film\u003c/a> shows Wyatt speaking to their leader, Chief Juda, through a translator named James.\u003c/p>\n\u003cp>“All right now, James, will you tell them that the United States government now wants to attempt to turn this great destructive force into something good for mankind, and that these experiments here at Bikini are the first step in that direction.”\u003c/p>\n\u003cfigure id=\"attachment_11597358\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-11597358 size-medium\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/07/BikiniWyattCrop-1-800x535.jpg\" alt=\"\" width=\"800\" height=\"535\">\u003cfigcaption class=\"wp-caption-text\">Commodore Ben H. Wyatt, the military governor of the Marshall Islands, traveled to Bikini in 1946 to tell them about a plan to detonate nuclear weapons. \u003ccite>(National Security Archive)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The film then portrays the people leaving their islands willingly. But the Marshallese didn't have a choice. The U.S. moved them from island to island, using them as cheap laborers on the military bases.\u003c/p>\n\u003cp>“They never asked permission,” says Barbara Rose Johnston, an anthropologist in Santa Cruz who has studied the effects of the nuclear tests on Marshallese culture.\u003c/p>\n\u003cp>“They just dictated: We're taking over, we're doing our test here. And in the years since, they never did any full disclosure of the extent of what they were doing, how, and why,\" she says. \"The culture of the time did not think of the Marshallese as equal people.”\u003c/p>\n\u003cfigure id=\"attachment_11597359\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-11597359 size-medium\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/07/bikini-evacuation-edit-800x619.jpg\" alt=\"\" width=\"800\" height=\"619\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2017/07/bikini-evacuation-edit-800x619.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/bikini-evacuation-edit-160x124.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/bikini-evacuation-edit-1020x789.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/bikini-evacuation-edit-1180x912.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/bikini-evacuation-edit-960x742.jpg 960w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/bikini-evacuation-edit-240x186.jpg 240w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/bikini-evacuation-edit-375x290.jpg 375w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/bikini-evacuation-edit-520x402.jpg 520w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/bikini-evacuation-edit.jpg 1782w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Marshallese evacuate from their island of Bikini in 1946. \u003ccite>(National Security Archives)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Johnston has unearthed \u003ca href=\"https://assets.documentcloud.org/documents/3902551/Humanitarian-Impacts-of-Nuclear-War.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">previously classified documents revealing an invasive medical program called Project 4.1\u003c/a> that the U.S. performed on some Marshallese to learn how radiation damages the human body.\u003c/p>\n\u003cp>Over the course of four decades and 72 research trips to the islands, U.S. medical teams examined the Marshallese using X-rays and photography, and took samples of blood, urine and tissue. Some Marshallese even received radioisotope injections and underwent experimental surgery.\u003c/p>\n\u003cp>Since that time, the U.S. government has formally recognized some of the harm caused by the bombings, and the U.S. government pays for health care and government assistance on the Marshall Islands. But those programs aren't available to the Marshallese who have migrated to California and other states, and many remain poor and isolated.\u003c/p>\n\u003cp>As the sole health educator in Costa Mesa, Greta Briand is the only one connecting the dots, explaining to her people how the nuclear history of the past created the medical problems of the present.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>The 23,000 Marshallese who live in the United States have settled most heavily in Arkansas, California, Hawaii, Missouri, Washington and Oregon. In some of those states, the unique migration status of the Marshallese means they are ineligible for Medicaid. Sarah Craig has also reported on a community in Enid, Oklahoma, where most of the Marshallese are uninsured. One Enid resident, Terry Mote, is fighting to improve health care for his people. The story won the Untold Story Award from Narrative.ly. You can see her photos and \u003ca href=\"http://narrative.ly/how-years-of-ruthless-nuclear-testing-in-the-south-pacific-forged-americas-most-impoverished-ethnic-group/\" target=\"_blank\" rel=\"noopener noreferrer\">read the whole story here.\u003c/a>\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"More than 70 years ago, the U.S. began testing dozens of nuclear weapons on the Marshall Islands. In California, their community is still hurting.","status":"publish","parent":0,"modified":1501290428,"stats":{"hasAudio":true,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":42,"wordCount":1837},"headData":{"title":"Healing America’s Forgotten Nuclear Refugees Is One Woman's Mission | KQED","description":"More than 70 years ago, the U.S. began testing dozens of nuclear weapons on the Marshall Islands. In California, their community is still hurting.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"11498766 https://ww2.kqed.org/news/?p=11498766","disqusUrl":"https://ww2.kqed.org/news/2017/07/28/healing-americas-forgotten-nuclear-refugees-is-one-womans-mission/","disqusTitle":"Healing America’s Forgotten Nuclear Refugees Is One Woman's Mission","path":"/news/11498766/healing-americas-forgotten-nuclear-refugees-is-one-womans-mission","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Nestled in Orange County, among the Starbucks, strip malls and highways, there’s a tiny immigrant community with an enormous historical burden.\u003c/p>\n\u003cp>They come from the Marshall Islands, an archipelago in the South Pacific made up of 2,000 small tropical atolls. And they have the unfortunate distinction of having the\u003ca href=\"https://assets.documentcloud.org/documents/3902548/A-Community-of-Contrasts-NHPI-US-2014.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"> lowest per capita income of any racial and ethnic group \u003c/a>in the entire United States.\u003c/p>\n\u003cp>In Southern California, the Marshallese settled in Costa Mesa. Some of the adults work as baggage handlers at nearby airports. Others work at a medical device company, sewing pig valves onto heart stents. Although poor, they are knit together by their faith and their history.\u003c/p>\n\u003cp>Greta Briand is the pastor’s wife, a volunteer health educator and a respected elder among the Marshallese. The children call her “bubu\" -- Marshallese for “grandmother.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"audio","attributes":{"named":{"src":"http://www.kqed.org/.stream/anon/radio/tcrmag/2017/07/Marshallese.mp3","image":"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/07/BriandTalking-800x576.jpg","title":"Healing America’s Forgotten Nuclear Refugees Is One Woman's Mission","program":"The California Report","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Briand started training as a health educator 12 years ago. She wanted to help her community deal with \u003ca href=\"http://www.migrationpolicy.org/article/marshall-islanders-migration-patterns-and-health-care-challenges\" target=\"_blank\" rel=\"noopener noreferrer\">alarming rates \u003c/a>of cancer, heart disease and diabetes. Marshall Islanders have the \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4358182/\" target=\"_blank\" rel=\"noopener noreferrer\">second-highest rate of diabetes\u003c/a> in the world, and they also suffer from thyroid cancer, breast cancer, and cancers of the blood, stomach and colon.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>These illnesses, Briand says, can be traced back 70 years, to the immediate aftermath of World War II, when the U.S. occupied the atolls of the Marshall Islands and used them as a nuclear proving ground.\u003c/p>\n\u003cp>Over the course of 12 years, the U.S. detonated 67 nuclear bombs there.\u003c/p>\n\u003cp>\"I always call it nuke. They nuke us!\" she says. \"And we never had these kind of diseases before. And I do believe it was because we were exposed to radiation. It was too strong.\"\u003c/p>\n\u003cp>Briand’s own family has suffered. Her older and younger sisters are cancer survivors, of breast and thyroid, respectively. Both these cancers are on an official list from the Nuclear Claims Tribunal of \u003ca href=\"https://assets.documentcloud.org/documents/3902551/Humanitarian-Impacts-of-Nuclear-War.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">37 cancers and diseases linked to nuclear weapons testing\u003c/a>.\u003c/p>\n\u003cfigure id=\"attachment_11599022\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11599022\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/07/GretaFlower800-800x905.jpg\" alt=\"Greta Briand wears a traditional blossom in her hair. It’s woven together with the leaves of palm fronds.\" width=\"800\" height=\"905\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2017/07/GretaFlower800.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/GretaFlower800-160x181.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/GretaFlower800-240x272.jpg 240w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/GretaFlower800-375x424.jpg 375w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/GretaFlower800-520x588.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Greta Briand wears a traditional blossom in her hair. It’s woven together with the leaves of palm fronds. \u003ccite>(Courtesy of Melody Seanoa)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>Nuclear Refugees in California\u003c/h3>\n\u003cp>Greta Briand, now almost 70, came to California when she was a teenager, to work and to go to college. She was among the first group who came to Costa Mesa, which became the first Marshallese community in the U.S. Over the years, thousands of Marshallese followed her to America, uprooted and displaced by the U.S. nuclear testing.\u003c/p>\n\u003cp>Today, there are more than 23,000 Marshallese living in the U.S., \u003ca href=\"https://assets.documentcloud.org/documents/3902543/A-Community-of-Contrasts-NHPI-CA-2014.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">and about 2,000 in California.\u003c/a> They were able to come because of an agreement made between the Marshall Islands and the U.S. -- the \u003ca href=\"http://uscompact.org/about/cofa.php\">Compact of Free Association\u003c/a>. The Compact allows Marshallese to work and live freely on U.S. soil for as long as they want, but does not convey citizenship.\u003c/p>\n\u003cp>Briand originally planned to return to the Marshall Islands after she got her degree. But one reason she stayed was the health issues in her community. She wanted to help.\u003c/p>\n\u003cp>\"You go to everybody's home, every home has a person sick -- or two -- with diabetes, cancer, heart disease,\" she says.\u003c/p>\n\u003cp>But the effects of the radiation and fallout may extend even farther. According to researchers, it’s possible that the radiation from the nuclear weapons tests \u003ca href=\"http://dels.nas.edu/resources/static-assets/materials-based-on-reports/reports-in-brief/beir_vii_final.pdf\">can cause genetic damage\u003c/a> that can be inherited. The possibility haunts Greta.\u003c/p>\n\u003cp>“If I don’t have it, my grandkids ...,” she breaks off tearfully. “My grandkids -- or my great-grandkids -- might have cancer. And it just breaks my heart. But that's why we got to live each day, because you know we don't know what will happen tomorrow.”\u003c/p>\n\u003cfigure id=\"attachment_11599024\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11599024\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/07/BriandFuneral-800x975.jpg\" alt=\"Greta Briand attends a Marshallese funeral and scatters dirt over a grave. Her younger sister, Delta Garstang, far right, is a thyroid cancer survivor.\" width=\"800\" height=\"975\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2017/07/BriandFuneral-800x975.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/BriandFuneral-160x195.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/BriandFuneral-1020x1243.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/BriandFuneral.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/BriandFuneral-1180x1438.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/BriandFuneral-960x1170.jpg 960w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/BriandFuneral-240x293.jpg 240w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/BriandFuneral-375x457.jpg 375w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/BriandFuneral-520x634.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Greta Briand attends a Marshallese funeral and scatters dirt over a grave. Her younger sister, Delta Garstang, far right, is a thyroid cancer survivor. \u003ccite>(Courtesty of Melody Seanoa)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>One Voice for Many Needs\u003c/h3>\n\u003cp>Jane Pang, an advocate at the\u003ca href=\"http://www.pacifichealthpartners.org/\" target=\"_blank\" rel=\"noopener noreferrer\"> Pacific Islander Health Partnership\u003c/a> in Orange County, trained Briand to recognize and combat the barriers that prevent many Marshallese from getting treatment.\u003c/p>\n\u003cp>\"They don't understand the medical challenges. They don't understand the symptoms,” Pang said of the Marshallese. “It’s difficult for them to understand, because they have very little education in terms of health. They personally will not know what to ask for, and that's why Greta was so valuable. She was such an excellent voice.\"\u003c/p>\n\u003cp>Greta holds health classes in women’s homes, or at the church, to teach women how to do breast self-exams. She also encourages them to go to the doctor regularly, because of the health risks posed by the nuclear tests.\u003c/p>\n\u003cp>\"I was thinking about what happened to us, and I know if I don't say anything, nobody will.\"\u003c/p>\n\u003cp>Briand is the only Marshallese resident in Costa Mesa who is trying to help her peers navigate the U.S. health system. She’s up against a lot. Aside from severe poverty, there’s a language barrier. One in four Marshallese households don’t speak English.\u003c/p>\n\u003cp>Marshallese culture also stigmatizes illness. Briand says this applies to any sickness: “You don't tell anybody,” she says. “Whenever a person is sick, they always think that they did something wrong and God is punishing them.\"\u003c/p>\n\u003cfigure id=\"attachment_11599138\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11599138\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/07/CastleBravo800-800x815.jpg\" alt=\"This is an archival photo of Castle Bravo, 3.5 seconds after detonation. at a a distance of 75 nautical miles from ground zero. This bomb was the largest and dirtiest bomb ever detonated by the U.S. It was so large you can still see the crater from space. \" width=\"800\" height=\"815\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2017/07/CastleBravo800.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/CastleBravo800-160x163.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/CastleBravo800-240x245.jpg 240w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/CastleBravo800-375x382.jpg 375w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/CastleBravo800-520x530.jpg 520w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/CastleBravo800-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/CastleBravo800-50x50.jpg 50w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/CastleBravo800-64x64.jpg 64w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">This is an archival photo of Castle Bravo, 3.5 seconds after detonation. at a a distance of 75 nautical miles from ground zero. This bomb was the largest and dirtiest bomb ever detonated by the U.S. It was so large you can still see the crater from space. \u003ccite>(National Security Archive)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>A Childhood Among the Bombs\u003c/h3>\n\u003cp>To understand the root of the Marshallese health problems today, it’s important to go back to the late 1940s, when the Cold War began. At that time, the nuclear arms race was heating up and the U.S. needed a place, far from the populated mainland, to test bigger and more destructive nuclear weapons. Some of the 67 nuclear weapons tested in the Marshall Islands were detonated underwater, and some were dropped from airplanes. Some of the islands were completely destroyed.\u003c/p>\n\u003cp>When Briand was 5, she witnessed the largest and most radioactive of these bombs from her home island of Likiep. It was called \u003ca href=\"http://nsarchive.gwu.edu/nukevault/ebb459/\" target=\"_blank\" rel=\"noopener noreferrer\">Castle Bravo \u003c/a>and it had a nuclear force equivalent to 1,000 times the force of the bomb dropped on Hiroshima.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"It was like, the sky was beautiful with orange color,\" Briand says. “And we thought it was something beautiful. We didn't know it was poison!\"\u003c/p>\n\u003cp>After the detonation, dangerous clouds of radioactive, pulverized coral dust drifted across her island, coating homes and people.\u003c/p>\n\u003cp>Briand isn’t alone. Castle Bravo remains the most remembered bomb test on the islands -- and everyone received documented levels of fallout from the blast.\u003c/p>\n\u003cp>Kon Kon Wasay, 82, was a teenager when she saw the bomb. She remembers that she was outside playing with six other girls and one boy. “All of a sudden, we hear this loud noise and it looked like something evaporating.”\u003c/p>\n\u003cp>Afterward, her friends all got sick. They have all passed away from thyroid cancers and other diseases.\u003c/p>\n\u003cfigure id=\"attachment_11498781\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11498781\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/06/bikini-800x612.jpg\" alt=\"\" width=\"800\" height=\"612\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2017/06/bikini-800x612.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2017/06/bikini-160x122.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2017/06/bikini-1020x780.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2017/06/bikini-1180x902.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/10/2017/06/bikini-960x734.jpg 960w, https://ww2.kqed.org/app/uploads/sites/10/2017/06/bikini-240x183.jpg 240w, https://ww2.kqed.org/app/uploads/sites/10/2017/06/bikini-375x287.jpg 375w, https://ww2.kqed.org/app/uploads/sites/10/2017/06/bikini-520x398.jpg 520w, https://ww2.kqed.org/app/uploads/sites/10/2017/06/bikini.jpg 1800w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">The U.S. Navy filming Commodore Wyatt “consulting” the Bikinians about their evacuation on March 6, 1946. \u003ccite>(National Security Archive)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>'Something Good for Mankind'\u003c/h3>\n\u003cp>The U.S. was able to conduct these nuclear tests because it had occupied the Marshall Islands since World War II. After defeating the Japanese, who had previously occupied the archipelago, the U.S. military moved in, permanently.\u003c/p>\n\u003cp>Before the tests began, military governor Commodore Ben H. Wyatt took a sea plane to Bikini Island to talk to the islanders. \u003ca href=\"https://www.youtube.com/watch?v=zri2knpOSqo\" target=\"_blank\" rel=\"noopener noreferrer\">Footage from a Navy propaganda film\u003c/a> shows Wyatt speaking to their leader, Chief Juda, through a translator named James.\u003c/p>\n\u003cp>“All right now, James, will you tell them that the United States government now wants to attempt to turn this great destructive force into something good for mankind, and that these experiments here at Bikini are the first step in that direction.”\u003c/p>\n\u003cfigure id=\"attachment_11597358\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-11597358 size-medium\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/07/BikiniWyattCrop-1-800x535.jpg\" alt=\"\" width=\"800\" height=\"535\">\u003cfigcaption class=\"wp-caption-text\">Commodore Ben H. Wyatt, the military governor of the Marshall Islands, traveled to Bikini in 1946 to tell them about a plan to detonate nuclear weapons. \u003ccite>(National Security Archive)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The film then portrays the people leaving their islands willingly. But the Marshallese didn't have a choice. The U.S. moved them from island to island, using them as cheap laborers on the military bases.\u003c/p>\n\u003cp>“They never asked permission,” says Barbara Rose Johnston, an anthropologist in Santa Cruz who has studied the effects of the nuclear tests on Marshallese culture.\u003c/p>\n\u003cp>“They just dictated: We're taking over, we're doing our test here. And in the years since, they never did any full disclosure of the extent of what they were doing, how, and why,\" she says. \"The culture of the time did not think of the Marshallese as equal people.”\u003c/p>\n\u003cfigure id=\"attachment_11597359\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-11597359 size-medium\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/07/bikini-evacuation-edit-800x619.jpg\" alt=\"\" width=\"800\" height=\"619\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2017/07/bikini-evacuation-edit-800x619.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/bikini-evacuation-edit-160x124.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/bikini-evacuation-edit-1020x789.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/bikini-evacuation-edit-1180x912.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/bikini-evacuation-edit-960x742.jpg 960w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/bikini-evacuation-edit-240x186.jpg 240w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/bikini-evacuation-edit-375x290.jpg 375w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/bikini-evacuation-edit-520x402.jpg 520w, https://ww2.kqed.org/app/uploads/sites/10/2017/07/bikini-evacuation-edit.jpg 1782w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Marshallese evacuate from their island of Bikini in 1946. \u003ccite>(National Security Archives)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Johnston has unearthed \u003ca href=\"https://assets.documentcloud.org/documents/3902551/Humanitarian-Impacts-of-Nuclear-War.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">previously classified documents revealing an invasive medical program called Project 4.1\u003c/a> that the U.S. performed on some Marshallese to learn how radiation damages the human body.\u003c/p>\n\u003cp>Over the course of four decades and 72 research trips to the islands, U.S. medical teams examined the Marshallese using X-rays and photography, and took samples of blood, urine and tissue. Some Marshallese even received radioisotope injections and underwent experimental surgery.\u003c/p>\n\u003cp>Since that time, the U.S. government has formally recognized some of the harm caused by the bombings, and the U.S. government pays for health care and government assistance on the Marshall Islands. But those programs aren't available to the Marshallese who have migrated to California and other states, and many remain poor and isolated.\u003c/p>\n\u003cp>As the sole health educator in Costa Mesa, Greta Briand is the only one connecting the dots, explaining to her people how the nuclear history of the past created the medical problems of the present.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>The 23,000 Marshallese who live in the United States have settled most heavily in Arkansas, California, Hawaii, Missouri, Washington and Oregon. In some of those states, the unique migration status of the Marshallese means they are ineligible for Medicaid. Sarah Craig has also reported on a community in Enid, Oklahoma, where most of the Marshallese are uninsured. One Enid resident, Terry Mote, is fighting to improve health care for his people. The story won the Untold Story Award from Narrative.ly. You can see her photos and \u003ca href=\"http://narrative.ly/how-years-of-ruthless-nuclear-testing-in-the-south-pacific-forged-americas-most-impoverished-ethnic-group/\" target=\"_blank\" rel=\"noopener noreferrer\">read the whole story here.\u003c/a>\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11498766/healing-americas-forgotten-nuclear-refugees-is-one-womans-mission","authors":["11327"],"programs":["news_72"],"categories":["news_19906","news_457","news_8","news_13"],"tags":["news_160","news_21080","news_17286","news_17041"],"featImg":"news_11598957","label":"news_72"},"news_11596552":{"type":"posts","id":"news_11596552","meta":{"index":"posts_1591205157","site":"news","id":"11596552","score":null,"sort":[1501175215000]},"guestAuthors":[],"slug":"states-have-already-tried-versions-of-skinny-repeal-it-didnt-go-well","title":"States Have Already Tried Versions of 'Skinny Repeal.' It Didn't Go Well","publishDate":1501175215,"format":"standard","headTitle":"The California Report | KQED News","labelTerm":{},"content":"\u003cp>Betting that thin is in — and might be the only way forward — Senate Republicans are eyeing a \"skinny repeal\" that would roll back an unpopular portion of the federal health law. But health policy analysts warn that the idea has been tried before, and with little success.\u003c/p>\n\u003cp>Senators are reportedly considering a narrow bill that would eliminate the Affordable Care Act's \"individual mandate,\" which assesses a tax on Americans who don't have insurance. The bill would also eliminate the ACA's penalties for some businesses -- those that have 50 or more workers and fail to offer their employees health coverage.\u003c/p>\n\u003cp>Details aren't clear, but it appears that — at least initially — much of the rest of the 2010 health law would remain, under this strategy, including the rule that says insurers must cover people who have pre-existing medical problems.\u003c/p>\n\u003cp>[contextly_sidebar id=\"3xCHRB83RCegO5eCE9I9b7XUGYrDBx2J\"]\u003c/p>\n\u003cp>In remarks on the Senate floor Wednesday, Sen. Minority Leader Charles Schumer, D-N.Y., said that \"we just heard from the nonpartisan Congressional Budget Office that under such a plan ... 16 million Americans would lose their health insurance, and millions more would pay a 20 percent increase in their premiums.\" The CBO \u003ca href=\"https://www.cbo.gov/publication/52977\" target=\"_blank\" rel=\"noopener noreferrer\">posted its evaluation\u003c/a> of the GOP's proposed plan Wednesday evening.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Earlier in the day, some Republicans seemed determined to find some way to keep the health care debate alive.\u003c/p>\n\u003cp>\"We need an outcome, and if a so-called skinny repeal is the first step, that's a good first step,\" said Sen. Thom Tillis, R-N.C.\u003c/p>\n\u003cp>Several Republican senators, including Dean Heller of Nevada and Jeff Flake of Arizona, appear to back this approach, according to \u003ca href=\"http://www.politico.com/story/2017/07/26/obamacare-repeal-republicans-minimum-240982\" target=\"_blank\" rel=\"noopener noreferrer\">published reports\u003c/a>. It is, at least for now, being viewed as a step along the way to Republican health reform.\u003c/p>\n\u003cp>\"I think that most people would understand that what you're really voting on is trying to keep the conversation alive,\" said Sen. Bob Corker, R-Tenn. \"It's not the policy itself ... it's about trying to create a bigger discussion about repeal between the House and Senate.\"\u003c/p>\n\u003cp>But what if, during these strange legislative times, the skinny repeal were to be passed by the Senate and then go on to become law? States' experiences with insurance market reforms and rollbacks highlight the possible trouble spots.\u003c/p>\n\u003ch3>Considering the Parallels\u003c/h3>\n\u003cp>By the late 1990s, states such as Washington, Kentucky and Massachusetts felt a backlash when some of the coverage requirement rules they'd previously put on the individual market were lifted. \"Things went badly,\" said \u003ca href=\"http://law.wfu.edu/faculty/profile/hallma/\" target=\"_blank\" rel=\"noopener noreferrer\">Mark Hall\u003c/a>, director of the health law and policy program at Wake Forest University.\u003c/p>\n\u003cp>Premiums rose and insurers fled these states, leaving consumers who buy their own coverage (usually because they don't get it through their jobs) with fewer choices and higher prices.\u003c/p>\n\u003cp>That's because — like the Senate plan — the states generally kept popular parts of their laws, including protections for people with pre-existing conditions. At the same time, they didn't include mandates that consumers carry coverage.\u003c/p>\n\u003cp>[contextly_sidebar id=\"uvPSgszQseNfQlpVIo48aD8k0r8xaCVy\"]\u003c/p>\n\u003cp>That goes to a basic concept about any kind of insurance: People who don't file claims in any given year subsidize those who do. Also, those healthy people are less likely to sign up, insurers said, and that leaves insurance companies with only the more costly policyholders.\u003c/p>\n\u003cp>Bottom line: Insurers end up \"less willing to participate in the market,\" said Hall.\u003c/p>\n\u003cp>It's not an exact comparison, though, he added, because the current federal health law offers something most states did not: significant subsidies to help some people buy coverage. Those subsidies could blunt the effect of not having a mandate.\u003c/p>\n\u003cp>During the debate that led to passage of the federal ACA, insurers flat-out said the plan would fail without an individual mandate. On Wednesday, the Blue Cross Blue Shield Association weighed in again, saying that if there is no longer a coverage requirement, there should be \"strong incentives for people to obtain health insurance and keep it year-round.\"\u003c/p>\n\u003ch3>Individual Mandate Is Still Unpopular in Voter Polls\u003c/h3>\n\u003cp>About 6.5 million Americans \u003ca href=\"http://www.cnbc.com/2017/01/11/fewer-people-paid-obamacare-tax-penalties-as-more-got-obamacare-aid.html\" target=\"_blank\" rel=\"noopener noreferrer\">reported\u003c/a> owing penalties for not having coverage in 2015.\u003c/p>\n\u003cp>Polls consistently show, though, that the individual mandate is unpopular with the public. Indeed, when asked about nine provisions in the ACA, registered voters in a recent Politico/Morning Consult \u003ca href=\"http://www.cnbc.com/2017/02/22/obamacare-getting-more-popular-with-voters-in-trumps-presidency-poll.html\">poll\u003c/a> said they want the Senate to keep eight, rejecting only the individual mandate.\u003c/p>\n\u003cp>Even though the mandate's penalty is often criticized as not strong enough, removing it would still affect the individual market.\u003c/p>\n\u003cp>\"Insurers would react conservatively and increase rates substantially to cover their risk,\" said insurance industry consultant \u003ca href=\"http://www.healthpol.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Robert Laszewski\u003c/a>.\u003c/p>\n\u003cp>That's what happened after Washington state lawmakers rolled back rules in 1995 legislation. Insurers requested significant rate increases, which were then rejected by the state's insurance commissioner. By 1998, the state's largest insurer — Premera Blue Cross — said it was losing so much money that it would stop selling new individual policies, \"precipitating a sense of crisis,\" according to a study \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/10804476\" target=\"_blank\" rel=\"noopener noreferrer\">published\u003c/a> in 2000 in the \u003cem>Journal of Health Politics, Policy and Law\u003c/em>.\u003c/p>\n\u003cp>\"When one pulled out, the others followed,\" said current Washington Insurance Commissioner \u003ca href=\"https://www.insurance.wa.gov/about-mike-kreidler\" target=\"_blank\" rel=\"noopener noreferrer\">Mike Kreidler\u003c/a>, who was then a regional director in the federal department of Health and Human Services.\u003c/p>\n\u003cp>The state's individual market was volatile and difficult for years after. Insurers did come back, but won a concession: For a time, the insurance commissioner lost the power to reject rate increases. Kreidler, first elected in 2000, reclaimed that authority.\u003c/p>\n\u003cp>Predicting the effect of removing the individual mandate is difficult, although Kreidler said he expects the impact would be modest, at least initially. Subsidies that help people purchase insurance coverage — if they remain as they are under current law — could help blunt the impact. But if those subsidies are reduced — or other changes are made that further drive healthy people out of the market — the impact could be greater.\u003c/p>\n\u003cp>\"Few markets can go bad on you as fast as a health insurance market,\" said Kreidler.\u003c/p>\n\u003cp>As for employers, dropping the requirement that those with 50 or more workers must offer health insurance or face a financial penalty could mean some workers would lose coverage. But their jobs might be more secure, said \u003ca href=\"http://www.aei.org/scholar/joseph-antos/\" target=\"_blank\" rel=\"noopener noreferrer\">Joseph Antos\u003c/a>, a health care economist and resident scholar at the American Enterprise Institute.\u003c/p>\n\u003cp>That's because the requirement under the ACA meant that some smaller firms didn't hire people or give workers more than 30 hours a week — the minimum needed under the ACA to be considered a full-time worker who qualified for health insurance.\u003c/p>\n\u003cp>The individual mandate, he added, may not be as much of a factor in getting people to enroll in coverage as some think, because the Trump administration has indicated it might not enforce it anyway — and the penalty amount is far less than most people would have to pay for health insurance.\u003c/p>\n\u003cp>However, the individual market could be roiled by other factors, Antos said.\u003c/p>\n\u003cp>\"The real impact would come if feds stopped promoting enrollment and did other things to make the exchanges the state and federal markets through which insurance is offered] work more poorly.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem> is a nonprofit health newsroom, an editorially independent part of the Kaiser Family Foundation. You can follow KHN senior correspondent Julie Appleby on Twitter \u003c/em>\u003ca href=\"http://twitter.com/Julie_Appleby\">\u003cem>\u003cstrong>@Julie_Appleby\u003c/strong>\u003c/em>\u003c/a>\u003cem> Congressional reporter \u003c/em>\u003ca href=\"https://twitter.com/RachelHBluth\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cem>Rachel Bluth\u003c/em>\u003c/a>\u003cem> also contributed to this report. \u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=States+Have+Already+Tried+Versions+Of+%27Skinny+Repeal.%27+It+Didn%27t+Go+Well&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"Republican senators are warming to the idea of a scaled-back plan that would delete the ACA's individual and employer mandates.","status":"publish","parent":0,"modified":1501191229,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":35,"wordCount":1259},"headData":{"title":"States Have Already Tried Versions of 'Skinny Repeal.' It Didn't Go Well | KQED","description":"Republican senators are warming to the idea of a scaled-back plan that would delete the ACA's individual and employer mandates.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"11596552 https://ww2.kqed.org/news/?p=11596552","disqusUrl":"https://ww2.kqed.org/news/2017/07/27/states-have-already-tried-versions-of-skinny-repeal-it-didnt-go-well/","disqusTitle":"States Have Already Tried Versions of 'Skinny Repeal.' It Didn't Go Well","source":"NPR","sourceUrl":"www.npr.org","nprImageCredit":"J. Scott Applewhite","nprByline":"Julie Appleby\u003cbr>NPR","nprImageAgency":"AP","nprStoryId":"539588546","nprApiLink":"http://api.npr.org/query?id=539588546&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2017/07/27/539588546/states-have-already-tried-versions-of-skinny-repeal-it-didn-t-go-well?ft=nprml&f=539588546","nprRetrievedStory":"1","nprPubDate":"Thu, 27 Jul 2017 10:14:00 -0400","nprStoryDate":"Thu, 27 Jul 2017 05:00:24 -0400","nprLastModifiedDate":"Thu, 27 Jul 2017 10:14:44 -0400","path":"/news/11596552/states-have-already-tried-versions-of-skinny-repeal-it-didnt-go-well","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Betting that thin is in — and might be the only way forward — Senate Republicans are eyeing a \"skinny repeal\" that would roll back an unpopular portion of the federal health law. But health policy analysts warn that the idea has been tried before, and with little success.\u003c/p>\n\u003cp>Senators are reportedly considering a narrow bill that would eliminate the Affordable Care Act's \"individual mandate,\" which assesses a tax on Americans who don't have insurance. The bill would also eliminate the ACA's penalties for some businesses -- those that have 50 or more workers and fail to offer their employees health coverage.\u003c/p>\n\u003cp>Details aren't clear, but it appears that — at least initially — much of the rest of the 2010 health law would remain, under this strategy, including the rule that says insurers must cover people who have pre-existing medical problems.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In remarks on the Senate floor Wednesday, Sen. Minority Leader Charles Schumer, D-N.Y., said that \"we just heard from the nonpartisan Congressional Budget Office that under such a plan ... 16 million Americans would lose their health insurance, and millions more would pay a 20 percent increase in their premiums.\" The CBO \u003ca href=\"https://www.cbo.gov/publication/52977\" target=\"_blank\" rel=\"noopener noreferrer\">posted its evaluation\u003c/a> of the GOP's proposed plan Wednesday evening.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Earlier in the day, some Republicans seemed determined to find some way to keep the health care debate alive.\u003c/p>\n\u003cp>\"We need an outcome, and if a so-called skinny repeal is the first step, that's a good first step,\" said Sen. Thom Tillis, R-N.C.\u003c/p>\n\u003cp>Several Republican senators, including Dean Heller of Nevada and Jeff Flake of Arizona, appear to back this approach, according to \u003ca href=\"http://www.politico.com/story/2017/07/26/obamacare-repeal-republicans-minimum-240982\" target=\"_blank\" rel=\"noopener noreferrer\">published reports\u003c/a>. It is, at least for now, being viewed as a step along the way to Republican health reform.\u003c/p>\n\u003cp>\"I think that most people would understand that what you're really voting on is trying to keep the conversation alive,\" said Sen. Bob Corker, R-Tenn. \"It's not the policy itself ... it's about trying to create a bigger discussion about repeal between the House and Senate.\"\u003c/p>\n\u003cp>But what if, during these strange legislative times, the skinny repeal were to be passed by the Senate and then go on to become law? States' experiences with insurance market reforms and rollbacks highlight the possible trouble spots.\u003c/p>\n\u003ch3>Considering the Parallels\u003c/h3>\n\u003cp>By the late 1990s, states such as Washington, Kentucky and Massachusetts felt a backlash when some of the coverage requirement rules they'd previously put on the individual market were lifted. \"Things went badly,\" said \u003ca href=\"http://law.wfu.edu/faculty/profile/hallma/\" target=\"_blank\" rel=\"noopener noreferrer\">Mark Hall\u003c/a>, director of the health law and policy program at Wake Forest University.\u003c/p>\n\u003cp>Premiums rose and insurers fled these states, leaving consumers who buy their own coverage (usually because they don't get it through their jobs) with fewer choices and higher prices.\u003c/p>\n\u003cp>That's because — like the Senate plan — the states generally kept popular parts of their laws, including protections for people with pre-existing conditions. At the same time, they didn't include mandates that consumers carry coverage.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>That goes to a basic concept about any kind of insurance: People who don't file claims in any given year subsidize those who do. Also, those healthy people are less likely to sign up, insurers said, and that leaves insurance companies with only the more costly policyholders.\u003c/p>\n\u003cp>Bottom line: Insurers end up \"less willing to participate in the market,\" said Hall.\u003c/p>\n\u003cp>It's not an exact comparison, though, he added, because the current federal health law offers something most states did not: significant subsidies to help some people buy coverage. Those subsidies could blunt the effect of not having a mandate.\u003c/p>\n\u003cp>During the debate that led to passage of the federal ACA, insurers flat-out said the plan would fail without an individual mandate. On Wednesday, the Blue Cross Blue Shield Association weighed in again, saying that if there is no longer a coverage requirement, there should be \"strong incentives for people to obtain health insurance and keep it year-round.\"\u003c/p>\n\u003ch3>Individual Mandate Is Still Unpopular in Voter Polls\u003c/h3>\n\u003cp>About 6.5 million Americans \u003ca href=\"http://www.cnbc.com/2017/01/11/fewer-people-paid-obamacare-tax-penalties-as-more-got-obamacare-aid.html\" target=\"_blank\" rel=\"noopener noreferrer\">reported\u003c/a> owing penalties for not having coverage in 2015.\u003c/p>\n\u003cp>Polls consistently show, though, that the individual mandate is unpopular with the public. Indeed, when asked about nine provisions in the ACA, registered voters in a recent Politico/Morning Consult \u003ca href=\"http://www.cnbc.com/2017/02/22/obamacare-getting-more-popular-with-voters-in-trumps-presidency-poll.html\">poll\u003c/a> said they want the Senate to keep eight, rejecting only the individual mandate.\u003c/p>\n\u003cp>Even though the mandate's penalty is often criticized as not strong enough, removing it would still affect the individual market.\u003c/p>\n\u003cp>\"Insurers would react conservatively and increase rates substantially to cover their risk,\" said insurance industry consultant \u003ca href=\"http://www.healthpol.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Robert Laszewski\u003c/a>.\u003c/p>\n\u003cp>That's what happened after Washington state lawmakers rolled back rules in 1995 legislation. Insurers requested significant rate increases, which were then rejected by the state's insurance commissioner. By 1998, the state's largest insurer — Premera Blue Cross — said it was losing so much money that it would stop selling new individual policies, \"precipitating a sense of crisis,\" according to a study \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/10804476\" target=\"_blank\" rel=\"noopener noreferrer\">published\u003c/a> in 2000 in the \u003cem>Journal of Health Politics, Policy and Law\u003c/em>.\u003c/p>\n\u003cp>\"When one pulled out, the others followed,\" said current Washington Insurance Commissioner \u003ca href=\"https://www.insurance.wa.gov/about-mike-kreidler\" target=\"_blank\" rel=\"noopener noreferrer\">Mike Kreidler\u003c/a>, who was then a regional director in the federal department of Health and Human Services.\u003c/p>\n\u003cp>The state's individual market was volatile and difficult for years after. Insurers did come back, but won a concession: For a time, the insurance commissioner lost the power to reject rate increases. Kreidler, first elected in 2000, reclaimed that authority.\u003c/p>\n\u003cp>Predicting the effect of removing the individual mandate is difficult, although Kreidler said he expects the impact would be modest, at least initially. Subsidies that help people purchase insurance coverage — if they remain as they are under current law — could help blunt the impact. But if those subsidies are reduced — or other changes are made that further drive healthy people out of the market — the impact could be greater.\u003c/p>\n\u003cp>\"Few markets can go bad on you as fast as a health insurance market,\" said Kreidler.\u003c/p>\n\u003cp>As for employers, dropping the requirement that those with 50 or more workers must offer health insurance or face a financial penalty could mean some workers would lose coverage. But their jobs might be more secure, said \u003ca href=\"http://www.aei.org/scholar/joseph-antos/\" target=\"_blank\" rel=\"noopener noreferrer\">Joseph Antos\u003c/a>, a health care economist and resident scholar at the American Enterprise Institute.\u003c/p>\n\u003cp>That's because the requirement under the ACA meant that some smaller firms didn't hire people or give workers more than 30 hours a week — the minimum needed under the ACA to be considered a full-time worker who qualified for health insurance.\u003c/p>\n\u003cp>The individual mandate, he added, may not be as much of a factor in getting people to enroll in coverage as some think, because the Trump administration has indicated it might not enforce it anyway — and the penalty amount is far less than most people would have to pay for health insurance.\u003c/p>\n\u003cp>However, the individual market could be roiled by other factors, Antos said.\u003c/p>\n\u003cp>\"The real impact would come if feds stopped promoting enrollment and did other things to make the exchanges the state and federal markets through which insurance is offered] work more poorly.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem> is a nonprofit health newsroom, an editorially independent part of the Kaiser Family Foundation. You can follow KHN senior correspondent Julie Appleby on Twitter \u003c/em>\u003ca href=\"http://twitter.com/Julie_Appleby\">\u003cem>\u003cstrong>@Julie_Appleby\u003c/strong>\u003c/em>\u003c/a>\u003cem> Congressional reporter \u003c/em>\u003ca href=\"https://twitter.com/RachelHBluth\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cem>Rachel Bluth\u003c/em>\u003c/a>\u003cem> also contributed to this report. \u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=States+Have+Already+Tried+Versions+Of+%27Skinny+Repeal.%27+It+Didn%27t+Go+Well&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11596552/states-have-already-tried-versions-of-skinny-repeal-it-didnt-go-well","authors":["byline_news_11596552"],"programs":["news_6944","news_72"],"categories":["news_457","news_8","news_13"],"tags":["news_2409","news_3890","news_17286"],"featImg":"news_11596651","label":"source_news_11596552"},"news_11593208":{"type":"posts","id":"news_11593208","meta":{"index":"posts_1591205157","site":"news","id":"11593208","score":null,"sort":[1501007165000]},"guestAuthors":[],"slug":"the-senate-health-care-vote-simplified","title":"The Senate Health Care Vote, Simplified","publishDate":1501007165,"format":"standard","headTitle":"The California Report | KQED News","labelTerm":{},"content":"\u003cp>The Senate is expected to vote Tuesday on whether to advance health care legislation to the Senate floor. That would open up debate on an Obamacare repeal and/or replacement plan.\u003c/p>\n\u003cp>The importance of the vote was highlighted by \u003ca href=\"https://twitter.com/SenJohnMcCain/status/889652943791824897\" target=\"_blank\" rel=\"noopener noreferrer\">Sen. John McCain's decision\u003c/a> to return to Washington to take part. He announced last week that he had been diagnosed with brain cancer.\u003c/p>\n\u003cp>At a White House event Monday, President Trump highlighted what he called the \"failures\" of the Affordable Care Act, also known as Obamacare, and called on senators to pass a bill that both repeals and replaces the ACA. Last week, Trump \u003ca href=\"https://twitter.com/realDonaldTrump/status/887134287350439936\" target=\"_blank\" rel=\"noopener noreferrer\">urged an approach\u003c/a> that would repeal the law over two years, giving lawmakers more time to craft new health care legislation. Several days later \u003ca href=\"http://www.npr.org/2017/07/20/538171317/fact-check-trumps-confusing-remarks-to-senate-republicans-on-health-care\" target=\"_blank\" rel=\"noopener noreferrer\">at a lunch\u003c/a> with lawmakers, he advocated repeal and replace.\u003c/p>\n\u003cp>But it's still not clear what the Senate will be voting on. There are \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/20/538360550/with-so-many-obamacare-repeal-options-in-play-confusion-reigns\" target=\"_blank\" rel=\"noopener noreferrer\">multiple bills\u003c/a> in play.\u003c/p>\n\u003cp>The Senate hopes it can muster the 51 votes needed to pass a bill, but some Republicans are wavering, both in the center and on the right.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>NPR's health and politics teams have been doing our best to shed some light on what's a very confusing situation, even by health policy standards.\u003c/p>\n\u003cp>\u003cstrong>What are they voting on?\u003c/strong>\u003c/p>\n\u003cp>There are at least four bills that could advance to the Senate floor. \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/20/538360550/with-so-many-obamacare-repeal-options-in-play-confusion-reigns\" target=\"_blank\" rel=\"noopener noreferrer\">Here's our summary\u003c/a>, with a chart comparing House and Senate bills to the Affordable Care Act, and links to stories that dive into the implications of the legislation.\u003c/p>\n\u003cp>\u003cstrong>Who wins? Who loses?\u003c/strong>\u003c/p>\n\u003cp>We worked with NPR member station reporters and editors to create an interactive \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/10/535851043/faq-how-would-the-republican-health-care-bills-affect-you\" target=\"_blank\" rel=\"noopener noreferrer\">Q&A\u003c/a> on how key elements of the bills would affect people in different states.\u003c/p>\n\u003cp>\u003cstrong>What if the Senate parliamentarian says \"nope\"?\u003c/strong>\u003c/p>\n\u003cp>Another \u003ca href=\"http://khn.org/news/ruling-by-senate-parliamentarian-upends-gop-hopes-for-health-care-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">potential wrinkle\u003c/a> came up late Friday. Julie Rovner with Kaiser Health News reports that the Senate rule-keeper has advised that some key parts of some of the bills could need 60 votes to proceed. They include defunding Planned Parenthood and incentives to have people keep health insurance. Getting 60 votes would require Democratic support, which they won't get.\u003c/p>\n\u003cp>\u003cstrong>And if Obamacare remains the law of the land?\u003c/strong>\u003c/p>\n\u003cp>For now, the Affordable Care Act is still the law, and insurers are trying to plan for next year. That's \u003ca href=\"http://www.npr.org/2017/07/21/538399298/even-talking-about-weakening-obamacare-provisions-weakens-the-exchanges\" target=\"_blank\" rel=\"noopener noreferrer\">proving to be difficult\u003c/a> and might \u003ca href=\"http://www.npr.org/templates/transcript/transcript.php?storyId=538099050\" target=\"_blank\" rel=\"noopener noreferrer\">drive up costs\u003c/a> for \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/22/538396570/rural-californians-want-price-relief-from-gop-health-bill-but-most-won-t-get-it\" target=\"_blank\" rel=\"noopener noreferrer\">consumers\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Congressional action could have an enormous impact on people's health insurance. But the U.S. Department of Health and Human Services has some wide berth in interpreting the law and could make a lot of changes without congressional action. Here are some \u003ca href=\"http://www.npr.org/sections/health-shots/2017/03/29/521713002/even-without-congress-the-trump-administration-can-still-redo-obamacare\" target=\"_blank\" rel=\"noopener noreferrer\">key actions\u003c/a> and regulations that could affect the exchanges and Medicaid (and more).\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=The+Senate+Health+Care+Vote%2C+Simplified&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"The president called on the Senate to repeal and replace the ACA this week. Here's what they would vote on.","status":"publish","parent":0,"modified":1501022230,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":17,"wordCount":469},"headData":{"title":"The Senate Health Care Vote, Simplified | KQED","description":"The president called on the Senate to repeal and replace the ACA this week. Here's what they would vote on.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"11593208 https://ww2.kqed.org/news/?p=11593208","disqusUrl":"https://ww2.kqed.org/news/2017/07/25/the-senate-health-care-vote-simplified/","disqusTitle":"The Senate Health Care Vote, Simplified","source":"NPR","sourceUrl":"www.npr.org","nprByline":"\u003cstrong>\u003ca href=\"http://www.npr.org/people/536711382/gisele-grayson\">Gisele Grayson\u003c/a>\u003c/strong>","nprImageAgency":"John Holcroft/Getty Images/Ikon Images","nprStoryId":"539051768","nprApiLink":"http://api.npr.org/query?id=539051768&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2017/07/24/539051768/the-senate-health-care-vote-simplified?ft=nprml&f=539051768","nprRetrievedStory":"1","nprPubDate":"Tue, 25 Jul 2017 09:26:00 -0400","nprStoryDate":"Mon, 24 Jul 2017 16:23:00 -0400","nprLastModifiedDate":"Tue, 25 Jul 2017 09:26:43 -0400","path":"/news/11593208/the-senate-health-care-vote-simplified","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Senate is expected to vote Tuesday on whether to advance health care legislation to the Senate floor. That would open up debate on an Obamacare repeal and/or replacement plan.\u003c/p>\n\u003cp>The importance of the vote was highlighted by \u003ca href=\"https://twitter.com/SenJohnMcCain/status/889652943791824897\" target=\"_blank\" rel=\"noopener noreferrer\">Sen. John McCain's decision\u003c/a> to return to Washington to take part. He announced last week that he had been diagnosed with brain cancer.\u003c/p>\n\u003cp>At a White House event Monday, President Trump highlighted what he called the \"failures\" of the Affordable Care Act, also known as Obamacare, and called on senators to pass a bill that both repeals and replaces the ACA. Last week, Trump \u003ca href=\"https://twitter.com/realDonaldTrump/status/887134287350439936\" target=\"_blank\" rel=\"noopener noreferrer\">urged an approach\u003c/a> that would repeal the law over two years, giving lawmakers more time to craft new health care legislation. Several days later \u003ca href=\"http://www.npr.org/2017/07/20/538171317/fact-check-trumps-confusing-remarks-to-senate-republicans-on-health-care\" target=\"_blank\" rel=\"noopener noreferrer\">at a lunch\u003c/a> with lawmakers, he advocated repeal and replace.\u003c/p>\n\u003cp>But it's still not clear what the Senate will be voting on. There are \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/20/538360550/with-so-many-obamacare-repeal-options-in-play-confusion-reigns\" target=\"_blank\" rel=\"noopener noreferrer\">multiple bills\u003c/a> in play.\u003c/p>\n\u003cp>The Senate hopes it can muster the 51 votes needed to pass a bill, but some Republicans are wavering, both in the center and on the right.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>NPR's health and politics teams have been doing our best to shed some light on what's a very confusing situation, even by health policy standards.\u003c/p>\n\u003cp>\u003cstrong>What are they voting on?\u003c/strong>\u003c/p>\n\u003cp>There are at least four bills that could advance to the Senate floor. \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/20/538360550/with-so-many-obamacare-repeal-options-in-play-confusion-reigns\" target=\"_blank\" rel=\"noopener noreferrer\">Here's our summary\u003c/a>, with a chart comparing House and Senate bills to the Affordable Care Act, and links to stories that dive into the implications of the legislation.\u003c/p>\n\u003cp>\u003cstrong>Who wins? Who loses?\u003c/strong>\u003c/p>\n\u003cp>We worked with NPR member station reporters and editors to create an interactive \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/10/535851043/faq-how-would-the-republican-health-care-bills-affect-you\" target=\"_blank\" rel=\"noopener noreferrer\">Q&A\u003c/a> on how key elements of the bills would affect people in different states.\u003c/p>\n\u003cp>\u003cstrong>What if the Senate parliamentarian says \"nope\"?\u003c/strong>\u003c/p>\n\u003cp>Another \u003ca href=\"http://khn.org/news/ruling-by-senate-parliamentarian-upends-gop-hopes-for-health-care-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">potential wrinkle\u003c/a> came up late Friday. Julie Rovner with Kaiser Health News reports that the Senate rule-keeper has advised that some key parts of some of the bills could need 60 votes to proceed. They include defunding Planned Parenthood and incentives to have people keep health insurance. Getting 60 votes would require Democratic support, which they won't get.\u003c/p>\n\u003cp>\u003cstrong>And if Obamacare remains the law of the land?\u003c/strong>\u003c/p>\n\u003cp>For now, the Affordable Care Act is still the law, and insurers are trying to plan for next year. That's \u003ca href=\"http://www.npr.org/2017/07/21/538399298/even-talking-about-weakening-obamacare-provisions-weakens-the-exchanges\" target=\"_blank\" rel=\"noopener noreferrer\">proving to be difficult\u003c/a> and might \u003ca href=\"http://www.npr.org/templates/transcript/transcript.php?storyId=538099050\" target=\"_blank\" rel=\"noopener noreferrer\">drive up costs\u003c/a> for \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/22/538396570/rural-californians-want-price-relief-from-gop-health-bill-but-most-won-t-get-it\" target=\"_blank\" rel=\"noopener noreferrer\">consumers\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Congressional action could have an enormous impact on people's health insurance. But the U.S. Department of Health and Human Services has some wide berth in interpreting the law and could make a lot of changes without congressional action. Here are some \u003ca href=\"http://www.npr.org/sections/health-shots/2017/03/29/521713002/even-without-congress-the-trump-administration-can-still-redo-obamacare\" target=\"_blank\" rel=\"noopener noreferrer\">key actions\u003c/a> and regulations that could affect the exchanges and Medicaid (and more).\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=The+Senate+Health+Care+Vote%2C+Simplified&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11593208/the-senate-health-care-vote-simplified","authors":["byline_news_11593208"],"programs":["news_6944","news_72"],"categories":["news_457","news_8","news_13"],"tags":["news_21167","news_21264","news_3890","news_21249","news_17286"],"featImg":"news_11593211","label":"source_news_11593208"},"news_11574201":{"type":"posts","id":"news_11574201","meta":{"index":"posts_1591205157","site":"news","id":"11574201","score":null,"sort":[1500649523000]},"guestAuthors":[],"slug":"the-painful-side-of-positive-health-care-marketing","title":"The Painful Side of Positive Health Care Marketing","publishDate":1500649523,"format":"audio","headTitle":"News Fix | KQED News","labelTerm":{"term":6944,"site":"news"},"content":"\u003cp>Lori Wallace is sitting on a couch with her 11-year-old son and his new pet snake. It’s burrowing under his armpit, as if it were afraid. But Wallace says it’s not.\u003c/p>\n\u003cp>“If he was terrified,” Wallace said, “he would be balled up. See, that is why they are called ball pythons. When they are scared, they turn into a little ball.”\u003c/p>\n\u003cp>Wallace is dying of breast cancer, but a stranger couldn’t tell. She has a pixie haircut and a warm tan. She’s vibrant and chatty and looks you right in the eyes when she talks. Wallace doesn’t shy away from what’s happening to her. She shows me her cracked feet. They bleed from the chemotherapy pills she takes.\u003c/p>\n\u003cp>She says she used to be a hopeful person, someone who believed you could fight through any misfortune. Then, seven years ago, she was diagnosed with breast cancer. Wallace was 39. Her son was 4. She couldn’t believe it.\u003c/p>\n\u003cp>Wallace, who lives in San Jose, says the chemotherapy treatment makes her brain foggy. She is now in her fifth round. Wallace is Stage 4, metastatic. The cancer has spread throughout her body. It’s going to kill her, she tells me.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“The median survival of a woman with metastatic breast cancer is 33 months,” Wallace says. “My 33 months would have been Dec. 6 last year. So I am on bonus time right now.”\u003c/p>\n\u003cp>As Wallace’s cancer has progressed, she has become more critical of what she sees as excessive positivity in health care marketing. It’s everywhere: TV ads, radio commercials, \u003ca href=\"https://serpninja.io/\">search engine campaigns\u003c/a>, billboards. The advertisements feature happy, healed patients and tell stories of miraculous recoveries. The messages are optimistic, about people beating steep odds. Wallace says the ads spread false hope, and for a patient like her they are a slap in the face.\u003c/p>\n\u003cp>A couple of decades ago you would not have seen ads like this. Hospitals and clinics did not advertise much to customers. Now, they are spending more and more each year on marketing.\u003c/p>\n\u003cp>Wallace pulls up an ad on her computer from \u003ca href=\"http://possible.ucsfbenioffchildrens.org\">UCSF Benioff Children’s Hospital\u003c/a>. It says “Amid a thousand maybes and a million nos, we believe in the profound and unstoppable power of yes.”\u003c/p>\n\u003cp>There is a similar kind of optimism at the heart of a lot of Bay Area health provider campaigns. Kaiser Permanente ads are constructed around the word “Thrive”; for Sutter Health it’s “Smile Out.” Wallace says the subtext of the ads is that those like her who get sick and will die maybe just aren’t being positive enough.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I have said yes to every possible treatment. And the cancer doesn't care.' \u003ccite>Lori Wallace\u003c/cite>\u003c/aside>\n\u003cp>“I didn’t say yes to cancer,” Wallace says. “I have tried everything I can. I have done clinical trials. I have said yes to every possible treatment. And the cancer doesn't care.”\u003c/p>\n\u003cp>Karuna Jaggar is executive director of Breast Cancer Action. She says health care providers are following in the footsteps of other companies.\u003c/p>\n\u003cp>“It's the basics of marketing,\" Jaggar says. \"In order to sell products or services, you have to sell hope.\"\u003c/p>\n\u003cp>She says health care advertisers are now adopting the kind of optimistic messaging that really began in force with the pink ribbons and rosy depictions of breast cancer.\u003c/p>\n\u003cp>“Thirty years ago, breast cancer was the poster child of positive thinking,” Jaggar says. “Look good, feel better, don't let breast cancer get you down. Fight strong and be cheerful while you do it.”\u003c/p>\n\u003cp>Thirty or 40 years ago health care providers marketed to physicians more than consumers. The ads were drier, more factual, says Guy David, a professor of health care management at the University of Pennsylvania.\u003c/p>\n\u003cp>“When the ads are more consumer-facing as opposed to professional-facing, the content tends to be more passionate,” David says.\u003c/p>\n\u003cp>The ads tug at emotions, just like other advertising that’s trying to win over consumers. With increasing health care costs and choices, patients are shopping around for care. Tim Calkins is a professor of marketing at Northwestern University. He says these days hospitals have to sell themselves.\u003c/p>\n\u003cp>“Right now in health care if you don't have some leverage, if you don't have a brand people care about, if you don't have a reason for people to pick you over competitors, well then you are in a really tough spot,\" Calkins says.\u003c/p>\n\u003cp>Calkins says hospitals are spending more than ever on advertising and, as with other products, it’s filled with lots of promises. He says you don’t see the same promises in the pharmaceutical industry. Their ads are regulated by the FDA, which is why they have to list all those side effects and show scientific backing for their claims.\u003c/p>\n\u003cp>“Hospitals aren't held to any of those standards at all,” Calkins says. “So a hospital can go out and say this is where miracles happen. And here's Joe. Joe was about to die. And now Joe is going to live forever.”\u003c/p>\n\u003cp>Lori Wallace is not going to live forever. Before cancer, she says, she would have been attracted to the messages of hope. Now Wallace says she needs realism, acceptance of both the world’s beauty and its harshness. She wrote an essay about that for the women in her breast cancer support group.\u003c/p>\n\u003cp>The essay is titled “Fuck Silver Linings and Pink Ribbons.” Wallace reads me the whole piece from start to finish. We are sitting at the kitchen table. Her son is nearby with his pet snake.\u003c/p>\n\u003cp>Toward the middle of the essay Wallace writes, “My ovaries are gone and without them my skin is aging at hyperspeed. I have hot flashes and cold flashes. My bones ache. My libido is shot and my vagina is a desert.” The essay is open, funny and unflinching, just like Wallace.\u003c/p>\n\u003cp>Before I leave, she reads me the final paragraph. “I will try to be thankful for every laugh, hug and kiss, and other things, too. That is if my chemo brain allows me to remember.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“That’s what I wrote,” Wallace says. “That's what I wrote. Brutal honesty.”\u003c/p>\n\n","blocks":[],"excerpt":"Lori Wallace is dying of cancer, and she is tired of health care provider ads that tell stories of miraculous recoveries.","status":"publish","parent":0,"modified":1631134247,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":28,"wordCount":1103},"headData":{"title":"The Painful Side of Positive Health Care Marketing | KQED","description":"Lori Wallace is dying of cancer, and she is tired of health care provider ads that tell stories of miraculous recoveries.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"11574201 https://ww2.kqed.org/news/?p=11574201","disqusUrl":"https://ww2.kqed.org/news/2017/07/21/the-painful-side-of-positive-health-care-marketing/","disqusTitle":"The Painful Side of Positive Health Care Marketing","audioUrl":"http://www.kqed.org/.stream/anon/radio/RDnews/2017/07/HealthCareMarketing.mp3","path":"/news/11574201/the-painful-side-of-positive-health-care-marketing","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Lori Wallace is sitting on a couch with her 11-year-old son and his new pet snake. It’s burrowing under his armpit, as if it were afraid. But Wallace says it’s not.\u003c/p>\n\u003cp>“If he was terrified,” Wallace said, “he would be balled up. See, that is why they are called ball pythons. When they are scared, they turn into a little ball.”\u003c/p>\n\u003cp>Wallace is dying of breast cancer, but a stranger couldn’t tell. She has a pixie haircut and a warm tan. She’s vibrant and chatty and looks you right in the eyes when she talks. Wallace doesn’t shy away from what’s happening to her. She shows me her cracked feet. They bleed from the chemotherapy pills she takes.\u003c/p>\n\u003cp>She says she used to be a hopeful person, someone who believed you could fight through any misfortune. Then, seven years ago, she was diagnosed with breast cancer. Wallace was 39. Her son was 4. She couldn’t believe it.\u003c/p>\n\u003cp>Wallace, who lives in San Jose, says the chemotherapy treatment makes her brain foggy. She is now in her fifth round. Wallace is Stage 4, metastatic. The cancer has spread throughout her body. It’s going to kill her, she tells me.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“The median survival of a woman with metastatic breast cancer is 33 months,” Wallace says. “My 33 months would have been Dec. 6 last year. So I am on bonus time right now.”\u003c/p>\n\u003cp>As Wallace’s cancer has progressed, she has become more critical of what she sees as excessive positivity in health care marketing. It’s everywhere: TV ads, radio commercials, \u003ca href=\"https://serpninja.io/\">search engine campaigns\u003c/a>, billboards. The advertisements feature happy, healed patients and tell stories of miraculous recoveries. The messages are optimistic, about people beating steep odds. Wallace says the ads spread false hope, and for a patient like her they are a slap in the face.\u003c/p>\n\u003cp>A couple of decades ago you would not have seen ads like this. Hospitals and clinics did not advertise much to customers. Now, they are spending more and more each year on marketing.\u003c/p>\n\u003cp>Wallace pulls up an ad on her computer from \u003ca href=\"http://possible.ucsfbenioffchildrens.org\">UCSF Benioff Children’s Hospital\u003c/a>. It says “Amid a thousand maybes and a million nos, we believe in the profound and unstoppable power of yes.”\u003c/p>\n\u003cp>There is a similar kind of optimism at the heart of a lot of Bay Area health provider campaigns. Kaiser Permanente ads are constructed around the word “Thrive”; for Sutter Health it’s “Smile Out.” Wallace says the subtext of the ads is that those like her who get sick and will die maybe just aren’t being positive enough.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I have said yes to every possible treatment. And the cancer doesn't care.' \u003ccite>Lori Wallace\u003c/cite>\u003c/aside>\n\u003cp>“I didn’t say yes to cancer,” Wallace says. “I have tried everything I can. I have done clinical trials. I have said yes to every possible treatment. And the cancer doesn't care.”\u003c/p>\n\u003cp>Karuna Jaggar is executive director of Breast Cancer Action. She says health care providers are following in the footsteps of other companies.\u003c/p>\n\u003cp>“It's the basics of marketing,\" Jaggar says. \"In order to sell products or services, you have to sell hope.\"\u003c/p>\n\u003cp>She says health care advertisers are now adopting the kind of optimistic messaging that really began in force with the pink ribbons and rosy depictions of breast cancer.\u003c/p>\n\u003cp>“Thirty years ago, breast cancer was the poster child of positive thinking,” Jaggar says. “Look good, feel better, don't let breast cancer get you down. Fight strong and be cheerful while you do it.”\u003c/p>\n\u003cp>Thirty or 40 years ago health care providers marketed to physicians more than consumers. The ads were drier, more factual, says Guy David, a professor of health care management at the University of Pennsylvania.\u003c/p>\n\u003cp>“When the ads are more consumer-facing as opposed to professional-facing, the content tends to be more passionate,” David says.\u003c/p>\n\u003cp>The ads tug at emotions, just like other advertising that’s trying to win over consumers. With increasing health care costs and choices, patients are shopping around for care. Tim Calkins is a professor of marketing at Northwestern University. He says these days hospitals have to sell themselves.\u003c/p>\n\u003cp>“Right now in health care if you don't have some leverage, if you don't have a brand people care about, if you don't have a reason for people to pick you over competitors, well then you are in a really tough spot,\" Calkins says.\u003c/p>\n\u003cp>Calkins says hospitals are spending more than ever on advertising and, as with other products, it’s filled with lots of promises. He says you don’t see the same promises in the pharmaceutical industry. Their ads are regulated by the FDA, which is why they have to list all those side effects and show scientific backing for their claims.\u003c/p>\n\u003cp>“Hospitals aren't held to any of those standards at all,” Calkins says. “So a hospital can go out and say this is where miracles happen. And here's Joe. Joe was about to die. And now Joe is going to live forever.”\u003c/p>\n\u003cp>Lori Wallace is not going to live forever. Before cancer, she says, she would have been attracted to the messages of hope. Now Wallace says she needs realism, acceptance of both the world’s beauty and its harshness. She wrote an essay about that for the women in her breast cancer support group.\u003c/p>\n\u003cp>The essay is titled “Fuck Silver Linings and Pink Ribbons.” Wallace reads me the whole piece from start to finish. We are sitting at the kitchen table. Her son is nearby with his pet snake.\u003c/p>\n\u003cp>Toward the middle of the essay Wallace writes, “My ovaries are gone and without them my skin is aging at hyperspeed. I have hot flashes and cold flashes. My bones ache. My libido is shot and my vagina is a desert.” The essay is open, funny and unflinching, just like Wallace.\u003c/p>\n\u003cp>Before I leave, she reads me the final paragraph. “I will try to be thankful for every laugh, hug and kiss, and other things, too. That is if my chemo brain allows me to remember.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“That’s what I wrote,” Wallace says. “That's what I wrote. Brutal honesty.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11574201/the-painful-side-of-positive-health-care-marketing","authors":["253"],"programs":["news_6944"],"categories":["news_457","news_8"],"tags":["news_21267","news_2275"],"featImg":"news_11574202","label":"news_6944"},"futureofyou_420143":{"type":"posts","id":"futureofyou_420143","meta":{"index":"posts_1591205157","site":"futureofyou","id":"420143","score":null,"sort":[1500393631000]},"guestAuthors":[],"slug":"hold-on-your-doctor-is-typing","title":"Doctors: Electronic Health Records Hurting Relationship With Patients","publishDate":1500393631,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>Dr. Lloyd Minor is frustrated. As dean of Stanford University Medical School, he says he can handle the constant cascade of large-scale challenges that come with his job. But what flummoxes him — drives him crazy, in fact — is something that occurs on a much smaller scale every time he examines someone in his clinical practice.\u003c/p>\n\u003cp>Minor cannot get the electronic health record, which provides a medical history of each patient, to work the way he wants. So he spends too much time wrestling with the computer and not enough directly communicating with his patient.\u003c/p>\n\u003caside class=\"pullquote alignright\">'There is nothing more frustrating to a patient than talking to their doctor, wanting advice, and that provider is typing away and looking at a computer screen instead of the patient.' \u003ccite>Stanford medical school Dean Lloyd Minor\u003c/cite>\u003c/aside>\n\u003cp>“There is nothing more frustrating to a patient than talking to their doctor, wanting advice, and that provider is typing away and looking at a computer screen instead of the patient,\" Minor says. \"That most fundamental aspect of human communication, which is eye contact, now is being robbed from the medical encounter because of the electronic health record.”\u003c/p>\n\u003cp>He says EHRs now function primarily as documentation for billing and quality reporting rather than as an aid to doctors. Given their cumbersome nature, the EHR, long touted as a way to dramatically improve patient care, often does just the opposite, Minor believes.\u003c/p>\n\u003cp>“As a provider, you’re thinking about what do I need to document, or how do I navigate the EHR system, not how do I assimilate this information to provide the best care advice to the patient,\" he says. \"You’re thinking about the mechanics of the documentation, rather than the implications of the symptoms and findings.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Data Entry or Medicine?\u003c/strong>\u003c/p>\n\u003cp>Many physicians are fed up with the amount of documentation required in EHRs. Many feel they spend more time as data-entry clerks than as doctors.\u003c/p>\n\u003cp>[contextly_sidebar id=\"iCL76xAqQztIVtwiKb3Jdka9M3FawwGC\"]Studies bear that out. Only 27 percent of a doctor’s time is spent with patients — and nearly half is spent on EHR and desk work, according to a \u003ca href=\"http://annals.org/aim/article/2546704/allocation-physician-time-ambulatory-practice-time-motion-study-4-specialties\">2016 study\u003c/a> published in \u003cem>Annals of Internal Medicine\u003c/em>. The study looked at physicians in family practice, internal medicine, cardiology and orthopedics. A smaller\u003ca href=\"http://content.healthaffairs.org/content/36/4/655.abstract\" target=\"_blank\" rel=\"noopener noreferrer\"> study\u003c/a> published in April by \u003cem>Health Affairs, \u003c/em>focusing on primary care physicians, also found about a 50-50 split in direct patient care time versus desktop medicine.\u003c/p>\n\u003cp>When doctors do spend time in the exam room with patients, they spent 37 percent of that time looking at the computer, the 2016 study estimated.\u003c/p>\n\u003cp>It's not just recording the patient's medical information that takes up time, according to Dr. Albert Chan, a family practice physician and the chief of digital patient experience for the Sutter Health Network. Doctors now need to report a series of quality measurements, provide proper insurance coding, and introduce more legalistic wording into the EHR to prevent lawsuits, he says.\u003c/p>\n\u003cp>There’s so much required paperwork and documentation now that primary care physicians spend an estimated one to two hours every night after work finishing up their data entry on EHRs, the study in \u003cem>Annals of Internal Medicine\u003c/em> found.\u003c/p>\n\u003cp>In the business, that’s called \"pajama time.\" In the real world, it's called one reason for burnout. Fifty-four \u003ca href=\"http://www.mayoclinicproceedings.org/article/S0025-6196(15)00716-8/abstract\">percent of physicians\u003c/a> reported at least one symptom of burnout, according to a recent Mayo Clinic study. A separate Mayo study found that a higher risk of burnout was \u003ca href=\"http://www.mayoclinicproceedings.org/article/S0025-6196(16)30215-4/abstract\">linked\u003c/a> to frustrations with the data-entry workload of EHRs.\u003c/p>\n\u003cp>\u003cstrong>A Powerful Tool\u003c/strong>\u003c/p>\n\u003cp>When the Affordable Care Act and the 2009 \u003ca href=\"https://www.hhs.gov/hipaa/for-professionals/special-topics/HITECH-act-enforcement-interim-final-rule/index.html\">HITECH Act\u003c/a> required electronic health records to be incorporated into medical practices, Dr. Chan says, many medical groups and physicians rushed to install EHR systems. That means the search function may not work well, or the system may require multiple keystrokes and screens to accomplish common tasks.\u003c/p>\n\u003cp>(Eric Helsher, vice president of client success at Epic, one of the leading EHR providers, responded that customer feedback \"drives our continuous development, with the aim of making the software a joy to use, helping them get value from their data, and facilitating collaboration across the Epic community.\")\u003c/p>\n\u003caside class=\"pullquote alignright\">'I remember back in the old days of paper medical records … not being able to find a patient’s chart was just maddening. We don’t have that anymore.'\u003ccite>Dr. Albert Chan\u003c/cite>\u003c/aside>\n\u003cp>But, Chan says, as flawed as the EHR is, it would be wise not to throw the baby out with the bathwater.\u003c/p>\n\u003cp>“It’s important to note that the EHR is an incredibly powerful tool,” he says. “There are tremendous things you can do with the EHR. You can automatically alert patients about their conditions, for example; you can personalize their care. The lesson I’ve learned is that the EHR requires work to make it work.”\u003c/p>\n\u003cp>Chan says he would never want to go back to the paper-only era.\u003c/p>\n\u003cp>“I remember back in the old days of paper medical records ... not being able to find a patient’s chart was just maddening. We don’t have that anymore.\"\u003c/p>\n\u003cp>\u003cstrong>The Interoperability Problem\u003c/strong>\u003c/p>\n\u003cp>Current design problems can be corrected over time by EHR system vendors, Chan says, and he expects the furor over EHRs to dissipate as annoying and time-consuming glitches are altered.\u003c/p>\n\u003cp>One of the big complaints doctors have had is the lack of interoperability between EHR systems, so that hospitals, medical groups, insurers and physicians can't easily share patient data with each other. In the San Francisco Bay Area, some sharing is now starting to occur among institutions like Sutter Health, Kaiser, UCSF and Stanford that all that use the EHR system Epic.\u003c/p>\n\u003cp>“We’re starting to see fruits of our labor to connect data,” Chan says.\u003c/p>\n\u003cp>But that may be a glass-half-full view, according to Will Ross, a project manager at Redwood MedNet, a nonprofit health information exchange based in Ukiah. Ross has been working on trying to improve the interoperability of EHRs for two decades, and says the progress has been plodding, to say the least.\u003c/p>\n\u003cp>Ross says EHRs took a turn for the worse after Congress tried to get physicians to prove they were meaningfully using them in the HITECH Act of 2009. Those rules, which he calls arbitrary, made the whole process much more complex and time-consuming.\u003c/p>\n\u003cp>\u003cspan style=\"color: #2b2b2b\">“That transformed all of this into busy work and nonsense,” Ross says. \u003c/span>\u003c/p>\n\u003cp>The obvious solution is for vendors to improve their products, he says. But that’s easier proposed than accomplished.\u003c/p>\n\u003cp>“A lot of the EHRs are cash cows to their owners,” Ross says. “They make their money on installing them, not changing them.”\u003c/p>\n\u003cp>Even if the complex problems of interoperability and ease of use were magically solved today, physicians would still be overloaded by reporting requirements, Ross says.\u003c/p>\n\u003cp>“Documentation is still there, so blaming the computer for what insurers and the government are requiring you to do is misplacing the blame.\"\u003c/p>\n\u003cp>Large organizations such as Kaiser and Sutter Health have tackled some of the ease-of-use problems of the EHR, according to David Lansky, executive director of the Pacific Business Group on Health, a nonprofit consortium of private businesses and public agencies. That’s not so easy for smaller practices to do.\u003c/p>\n\u003cp>“In big medical groups, the burden on the individual doctor using EHR is lower already, it’s easier,” Lansky says. “But small-group practices and individuals have the same administrative burden as the large-group practices.\"\u003c/p>\n\u003cp>Lansky’s organization is encouraging smaller groups to join provider contracting networks — niche companies that will help them track patients, install reminder systems, streamline quality reporting and connect with health information exchanges — so smaller practices are not trying to solve the problem themselves.\u003c/p>\n\u003cp class=\"p1\">He says the idea is to get doctors to use their skills and training properly. “We have this cult of the physician, and we pay a lot of money to train them,” Lansky says, “yet they’re being asked to do work others can do very well.”\u003c/p>\n\u003cp>That rings true for Stanford medical school's Dean Minor. He’s sick of scrolling down page by page; sick of checking off a million little boxes. All the time spent on medical documentation cuts down on physician efficiency, he says.\u003c/p>\n\u003cp>If doctors are working so many extra hours entering data, they’re likely to cut down on their patient load to make up for it. That means they make less money, and the quality of patient visits continues to decline.\u003c/p>\n\u003cp>“It negatively impacts patient care, that’s the main thing,” he says.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This post had been edited.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Electronic health records were supposed to make life easier for physicians and help improve patient care. But clunky design and the mountain of new documentation requirements have contributed to doctor frustration and burnout.","status":"publish","parent":0,"modified":1500585788,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":39,"wordCount":1527},"headData":{"title":"Doctors: Electronic Health Records Hurting Relationship With Patients | KQED","description":"Electronic health records were supposed to make life easier for physicians and help improve patient care. But clunky design and the mountain of new documentation requirements have contributed to doctor frustration and burnout.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"420143 https://ww2.kqed.org/futureofyou/?p=420143","disqusUrl":"https://ww2.kqed.org/futureofyou/2017/07/18/hold-on-your-doctor-is-typing/","disqusTitle":"Doctors: Electronic Health Records Hurting Relationship With Patients","source":"KQED Future of You","nprByline":"David Gorn\u003cbr />Future of You","path":"/futureofyou/420143/hold-on-your-doctor-is-typing","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Dr. Lloyd Minor is frustrated. As dean of Stanford University Medical School, he says he can handle the constant cascade of large-scale challenges that come with his job. But what flummoxes him — drives him crazy, in fact — is something that occurs on a much smaller scale every time he examines someone in his clinical practice.\u003c/p>\n\u003cp>Minor cannot get the electronic health record, which provides a medical history of each patient, to work the way he wants. So he spends too much time wrestling with the computer and not enough directly communicating with his patient.\u003c/p>\n\u003caside class=\"pullquote alignright\">'There is nothing more frustrating to a patient than talking to their doctor, wanting advice, and that provider is typing away and looking at a computer screen instead of the patient.' \u003ccite>Stanford medical school Dean Lloyd Minor\u003c/cite>\u003c/aside>\n\u003cp>“There is nothing more frustrating to a patient than talking to their doctor, wanting advice, and that provider is typing away and looking at a computer screen instead of the patient,\" Minor says. \"That most fundamental aspect of human communication, which is eye contact, now is being robbed from the medical encounter because of the electronic health record.”\u003c/p>\n\u003cp>He says EHRs now function primarily as documentation for billing and quality reporting rather than as an aid to doctors. Given their cumbersome nature, the EHR, long touted as a way to dramatically improve patient care, often does just the opposite, Minor believes.\u003c/p>\n\u003cp>“As a provider, you’re thinking about what do I need to document, or how do I navigate the EHR system, not how do I assimilate this information to provide the best care advice to the patient,\" he says. \"You’re thinking about the mechanics of the documentation, rather than the implications of the symptoms and findings.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Data Entry or Medicine?\u003c/strong>\u003c/p>\n\u003cp>Many physicians are fed up with the amount of documentation required in EHRs. Many feel they spend more time as data-entry clerks than as doctors.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Studies bear that out. Only 27 percent of a doctor’s time is spent with patients — and nearly half is spent on EHR and desk work, according to a \u003ca href=\"http://annals.org/aim/article/2546704/allocation-physician-time-ambulatory-practice-time-motion-study-4-specialties\">2016 study\u003c/a> published in \u003cem>Annals of Internal Medicine\u003c/em>. The study looked at physicians in family practice, internal medicine, cardiology and orthopedics. A smaller\u003ca href=\"http://content.healthaffairs.org/content/36/4/655.abstract\" target=\"_blank\" rel=\"noopener noreferrer\"> study\u003c/a> published in April by \u003cem>Health Affairs, \u003c/em>focusing on primary care physicians, also found about a 50-50 split in direct patient care time versus desktop medicine.\u003c/p>\n\u003cp>When doctors do spend time in the exam room with patients, they spent 37 percent of that time looking at the computer, the 2016 study estimated.\u003c/p>\n\u003cp>It's not just recording the patient's medical information that takes up time, according to Dr. Albert Chan, a family practice physician and the chief of digital patient experience for the Sutter Health Network. Doctors now need to report a series of quality measurements, provide proper insurance coding, and introduce more legalistic wording into the EHR to prevent lawsuits, he says.\u003c/p>\n\u003cp>There’s so much required paperwork and documentation now that primary care physicians spend an estimated one to two hours every night after work finishing up their data entry on EHRs, the study in \u003cem>Annals of Internal Medicine\u003c/em> found.\u003c/p>\n\u003cp>In the business, that’s called \"pajama time.\" In the real world, it's called one reason for burnout. Fifty-four \u003ca href=\"http://www.mayoclinicproceedings.org/article/S0025-6196(15)00716-8/abstract\">percent of physicians\u003c/a> reported at least one symptom of burnout, according to a recent Mayo Clinic study. A separate Mayo study found that a higher risk of burnout was \u003ca href=\"http://www.mayoclinicproceedings.org/article/S0025-6196(16)30215-4/abstract\">linked\u003c/a> to frustrations with the data-entry workload of EHRs.\u003c/p>\n\u003cp>\u003cstrong>A Powerful Tool\u003c/strong>\u003c/p>\n\u003cp>When the Affordable Care Act and the 2009 \u003ca href=\"https://www.hhs.gov/hipaa/for-professionals/special-topics/HITECH-act-enforcement-interim-final-rule/index.html\">HITECH Act\u003c/a> required electronic health records to be incorporated into medical practices, Dr. Chan says, many medical groups and physicians rushed to install EHR systems. That means the search function may not work well, or the system may require multiple keystrokes and screens to accomplish common tasks.\u003c/p>\n\u003cp>(Eric Helsher, vice president of client success at Epic, one of the leading EHR providers, responded that customer feedback \"drives our continuous development, with the aim of making the software a joy to use, helping them get value from their data, and facilitating collaboration across the Epic community.\")\u003c/p>\n\u003caside class=\"pullquote alignright\">'I remember back in the old days of paper medical records … not being able to find a patient’s chart was just maddening. We don’t have that anymore.'\u003ccite>Dr. Albert Chan\u003c/cite>\u003c/aside>\n\u003cp>But, Chan says, as flawed as the EHR is, it would be wise not to throw the baby out with the bathwater.\u003c/p>\n\u003cp>“It’s important to note that the EHR is an incredibly powerful tool,” he says. “There are tremendous things you can do with the EHR. You can automatically alert patients about their conditions, for example; you can personalize their care. The lesson I’ve learned is that the EHR requires work to make it work.”\u003c/p>\n\u003cp>Chan says he would never want to go back to the paper-only era.\u003c/p>\n\u003cp>“I remember back in the old days of paper medical records ... not being able to find a patient’s chart was just maddening. We don’t have that anymore.\"\u003c/p>\n\u003cp>\u003cstrong>The Interoperability Problem\u003c/strong>\u003c/p>\n\u003cp>Current design problems can be corrected over time by EHR system vendors, Chan says, and he expects the furor over EHRs to dissipate as annoying and time-consuming glitches are altered.\u003c/p>\n\u003cp>One of the big complaints doctors have had is the lack of interoperability between EHR systems, so that hospitals, medical groups, insurers and physicians can't easily share patient data with each other. In the San Francisco Bay Area, some sharing is now starting to occur among institutions like Sutter Health, Kaiser, UCSF and Stanford that all that use the EHR system Epic.\u003c/p>\n\u003cp>“We’re starting to see fruits of our labor to connect data,” Chan says.\u003c/p>\n\u003cp>But that may be a glass-half-full view, according to Will Ross, a project manager at Redwood MedNet, a nonprofit health information exchange based in Ukiah. Ross has been working on trying to improve the interoperability of EHRs for two decades, and says the progress has been plodding, to say the least.\u003c/p>\n\u003cp>Ross says EHRs took a turn for the worse after Congress tried to get physicians to prove they were meaningfully using them in the HITECH Act of 2009. Those rules, which he calls arbitrary, made the whole process much more complex and time-consuming.\u003c/p>\n\u003cp>\u003cspan style=\"color: #2b2b2b\">“That transformed all of this into busy work and nonsense,” Ross says. \u003c/span>\u003c/p>\n\u003cp>The obvious solution is for vendors to improve their products, he says. But that’s easier proposed than accomplished.\u003c/p>\n\u003cp>“A lot of the EHRs are cash cows to their owners,” Ross says. “They make their money on installing them, not changing them.”\u003c/p>\n\u003cp>Even if the complex problems of interoperability and ease of use were magically solved today, physicians would still be overloaded by reporting requirements, Ross says.\u003c/p>\n\u003cp>“Documentation is still there, so blaming the computer for what insurers and the government are requiring you to do is misplacing the blame.\"\u003c/p>\n\u003cp>Large organizations such as Kaiser and Sutter Health have tackled some of the ease-of-use problems of the EHR, according to David Lansky, executive director of the Pacific Business Group on Health, a nonprofit consortium of private businesses and public agencies. That’s not so easy for smaller practices to do.\u003c/p>\n\u003cp>“In big medical groups, the burden on the individual doctor using EHR is lower already, it’s easier,” Lansky says. “But small-group practices and individuals have the same administrative burden as the large-group practices.\"\u003c/p>\n\u003cp>Lansky’s organization is encouraging smaller groups to join provider contracting networks — niche companies that will help them track patients, install reminder systems, streamline quality reporting and connect with health information exchanges — so smaller practices are not trying to solve the problem themselves.\u003c/p>\n\u003cp class=\"p1\">He says the idea is to get doctors to use their skills and training properly. “We have this cult of the physician, and we pay a lot of money to train them,” Lansky says, “yet they’re being asked to do work others can do very well.”\u003c/p>\n\u003cp>That rings true for Stanford medical school's Dean Minor. He’s sick of scrolling down page by page; sick of checking off a million little boxes. All the time spent on medical documentation cuts down on physician efficiency, he says.\u003c/p>\n\u003cp>If doctors are working so many extra hours entering data, they’re likely to cut down on their patient load to make up for it. That means they make less money, and the quality of patient visits continues to decline.\u003c/p>\n\u003cp>“It negatively impacts patient care, that’s the main thing,” he says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This post had been edited.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/420143/hold-on-your-doctor-is-typing","authors":["byline_futureofyou_420143"],"categories":["futureofyou_452","futureofyou_1","futureofyou_73"],"tags":["futureofyou_190","futureofyou_794","futureofyou_1275","futureofyou_177"],"featImg":"futureofyou_427912","label":"source_futureofyou_420143"},"news_11573069":{"type":"posts","id":"news_11573069","meta":{"index":"posts_1591205157","site":"news","id":"11573069","score":null,"sort":[1500330247000]},"guestAuthors":[],"slug":"health-care-vote-delay-gives-foes-supporters-more-time","title":"Health Care Vote Delay Gives Foes, Supporters More Time","publishDate":1500330247,"format":"standard","headTitle":"The California Report | KQED News","labelTerm":{"term":72,"site":"news"},"content":"\u003cp>Foes from left and right are using the delayed vote on the Republican health care bill to make it as politically toxic as possible for wavering GOP senators to support it.\u003c/p>\n\u003cp>Over the weekend Senate Majority Leader Mitch McConnell delayed a vote on the GOP health care bill. Arizona Sen. John McCain's absence has left Republicans short of the votes necessary to move ahead on the legislation to erase much of Barack Obama's health care law.\u003c/p>\n\u003cp>McCain's office says the 80-year-old Arizona senator underwent surgery Friday to remove a blood clot. McCain is at home and recuperating.\u003c/p>\n\u003cp>McConnell said he had spoken to McCain and that he hoped the ailing senator will be back in the Senate soon. McCain's office says he'll remain in Arizona this week.\u003c/p>\n\u003cp>President Trump says he hopes McCain gets better soon and calls him a \"crusty voice in Washington.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Trump added, \"Plus, we need his vote.\"\u003c/p>\n\u003cp>Trump brought up McCain while calling for the repeal of the national health care law during a trade event at the White House.\u003c/p>\n\u003cp>McCain's absence has led Senate leaders to postpone action on the health care measure. It needs almost every Republican vote to pass.\u003c/p>\n\u003cp>But the postponement also gives McConnell and the White House more time to cut the deals they need to rescue the imperiled measure.\u003c/p>\n\u003cp>McConnell signaled Monday that days of bargaining and persuasion with reluctant colleagues lie ahead. He says the only way to prevail \"is with continued hard work, and that's just what we intend to do. \"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The AARP is aiming TV and radio ads at undecided, moderate Republican senators in five states. From the right, Americans for Prosperity is rallying its members to urge senators to make the bill even more conservative.\u003c/p>\n\n","blocks":[],"excerpt":"Arizona Sen. John McCain's absence has left Republicans short of the votes necessary to move ahead on the legislation to erase much of Obamacare.","status":"publish","parent":0,"modified":1500336683,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":13,"wordCount":300},"headData":{"title":"Health Care Vote Delay Gives Foes, Supporters More Time | KQED","description":"Arizona Sen. John McCain's absence has left Republicans short of the votes necessary to move ahead on the legislation to erase much of Obamacare.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"11573069 https://ww2.kqed.org/news/?p=11573069","disqusUrl":"https://ww2.kqed.org/news/2017/07/17/health-care-vote-delay-gives-foes-supporters-more-time/","disqusTitle":"Health Care Vote Delay Gives Foes, Supporters More Time","nprByline":" \u003cstrong>Alan Fram\u003cbr>Associated Press\u003c/strong>","path":"/news/11573069/health-care-vote-delay-gives-foes-supporters-more-time","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Foes from left and right are using the delayed vote on the Republican health care bill to make it as politically toxic as possible for wavering GOP senators to support it.\u003c/p>\n\u003cp>Over the weekend Senate Majority Leader Mitch McConnell delayed a vote on the GOP health care bill. Arizona Sen. John McCain's absence has left Republicans short of the votes necessary to move ahead on the legislation to erase much of Barack Obama's health care law.\u003c/p>\n\u003cp>McCain's office says the 80-year-old Arizona senator underwent surgery Friday to remove a blood clot. McCain is at home and recuperating.\u003c/p>\n\u003cp>McConnell said he had spoken to McCain and that he hoped the ailing senator will be back in the Senate soon. McCain's office says he'll remain in Arizona this week.\u003c/p>\n\u003cp>President Trump says he hopes McCain gets better soon and calls him a \"crusty voice in Washington.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Trump added, \"Plus, we need his vote.\"\u003c/p>\n\u003cp>Trump brought up McCain while calling for the repeal of the national health care law during a trade event at the White House.\u003c/p>\n\u003cp>McCain's absence has led Senate leaders to postpone action on the health care measure. It needs almost every Republican vote to pass.\u003c/p>\n\u003cp>But the postponement also gives McConnell and the White House more time to cut the deals they need to rescue the imperiled measure.\u003c/p>\n\u003cp>McConnell signaled Monday that days of bargaining and persuasion with reluctant colleagues lie ahead. He says the only way to prevail \"is with continued hard work, and that's just what we intend to do. \"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The AARP is aiming TV and radio ads at undecided, moderate Republican senators in five states. From the right, Americans for Prosperity is rallying its members to urge senators to make the bill even more conservative.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11573069/health-care-vote-delay-gives-foes-supporters-more-time","authors":["byline_news_11573069"],"programs":["news_6944","news_72"],"categories":["news_457","news_8","news_13"],"tags":["news_683","news_21264"],"featImg":"news_11573075","label":"news_72"},"news_11563885":{"type":"posts","id":"news_11563885","meta":{"index":"posts_1591205157","site":"news","id":"11563885","score":null,"sort":[1499885624000]},"guestAuthors":[],"slug":"is-the-new-tobacco-tax-causing-a-drop-in-smoking-big-time-indicators-suggest","title":"Is the New Tobacco Tax Causing a Drop in Smoking? Big Time, Indicators Suggest","publishDate":1499885624,"format":"standard","headTitle":"The California Report | KQED News","labelTerm":{},"content":"\u003cp>Last fall, California voters approved the biggest increase in cigarette taxes since the state first began levying tobacco in the 1950s. Advocates for Proposition 56, which passed with a fairly overwhelming 64 percent of the vote, argued that a $2-per-pack tax hike would hurt pocketbooks enough to nudge millions of California smokers to quit, or at least to light up less frequently.\u003c/p>\n\u003cp>When the tax went into effect in April, smokers saw the average cost of a pack of cigarettes soar from under $6 to up to $9, making California one of the most expensive states in which to buy cigarettes. But the question then: Was that enough to force smokers to kick an increasingly expensive habit?\u003c/p>\n\u003cp>The early data suggest that yes, California cigarette sales have declined significantly since prices went up. In fact, the drop is even sharper than the state anticipated -- which could spell trouble for state coffers.\u003c/p>\n\u003cp>[cigtax]\u003c/p>\n\u003cp>Cigarette pack \"distributions\" -- tax lingo for a pack of cigarettes typically sold from a distributor to a retailer, and a good proxy for consumption -- dropped 56 percent year-over-year in the two months following the tax increase, according to data obtained from the California Department of Tax and Fee Administration and analyzed by CALmatters. That’s a decline of nearly 82 million packs.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“This is a big effect,” said Dr. Stanton Glantz, a researcher at UCSF's Center for Tobacco Control Research and Education. “I have felt for a long time where we’re getting to the point in California where smoking is so low that a couple of good shoves like this one, and we might be rid of it.”\u003c/p>\n\u003cp>Glantz and other tobacco experts cautioned that it is still far too early to make definitive conclusions: It’s difficult to draw inferences from two months of data, as both suppliers and consumers are still figuring out what they can and can’t afford.\u003c/p>\n\u003cp>Knowing that prices were about to rise, tobacco distributors and smokers also rushed to stockpile as many cigarettes as possible the month preceding the tax hike, deflating the April and May figures. California cigarette distributors sold nearly 104 million cigarette packs in March, by far the most of any month in the last two years.\u003c/p>\n\u003cp>[contextly_sidebar id=\"7wYFkDkJqpG5LX8BPIbgWZ6c23FJqkpm\"]\u003c/p>\n\u003cp>But even after adjusting for stockpiling, the tax hike appears to be having a major impact: Cigarette sales still dropped 23 percent year-over-year for the three-month period, including the pretax run-up.\u003c/p>\n\u003cp>Experts say cigarette consumption will likely rise slightly in the months ahead, before stabilizing in the next four to five months. Lower-income and younger smokers are typically the first to cut back in response to a tax hike.\u003c/p>\n\u003cp>But what’s beneficial for public health isn’t necessarily good for the state budget, at least in the near term.\u003c/p>\n\u003cp>Proposition 56 was supposed to generate an additional $1.3 billion in revenue for the state to shore up Medi-Cal, the state health insurance program for low-income Californians. In the two months since the tax has been in place, the state has raised a total of $182 million -- below what the Brown administration was expecting.\u003c/p>\n\u003cp>\"Sales are still more sluggish than had been originally anticipated,\" H.D. Palmer, spokesman for the Department of Finance, said via email. \"Given that we only have two months of data, it is too early to predict a trend. If the current trend holds, we would likely make a revision to our expected decline in consumption.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"B6j14NxRMaFQ9SqSivOZuj8kr97QZdE1\"]\u003c/p>\n\u003cp>How the new cigarette tax revenue would be spent became a \u003ca href=\"http://www.latimes.com/politics/la-pol-sac-tobacco-tax-budget-20170316-story.html\" target=\"_blank\" rel=\"noopener noreferrer\">hot-button issue\u003c/a> in state budget negotiations last month. Ultimately, legislators and Gov. Jerry Brown agreed to divide the new revenue between increased payments to physicians and general Medi-Cal expenses.\u003c/p>\n\u003cp>Palmer said that if cigarette tax revenues continue to come in lower than anticipated, the administration would need to identify an alternative revenue source or propose cutbacks to Medi-Cal.\u003c/p>\n\u003cp>Of course, tax revenue is just one side of the equation when it comes to the fiscal effects of the new cigarette tax. Savings from lower health care costs as more low-income smokers quit are not factored into the revenue side of the state budget.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"https://calmatters.org/\" target=\"_blank\" rel=\"noopener noreferrer\">CALmatters.org\u003c/a> is a nonprofit, nonpartisan media venture explaining California policies and politic\u003c/em>s.\u003c/p>\n\n","blocks":[],"excerpt":"Two months after California enacted a new $2-per-pack tax, one cigarette sales indicator has dropped 56 percent -- further than the state expected.","status":"publish","parent":0,"modified":1499903494,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":21,"wordCount":732},"headData":{"title":"Is the New Tobacco Tax Causing a Drop in Smoking? Big Time, Indicators Suggest | KQED","description":"Two months after California enacted a new $2-per-pack tax, one cigarette sales indicator has dropped 56 percent -- further than the state expected.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"11563885 https://ww2.kqed.org/news/?p=11563885","disqusUrl":"https://ww2.kqed.org/news/2017/07/12/is-the-new-tobacco-tax-causing-a-drop-in-smoking-big-time-indicators-suggest/","disqusTitle":"Is the New Tobacco Tax Causing a Drop in Smoking? Big Time, Indicators Suggest","source":"CALmatters","sourceUrl":"https://calmatters.org/","nprByline":"\u003cstrong>\u003ca href=\"https://calmatters.org/articles/author/matt-levin/\">Matt Levin\u003c/a>\u003c/strong>","path":"/news/11563885/is-the-new-tobacco-tax-causing-a-drop-in-smoking-big-time-indicators-suggest","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Last fall, California voters approved the biggest increase in cigarette taxes since the state first began levying tobacco in the 1950s. Advocates for Proposition 56, which passed with a fairly overwhelming 64 percent of the vote, argued that a $2-per-pack tax hike would hurt pocketbooks enough to nudge millions of California smokers to quit, or at least to light up less frequently.\u003c/p>\n\u003cp>When the tax went into effect in April, smokers saw the average cost of a pack of cigarettes soar from under $6 to up to $9, making California one of the most expensive states in which to buy cigarettes. But the question then: Was that enough to force smokers to kick an increasingly expensive habit?\u003c/p>\n\u003cp>The early data suggest that yes, California cigarette sales have declined significantly since prices went up. In fact, the drop is even sharper than the state anticipated -- which could spell trouble for state coffers.\u003c/p>\n\u003cp>[cigtax]\u003c/p>\n\u003cp>Cigarette pack \"distributions\" -- tax lingo for a pack of cigarettes typically sold from a distributor to a retailer, and a good proxy for consumption -- dropped 56 percent year-over-year in the two months following the tax increase, according to data obtained from the California Department of Tax and Fee Administration and analyzed by CALmatters. That’s a decline of nearly 82 million packs.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“This is a big effect,” said Dr. Stanton Glantz, a researcher at UCSF's Center for Tobacco Control Research and Education. “I have felt for a long time where we’re getting to the point in California where smoking is so low that a couple of good shoves like this one, and we might be rid of it.”\u003c/p>\n\u003cp>Glantz and other tobacco experts cautioned that it is still far too early to make definitive conclusions: It’s difficult to draw inferences from two months of data, as both suppliers and consumers are still figuring out what they can and can’t afford.\u003c/p>\n\u003cp>Knowing that prices were about to rise, tobacco distributors and smokers also rushed to stockpile as many cigarettes as possible the month preceding the tax hike, deflating the April and May figures. California cigarette distributors sold nearly 104 million cigarette packs in March, by far the most of any month in the last two years.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>But even after adjusting for stockpiling, the tax hike appears to be having a major impact: Cigarette sales still dropped 23 percent year-over-year for the three-month period, including the pretax run-up.\u003c/p>\n\u003cp>Experts say cigarette consumption will likely rise slightly in the months ahead, before stabilizing in the next four to five months. Lower-income and younger smokers are typically the first to cut back in response to a tax hike.\u003c/p>\n\u003cp>But what’s beneficial for public health isn’t necessarily good for the state budget, at least in the near term.\u003c/p>\n\u003cp>Proposition 56 was supposed to generate an additional $1.3 billion in revenue for the state to shore up Medi-Cal, the state health insurance program for low-income Californians. In the two months since the tax has been in place, the state has raised a total of $182 million -- below what the Brown administration was expecting.\u003c/p>\n\u003cp>\"Sales are still more sluggish than had been originally anticipated,\" H.D. Palmer, spokesman for the Department of Finance, said via email. \"Given that we only have two months of data, it is too early to predict a trend. If the current trend holds, we would likely make a revision to our expected decline in consumption.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>How the new cigarette tax revenue would be spent became a \u003ca href=\"http://www.latimes.com/politics/la-pol-sac-tobacco-tax-budget-20170316-story.html\" target=\"_blank\" rel=\"noopener noreferrer\">hot-button issue\u003c/a> in state budget negotiations last month. Ultimately, legislators and Gov. Jerry Brown agreed to divide the new revenue between increased payments to physicians and general Medi-Cal expenses.\u003c/p>\n\u003cp>Palmer said that if cigarette tax revenues continue to come in lower than anticipated, the administration would need to identify an alternative revenue source or propose cutbacks to Medi-Cal.\u003c/p>\n\u003cp>Of course, tax revenue is just one side of the equation when it comes to the fiscal effects of the new cigarette tax. Savings from lower health care costs as more low-income smokers quit are not factored into the revenue side of the state budget.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"https://calmatters.org/\" target=\"_blank\" rel=\"noopener noreferrer\">CALmatters.org\u003c/a> is a nonprofit, nonpartisan media venture explaining California policies and politic\u003c/em>s.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11563885/is-the-new-tobacco-tax-causing-a-drop-in-smoking-big-time-indicators-suggest","authors":["byline_news_11563885"],"programs":["news_6944","news_72"],"categories":["news_1758","news_457","news_8","news_13"],"tags":["news_458","news_423","news_17286","news_2561"],"affiliates":["news_18481"],"featImg":"news_11563889","label":"source_news_11563885"},"futureofyou_418097":{"type":"posts","id":"futureofyou_418097","meta":{"index":"posts_1591205157","site":"futureofyou","id":"418097","score":null,"sort":[1499877201000]},"guestAuthors":[],"slug":"google-glass-feed-connects-the-blind-with-remote-human-guides","title":"Through Google Glass, Remote Helper Sees What Blind Person Can't","publishDate":1499877201,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>The first thing I do is put on Google Glass, its tiny camera situated over my right eye.\u003c/p>\n\u003cp>A MiFi — a personal wireless hotspot — goes into my pocket. I pop in earbuds connected to a smartphone. Then I close my eyes. I am trying to simulate, for this demonstration, what it's like to navigate without being able to see.\u003c/p>\n\u003caside class=\"alignright\">Finding a cafe, describing a museum exhibit, or helping someone fold origami -- a new service guides blind people by connecting them with live agents who view their surroundings through smartglasses like Google Glass.\u003c/aside>\n\u003cp>All geared up, I am now ready for my test run. \u003ca href=\"https://aira.io/#service\" target=\"_blank\" rel=\"noopener noreferrer\">Aira\u003c/a>, based in San Diego, is a paid service that offers \"visual interpretation\" for the blind and visually impaired. With a smartphone app, Aira users connect with a remote agent who sees through any one of four types of smartglasses and describes the client's environment to her. Employees say the service, which became available in March, is like \u003ca href=\"https://www.theatlantic.com/business/archive/2016/04/onstar/480471/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"color: #24890d\">OnStar\u003c/span>\u003c/a>\u003cspan class=\"m-6819587429447741435apple-converted-space\"> \u003c/span>for the blind — or maybe like having your own personal “\u003ca href=\"http://24.wikia.com/wiki/Chloe_O%27Brian\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"color: #24890d\">Chloe\u003c/span>\u003c/a>,” the intelligence analyst on the TV show \"24\" who often remotely assists hero Jack Bauer.\u003c/p>\n\u003cp>I summon \u003cem>my\u003c/em> Chloe using the Aira interface, which consists of a giant blue button. All I have to do is tap anywhere on the phone's display.\u003c/p>\n\u003cp>“Thank you for calling Aira,” a friendly voice says. “How can I help you?”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>This is Andy Del Valle, my agent, and, for as long as I need him, my long-distance eyes. Del Valle — sitting in front of his laptop — can now see through my Google Glass feed. As I scan my surroundings, he sees Amy Bernal, the company’s vice president of customer experience, who has helped get me outfitted; then I lower my head so he can see the path before my feet.\u003c/p>\n\u003cp>Thanks to my GPS connection, Del Valle is also able to locate me using Google Maps. We’re on the campus of San Francisco State University, for me unfamiliar turf. I ask him to direct me to the nearest cafe.\u003c/p>\n\u003cp>Within seconds, he's produced a route.\u003c/p>\n\u003cp>Granted, we’re approximating the Aira experience; I’m a sighted person with no orientation and mobility training, and I'm not using a dog or cane, as regular users do. I am, to put it gently, perhaps not the most graceful mover Del Valle has ever assisted. But he is cheerful as he offers me directions, like to turn left toward 11 o’clock. As I walk, he offers environmental cues, telling me to turn when I feel the slope of the sidewalk level out, or when I can feel the sun as I emerge from a nearby building’s shadow.\u003c/p>\n\u003cp>I quickly grow to trust his voice in my ear.\u003c/p>\n\u003cp>After a short walk, I hear music and a cash register — we’ve arrived at our destination. I want to order an iced coffee; Del Valle asks me to turn so he can scan a posted menu.\u003c/p>\n\u003cfigure id=\"attachment_424306\" class=\"wp-caption alignleft\" style=\"max-width: 292px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/07/AiraPhoto1-e1499819013990.jpg\">\u003cimg class=\"wp-image-424306\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/07/AiraPhoto1-1020x1360.jpg\" alt=\"\" width=\"292\" height=\"390\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Orientation and mobility specialist using Aira at the International Mobility Conference in 2016. (Courtesy Aira)\u003c/figcaption>\u003c/figure>\n\u003cp>“Taking picture,” an automated voice intones as Del Valle grabs a shot from the camera feed and zooms in. He also pulls up a more detailed menu online and gives me a rundown of options — espresso? Blended java drink? — and a headcount of how many people are in line.\u003c/p>\n\u003cp>Del Valle is among the 33 agents working that day, covering customers across the United States. The service runs from 4 a.m. to 10 p.m., Pacific time or 7 a.m.to 1 a.m. Eastern, and clients subscribe to a monthly plan or a package of minutes. (The monthly plans go from $89 to $329, depending on \u003ca href=\"https://aira.io/plans\" target=\"_blank\" rel=\"noopener noreferrer\">level of service\u003c/a>.\u003cstrong>) \u003c/strong>Each user gets a personal profile that lists details like allergies, so an agent can warn someone allergic to shellfish, for example, that there’s shrimp salad on the potluck table. The company says it has \"hundreds\" of clients.\u003c/p>\n\u003cp>Bernal, the customer experience VP, is also an agent, and she's set up shop for the afternoon in the campus’ special education department. The calls she fields run from the mundane (a man looking for a trash can while cleaning up after his guide dog) to the complicated (a lost woman with bad directions from a passerby can't find her bus stop.) “You'll never know until you pick up the call,” Bernal says.\u003c/p>\n\u003caside class=\"pullquote alignright\">'There are hundreds of thousands of very clever and efficient solutions that don’t involve sight.'\u003ccite>Bryan Bashin, LightHouse for the Blind and Visually Impaired\u003c/cite>\u003c/aside>\n\u003cp>Sometimes they get a strange one — Bernal recalls an agent being asked to help a user do origami, having to hastily grab some paper and fold along. But most are the stuff of ordinary life: setting up the cable box, checking the expiration date on the milk, matching a shirt and tie.\u003c/p>\n\u003cp>Tiffany Manosh, president of the River City Chapter of the National Federation of the Blind, in Sacramento, has been using Aira for about a year. She likes it for tasks that involve browsing, like shopping. Sure, she could ask a clerk for help, but “they go directly to whatever item we’ve asked for,” she says. “Well, what if I want to see maybe what’s on sale?”\u003c/p>\n\u003cp>At a natural history museum, she once had an agent describe the exhibits. A docent could have done that — if she’d booked one a month in advance. “Sighted people don’t have to do that, so why should we?” she asks. “Aira gives us the freedom to be able to really integrate and do things at our own time — when we want to, and where we want to go.” An agent even helped her find her father’s gravesite at Arlington National Cemetery. “It was a very emotional and just phenomenal feeling to be able to do it on my own time,” says Manosh.\u003c/p>\n\u003cp>Aira, based in San Diego, test-launched three years ago with 200 beta users. Among them was Victorville resident Michael Hingson, who has been blind since birth and recently became the company’s director of strategic sales. “Aira is not helping a blind person see,” Hingson says. “Aira is giving me information that the sighted world has not learned to provide to us.”\u003c/p>\n\u003cp>For example, on emails or websites, those who are visually impaired might use a screen reader that speaks the text aloud. For printed materials, they might try a phone app like the \u003ca href=\"http://www.knfbreader.com/\" target=\"_blank\" rel=\"noopener noreferrer\">KNFB Reader\u003c/a>, which translates text using optical character recognition. But those don’t cover everything. Hingson recalls trying to assemble a laundry cart and discovering the instructions were in pictures, which his reader couldn’t decipher. So he called Aira. The agent zoomed in on the cart’s bar code and found assembly instructions on the internet. In a half-hour, Hingson said, “I had a working laundry cart.”\u003c/p>\n\u003cp>Aira agents are trained to give factual information without offering advice, deferring to the user’s orientation and mobility training. “What I don’t want is an agent telling me it’s safe to cross the street — because the agent doesn't \u003cem>know\u003c/em> it’s safe to cross the street,” says Hingson. “That should be my choice.”\u003c/p>\n\u003cp>Learning to give the right information is a balancing act, says Bernal. “When agents first start, they feel like they have to say every little thing that is in any remote path of a user,” she says. But a person’s dog or cane will help them avoid obstacles. Instead, it might be more useful to offer social information, like where the empty seat in the room is, or whether the driver greeting you at the airport is smiling and waving you over.\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=Jxkq-Ta0tv4&ab_channel=KansasCityStarVideo\u003c/p>\n\u003cp>\u003cstrong>Free Services\u003c/strong>\u003c/p>\n\u003cp>Bryan Bashin, CEO of the training and advocacy group \u003ca href=\"http://lighthouse-sf.org/\">LightHouse for the Blind and Visually Impaired\u003c/a>, in San Francisco, has tried Aira, and points out that while it’s the first such for-profit service, it’s not the first visual interpretation app.\u003c/p>\n\u003cp>Once the iPhone debuted, he says, “a lot of people had the same idea at the same time.” He sometimes uses \u003ca href=\"http://bemyeyes.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Be My Eyes\u003c/a>, a free worldwide service powered by volunteers who assist by cellphone video chat. The free app \u003ca href=\"http://taptapseeapp.com/\" target=\"_blank\" rel=\"noopener noreferrer\">TapTapSee\u003c/a> identifies the content of still photos and speaks it aloud. And people can also improvise by simply Facetiming with friends or relatives. Bashin says these solutions are more accessible to low-income people than Aira’s paid service, although they lack some of the features — smartglasses, GPS mapping, agents trained to work with the blind. But what they all have in common, Bashin says, “is the world is still not 100 percent accessible for blind people.”\u003c/p>\n\u003cp>Bashin says that dialing a sighted person can be especially helpful when optical character readers fail, noting they are often thwarted by glare (think thermostat screens) or fancy script (think wine bottle labels or handwritten mail). But Bashin cautions against over-reliance on visual interpreters.\u003c/p>\n\u003cp>“When somebody first becomes blind, they think that the answers to the obstacles of blindness are to have someone see for you,” he says. Yet a person can skillfully use other senses, like touch and hearing, and low-tech solutions, like Braille. “There are hundreds of thousands of very clever and efficient solutions that don’t involve sight,” Bashin continues. “That’s what we teach at the LightHouse, and that’s what will get us through the day with a little bit of grace, so that we can reserve these technologies for when they really count. I'm a little bit afraid that new students will avoid learning what they need to learn to be competent blind people.”\u003c/p>\n\u003cp>While some Aira users prefer a paid agent — often for fear of imposing on others’ time — Bashin doesn't mind asking a stranger to steer him toward the check-in desk or describe what’s on the buffet, because that’s a social activity. “Yes, I’ll learn where the strawberries are, but I’ll also learn about \u003cem>them\u003c/em>. Now I’ve made a bridge to another person instead of isolating myself talking into a headset and some goggles,” he says.\u003c/p>\n\u003cp>But Manosh, from the Sacramento National Federation of the Blind chapter, disagrees that the service will encourage isolation or over-reliance. She calls Aira “a tool in my toolbox” that also includes her cane and her mobility training. “You don’t have to rely \u003cem>just\u003c/em> on it, and that’s the beauty of it,” she says.\u003c/p>\n\u003cfigure id=\"attachment_418103\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/06/Aira5.jpg\">\u003cimg class=\"wp-image-418103 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/06/Aira5-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5.jpg 1600w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Amy Bernal, Aira's vice president of customer experience, demonstrates what agents connected to the company's clients see on their screen -- a Google Map of the user's location with an inset of the video stream coming from their glasses or phone. (Kara Platoni/KQED)\u003c/figcaption>\u003c/figure>\n\u003caside class=\"pullquote alignright\">'I’ve had this experience where I’ve actually gone to an airport and thought ‘How do I know this airport? I’ve never been here before. You realize that you’ve been an agent for a user in an airport. You are like, ‘Oh, I’ve been in this terminal, but I haven’t \u003cem>been in this terminal\u003c/em>.’ It’s very déjà vu.'\u003ccite>Amy Bernal, Aira’s vice president of customer experience\u003c/cite>\u003c/aside>\n\u003cp>The next phase of Aira’s development will be to turn some tasks over to a machine. At first, Bernal says, the AI will likely assist the agent. Later, it might guide people through routine tasks, like daily commutes. Or it might replace agents in sensitive situations, while users are in restrooms or dealing with finances, for instance. (Currently, users can go into “privacy mode” with no video or audio, or hang up and call back.)\u003c/p>\n\u003cp>Hingson imagines sending a shopping list to Aira, and having the AI map his path through the store and check barcodes to confirm that he's grabbed the right items. He’d also like Aira integration with Facebook, so the system could use facial recognition to let him know if his friends are nearby.\u003c/p>\n\u003cp>For now, employees like Bernal are happy to assist with just about everything, although she notes that there’s one oddly sci-fi effect of seeing the world through someone else’s lenses.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“I’ve had this experience where I’ve actually gone to an airport and thought ‘How do I know this airport? I’ve never been here before,’ ” she says. “But you realize that you’ve been an agent for a user in an airport. You are like, ‘Oh, I’ve been in this terminal, but I haven’t \u003cem>been in this terminal\u003c/em>.’ It’s very déjà vu.”\u003c/p>\n\n","blocks":[],"excerpt":"Finding a cafe, describing a museum exhibit or helping someone fold origami -- a new service helps blind people navigate by linking them with live agents who view their surroundings through smartglasses like Google Glass.","status":"publish","parent":0,"modified":1510960658,"stats":{"hasAudio":false,"hasVideo":true,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":34,"wordCount":2315},"headData":{"title":"Through Google Glass, Remote Helper Sees What Blind Person Can't | KQED","description":"Finding a cafe, describing a museum exhibit or helping someone fold origami -- a new service helps blind people navigate by linking them with live agents who view their surroundings through smartglasses like Google Glass.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"418097 https://ww2.kqed.org/futureofyou/?p=418097","disqusUrl":"https://ww2.kqed.org/futureofyou/2017/07/12/google-glass-feed-connects-the-blind-with-remote-human-guides/","disqusTitle":"Through Google Glass, Remote Helper Sees What Blind Person Can't","source":"KQED Future of You","nprByline":"Kara Platoni\u003cbr />Future of You","path":"/futureofyou/418097/google-glass-feed-connects-the-blind-with-remote-human-guides","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The first thing I do is put on Google Glass, its tiny camera situated over my right eye.\u003c/p>\n\u003cp>A MiFi — a personal wireless hotspot — goes into my pocket. I pop in earbuds connected to a smartphone. Then I close my eyes. I am trying to simulate, for this demonstration, what it's like to navigate without being able to see.\u003c/p>\n\u003caside class=\"alignright\">Finding a cafe, describing a museum exhibit, or helping someone fold origami -- a new service guides blind people by connecting them with live agents who view their surroundings through smartglasses like Google Glass.\u003c/aside>\n\u003cp>All geared up, I am now ready for my test run. \u003ca href=\"https://aira.io/#service\" target=\"_blank\" rel=\"noopener noreferrer\">Aira\u003c/a>, based in San Diego, is a paid service that offers \"visual interpretation\" for the blind and visually impaired. With a smartphone app, Aira users connect with a remote agent who sees through any one of four types of smartglasses and describes the client's environment to her. Employees say the service, which became available in March, is like \u003ca href=\"https://www.theatlantic.com/business/archive/2016/04/onstar/480471/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"color: #24890d\">OnStar\u003c/span>\u003c/a>\u003cspan class=\"m-6819587429447741435apple-converted-space\"> \u003c/span>for the blind — or maybe like having your own personal “\u003ca href=\"http://24.wikia.com/wiki/Chloe_O%27Brian\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"color: #24890d\">Chloe\u003c/span>\u003c/a>,” the intelligence analyst on the TV show \"24\" who often remotely assists hero Jack Bauer.\u003c/p>\n\u003cp>I summon \u003cem>my\u003c/em> Chloe using the Aira interface, which consists of a giant blue button. All I have to do is tap anywhere on the phone's display.\u003c/p>\n\u003cp>“Thank you for calling Aira,” a friendly voice says. “How can I help you?”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This is Andy Del Valle, my agent, and, for as long as I need him, my long-distance eyes. Del Valle — sitting in front of his laptop — can now see through my Google Glass feed. As I scan my surroundings, he sees Amy Bernal, the company’s vice president of customer experience, who has helped get me outfitted; then I lower my head so he can see the path before my feet.\u003c/p>\n\u003cp>Thanks to my GPS connection, Del Valle is also able to locate me using Google Maps. We’re on the campus of San Francisco State University, for me unfamiliar turf. I ask him to direct me to the nearest cafe.\u003c/p>\n\u003cp>Within seconds, he's produced a route.\u003c/p>\n\u003cp>Granted, we’re approximating the Aira experience; I’m a sighted person with no orientation and mobility training, and I'm not using a dog or cane, as regular users do. I am, to put it gently, perhaps not the most graceful mover Del Valle has ever assisted. But he is cheerful as he offers me directions, like to turn left toward 11 o’clock. As I walk, he offers environmental cues, telling me to turn when I feel the slope of the sidewalk level out, or when I can feel the sun as I emerge from a nearby building’s shadow.\u003c/p>\n\u003cp>I quickly grow to trust his voice in my ear.\u003c/p>\n\u003cp>After a short walk, I hear music and a cash register — we’ve arrived at our destination. I want to order an iced coffee; Del Valle asks me to turn so he can scan a posted menu.\u003c/p>\n\u003cfigure id=\"attachment_424306\" class=\"wp-caption alignleft\" style=\"max-width: 292px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/07/AiraPhoto1-e1499819013990.jpg\">\u003cimg class=\"wp-image-424306\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/07/AiraPhoto1-1020x1360.jpg\" alt=\"\" width=\"292\" height=\"390\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Orientation and mobility specialist using Aira at the International Mobility Conference in 2016. (Courtesy Aira)\u003c/figcaption>\u003c/figure>\n\u003cp>“Taking picture,” an automated voice intones as Del Valle grabs a shot from the camera feed and zooms in. He also pulls up a more detailed menu online and gives me a rundown of options — espresso? Blended java drink? — and a headcount of how many people are in line.\u003c/p>\n\u003cp>Del Valle is among the 33 agents working that day, covering customers across the United States. The service runs from 4 a.m. to 10 p.m., Pacific time or 7 a.m.to 1 a.m. Eastern, and clients subscribe to a monthly plan or a package of minutes. (The monthly plans go from $89 to $329, depending on \u003ca href=\"https://aira.io/plans\" target=\"_blank\" rel=\"noopener noreferrer\">level of service\u003c/a>.\u003cstrong>) \u003c/strong>Each user gets a personal profile that lists details like allergies, so an agent can warn someone allergic to shellfish, for example, that there’s shrimp salad on the potluck table. The company says it has \"hundreds\" of clients.\u003c/p>\n\u003cp>Bernal, the customer experience VP, is also an agent, and she's set up shop for the afternoon in the campus’ special education department. The calls she fields run from the mundane (a man looking for a trash can while cleaning up after his guide dog) to the complicated (a lost woman with bad directions from a passerby can't find her bus stop.) “You'll never know until you pick up the call,” Bernal says.\u003c/p>\n\u003caside class=\"pullquote alignright\">'There are hundreds of thousands of very clever and efficient solutions that don’t involve sight.'\u003ccite>Bryan Bashin, LightHouse for the Blind and Visually Impaired\u003c/cite>\u003c/aside>\n\u003cp>Sometimes they get a strange one — Bernal recalls an agent being asked to help a user do origami, having to hastily grab some paper and fold along. But most are the stuff of ordinary life: setting up the cable box, checking the expiration date on the milk, matching a shirt and tie.\u003c/p>\n\u003cp>Tiffany Manosh, president of the River City Chapter of the National Federation of the Blind, in Sacramento, has been using Aira for about a year. She likes it for tasks that involve browsing, like shopping. Sure, she could ask a clerk for help, but “they go directly to whatever item we’ve asked for,” she says. “Well, what if I want to see maybe what’s on sale?”\u003c/p>\n\u003cp>At a natural history museum, she once had an agent describe the exhibits. A docent could have done that — if she’d booked one a month in advance. “Sighted people don’t have to do that, so why should we?” she asks. “Aira gives us the freedom to be able to really integrate and do things at our own time — when we want to, and where we want to go.” An agent even helped her find her father’s gravesite at Arlington National Cemetery. “It was a very emotional and just phenomenal feeling to be able to do it on my own time,” says Manosh.\u003c/p>\n\u003cp>Aira, based in San Diego, test-launched three years ago with 200 beta users. Among them was Victorville resident Michael Hingson, who has been blind since birth and recently became the company’s director of strategic sales. “Aira is not helping a blind person see,” Hingson says. “Aira is giving me information that the sighted world has not learned to provide to us.”\u003c/p>\n\u003cp>For example, on emails or websites, those who are visually impaired might use a screen reader that speaks the text aloud. For printed materials, they might try a phone app like the \u003ca href=\"http://www.knfbreader.com/\" target=\"_blank\" rel=\"noopener noreferrer\">KNFB Reader\u003c/a>, which translates text using optical character recognition. But those don’t cover everything. Hingson recalls trying to assemble a laundry cart and discovering the instructions were in pictures, which his reader couldn’t decipher. So he called Aira. The agent zoomed in on the cart’s bar code and found assembly instructions on the internet. In a half-hour, Hingson said, “I had a working laundry cart.”\u003c/p>\n\u003cp>Aira agents are trained to give factual information without offering advice, deferring to the user’s orientation and mobility training. “What I don’t want is an agent telling me it’s safe to cross the street — because the agent doesn't \u003cem>know\u003c/em> it’s safe to cross the street,” says Hingson. “That should be my choice.”\u003c/p>\n\u003cp>Learning to give the right information is a balancing act, says Bernal. “When agents first start, they feel like they have to say every little thing that is in any remote path of a user,” she says. But a person’s dog or cane will help them avoid obstacles. Instead, it might be more useful to offer social information, like where the empty seat in the room is, or whether the driver greeting you at the airport is smiling and waving you over.\u003c/p>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/Jxkq-Ta0tv4'\n title='//www.youtube.com/embed/Jxkq-Ta0tv4'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>\u003cstrong>Free Services\u003c/strong>\u003c/p>\n\u003cp>Bryan Bashin, CEO of the training and advocacy group \u003ca href=\"http://lighthouse-sf.org/\">LightHouse for the Blind and Visually Impaired\u003c/a>, in San Francisco, has tried Aira, and points out that while it’s the first such for-profit service, it’s not the first visual interpretation app.\u003c/p>\n\u003cp>Once the iPhone debuted, he says, “a lot of people had the same idea at the same time.” He sometimes uses \u003ca href=\"http://bemyeyes.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Be My Eyes\u003c/a>, a free worldwide service powered by volunteers who assist by cellphone video chat. The free app \u003ca href=\"http://taptapseeapp.com/\" target=\"_blank\" rel=\"noopener noreferrer\">TapTapSee\u003c/a> identifies the content of still photos and speaks it aloud. And people can also improvise by simply Facetiming with friends or relatives. Bashin says these solutions are more accessible to low-income people than Aira’s paid service, although they lack some of the features — smartglasses, GPS mapping, agents trained to work with the blind. But what they all have in common, Bashin says, “is the world is still not 100 percent accessible for blind people.”\u003c/p>\n\u003cp>Bashin says that dialing a sighted person can be especially helpful when optical character readers fail, noting they are often thwarted by glare (think thermostat screens) or fancy script (think wine bottle labels or handwritten mail). But Bashin cautions against over-reliance on visual interpreters.\u003c/p>\n\u003cp>“When somebody first becomes blind, they think that the answers to the obstacles of blindness are to have someone see for you,” he says. Yet a person can skillfully use other senses, like touch and hearing, and low-tech solutions, like Braille. “There are hundreds of thousands of very clever and efficient solutions that don’t involve sight,” Bashin continues. “That’s what we teach at the LightHouse, and that’s what will get us through the day with a little bit of grace, so that we can reserve these technologies for when they really count. I'm a little bit afraid that new students will avoid learning what they need to learn to be competent blind people.”\u003c/p>\n\u003cp>While some Aira users prefer a paid agent — often for fear of imposing on others’ time — Bashin doesn't mind asking a stranger to steer him toward the check-in desk or describe what’s on the buffet, because that’s a social activity. “Yes, I’ll learn where the strawberries are, but I’ll also learn about \u003cem>them\u003c/em>. Now I’ve made a bridge to another person instead of isolating myself talking into a headset and some goggles,” he says.\u003c/p>\n\u003cp>But Manosh, from the Sacramento National Federation of the Blind chapter, disagrees that the service will encourage isolation or over-reliance. She calls Aira “a tool in my toolbox” that also includes her cane and her mobility training. “You don’t have to rely \u003cem>just\u003c/em> on it, and that’s the beauty of it,” she says.\u003c/p>\n\u003cfigure id=\"attachment_418103\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/06/Aira5.jpg\">\u003cimg class=\"wp-image-418103 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/06/Aira5-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5.jpg 1600w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Amy Bernal, Aira's vice president of customer experience, demonstrates what agents connected to the company's clients see on their screen -- a Google Map of the user's location with an inset of the video stream coming from their glasses or phone. (Kara Platoni/KQED)\u003c/figcaption>\u003c/figure>\n\u003caside class=\"pullquote alignright\">'I’ve had this experience where I’ve actually gone to an airport and thought ‘How do I know this airport? I’ve never been here before. You realize that you’ve been an agent for a user in an airport. You are like, ‘Oh, I’ve been in this terminal, but I haven’t \u003cem>been in this terminal\u003c/em>.’ It’s very déjà vu.'\u003ccite>Amy Bernal, Aira’s vice president of customer experience\u003c/cite>\u003c/aside>\n\u003cp>The next phase of Aira’s development will be to turn some tasks over to a machine. At first, Bernal says, the AI will likely assist the agent. Later, it might guide people through routine tasks, like daily commutes. Or it might replace agents in sensitive situations, while users are in restrooms or dealing with finances, for instance. (Currently, users can go into “privacy mode” with no video or audio, or hang up and call back.)\u003c/p>\n\u003cp>Hingson imagines sending a shopping list to Aira, and having the AI map his path through the store and check barcodes to confirm that he's grabbed the right items. He’d also like Aira integration with Facebook, so the system could use facial recognition to let him know if his friends are nearby.\u003c/p>\n\u003cp>For now, employees like Bernal are happy to assist with just about everything, although she notes that there’s one oddly sci-fi effect of seeing the world through someone else’s lenses.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I’ve had this experience where I’ve actually gone to an airport and thought ‘How do I know this airport? I’ve never been here before,’ ” she says. “But you realize that you’ve been an agent for a user in an airport. You are like, ‘Oh, I’ve been in this terminal, but I haven’t \u003cem>been in this terminal\u003c/em>.’ It’s very déjà vu.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/418097/google-glass-feed-connects-the-blind-with-remote-human-guides","authors":["byline_futureofyou_418097"],"categories":["futureofyou_452","futureofyou_1062","futureofyou_1","futureofyou_73"],"tags":["futureofyou_1130","futureofyou_1275","futureofyou_226"],"featImg":"futureofyou_424272","label":"source_futureofyou_418097"},"news_11554109":{"type":"posts","id":"news_11554109","meta":{"index":"posts_1591205157","site":"news","id":"11554109","score":null,"sort":[1499465917000]},"guestAuthors":[],"slug":"gop-senate-leader-wont-get-votes-for-health-care-bill-sen-feinstein","title":"GOP Senate Leader Won't Get Votes for Health Care Bill: Sen. Feinstein","publishDate":1499465917,"format":"standard","headTitle":"The California Report | KQED News","labelTerm":{"term":72,"site":"news"},"content":"\u003cp>Sen. Dianne Feinstein said Friday that she thinks the Democrats have the votes to permanently stop the Republican health care bill in the Senate, noting \"we're very close to defeating it.\"\u003c/p>\n\u003cp>The Republicans can stand to lose only two votes from their own party, and nine Republicans signaled their opposition before leaving Washington for the July 4 recess.\u003c/p>\n\u003cp>Feinstein expressed her vote of confidence in front of doctors, nurses and other health care staff at UCSF Benioff Children’s Hospital in San Francisco.\u003c/p>\n\u003cp>“We're very close to defeating it. We're very close. Mitch McConnell, the leader, hasn’t brought it to the floor,” she said. “My sense is he won’t until he has the votes, and my sense is that he’s not going to have the votes.”\u003c/p>\n\u003cp>Feinstein said the Congressional Budget Office’s estimate that 22 million Americans would lose their insurance under the bill ensures it will never pass.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The bill would roll back Obamacare taxes that help pay for Medicaid, resulting in huge cuts to the program -- something Feinstein has called immoral.\u003c/p>\n\u003cp>“How very sad,” she said. “I know not one person that would ever want a tax cut based on the health of a child or the health of an adult.”\u003c/p>\n\u003cp>Supporters of the bill note that the CBO report found the tax cuts would allow a federal deficit reduction of more than $320 billion over the next decade.\u003c/p>\n\u003cp>Feinstein urged the hospital staff to call Republicans and ask them not to support the bill.\u003c/p>\n\u003cp>UCSF Benioff Children’s Hospital will be heavily affected by the proposed cuts: About 70 percent of their patients are covered by Medi-Cal, California’s Medicaid program at its Oakland campus, that number stands at 50 percent at the San Francisco location.\u003c/p>\n\u003cp>“Medicaid is the Medicare program for the working people in this country,” said Mark Laret, CEO of UCSF Health. “There is no better investment that our nation can make than in its people.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Members of Congress head back to work on Monday.\u003c/p>\n\n","blocks":[],"excerpt":"The bill would roll back Obamacare taxes that help pay for Medicaid, resulting in huge cuts to the program — something Feinstein has called immoral.","status":"publish","parent":0,"modified":1499471834,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":14,"wordCount":361},"headData":{"title":"GOP Senate Leader Won't Get Votes for Health Care Bill: Sen. Feinstein | KQED","description":"The bill would roll back Obamacare taxes that help pay for Medicaid, resulting in huge cuts to the program — something Feinstein has called immoral.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"11554109 https://ww2.kqed.org/news/?p=11554109","disqusUrl":"https://ww2.kqed.org/news/2017/07/07/gop-senate-leader-wont-get-votes-for-health-care-bill-sen-feinstein/","disqusTitle":"GOP Senate Leader Won't Get Votes for Health Care Bill: Sen. Feinstein","path":"/news/11554109/gop-senate-leader-wont-get-votes-for-health-care-bill-sen-feinstein","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Sen. Dianne Feinstein said Friday that she thinks the Democrats have the votes to permanently stop the Republican health care bill in the Senate, noting \"we're very close to defeating it.\"\u003c/p>\n\u003cp>The Republicans can stand to lose only two votes from their own party, and nine Republicans signaled their opposition before leaving Washington for the July 4 recess.\u003c/p>\n\u003cp>Feinstein expressed her vote of confidence in front of doctors, nurses and other health care staff at UCSF Benioff Children’s Hospital in San Francisco.\u003c/p>\n\u003cp>“We're very close to defeating it. We're very close. Mitch McConnell, the leader, hasn’t brought it to the floor,” she said. “My sense is he won’t until he has the votes, and my sense is that he’s not going to have the votes.”\u003c/p>\n\u003cp>Feinstein said the Congressional Budget Office’s estimate that 22 million Americans would lose their insurance under the bill ensures it will never pass.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The bill would roll back Obamacare taxes that help pay for Medicaid, resulting in huge cuts to the program -- something Feinstein has called immoral.\u003c/p>\n\u003cp>“How very sad,” she said. “I know not one person that would ever want a tax cut based on the health of a child or the health of an adult.”\u003c/p>\n\u003cp>Supporters of the bill note that the CBO report found the tax cuts would allow a federal deficit reduction of more than $320 billion over the next decade.\u003c/p>\n\u003cp>Feinstein urged the hospital staff to call Republicans and ask them not to support the bill.\u003c/p>\n\u003cp>UCSF Benioff Children’s Hospital will be heavily affected by the proposed cuts: About 70 percent of their patients are covered by Medi-Cal, California’s Medicaid program at its Oakland campus, that number stands at 50 percent at the San Francisco location.\u003c/p>\n\u003cp>“Medicaid is the Medicare program for the working people in this country,” said Mark Laret, CEO of UCSF Health. “There is no better investment that our nation can make than in its people.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Members of Congress head back to work on Monday.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11554109/gop-senate-leader-wont-get-votes-for-health-care-bill-sen-feinstein","authors":["11216"],"programs":["news_6944","news_72"],"categories":["news_457","news_8","news_13"],"tags":["news_274"],"featImg":"news_11554196","label":"news_72"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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