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We are seeking qualified candidates for the following open positions based in Washington DC:
The Tribal Employment and Jobs Protection Act (H.R. 3080) was considered in a Full Committee Markup of the U.S. House of Representatives House Ways and Means Committee:
H.R. 3080 was reported favorably by the Committee on a vote of 24 (yes) - 13 (no)
This legislation, introduced by Representative Kristi Noem (R-SD), seeks to exempt Tribes and Tribal employers from the employer mandate under the Patient Protection and Affordable Care Act (ACA). It would prevent fines that Tribal employers would incur under the employer mandate and ensure that the U.S. federal government lives up to its trust responsibility to federally recognized Tribes.
As the House Ways and Means Committee Chairman Kevin Brady (R-TX) said today in his opening statement, "Congresswoman Noem's legislation brings relief from Obamacare's employer mandate to Tribally owned businesses...by advancing these bills today, we can demonstrate that we are serious about addressing major challenges in child welfare and health care."
The legislation will now move to be considered by the full House of Representatives. NIHB will continue to monitor and provide updates on this important legislation. If you have questions or feedback regarding this issue, please contact Mr. Devin Delrow, NIHB Director of Federal Relations, at (202)-507-4070 or [email protected].
Yesterday, the Indian Health Service (IHS) released a Dear Tribal Leader Letter to provide an update on the proposed rule for the Catastrophic Health Emergency Fund (CHEF). Several Tribes and Tribal Organizations, including the National Indian Health Board (NIHB), submitted comments and expressed concerns about the provisions and requested Tribal consultation before finalizing the rule. In response, IHS is listening to Tribes and will not move forward with the proposed rule until Tribal consultation has taken place, which will include two telephone consultation sessions and an in-person consultation session at the National Congress of American Indians (NCAI) Convention scheduled for October 9-14, in Phoenix, Arizona...
Today the Indian Health Service (IHS) released a Dear Tribal Leader letter requesting Tribal Consultation on a draft policy statement detailing the planned national expansion of the Community Health Aide Program (CHAP, including the creation of a national certification board.
The national expansion of the CHAP would mean an increase in paraprofessionals and workers providing services for health education, communicable disease control, maternal and child health, dental health, behavioral health, family planning, and environmental health. Community health aide is an encompassing term that includes behavioral health aides, nursing aides, and dental health aides. Many Tribal communities are likely familiar with a community health aide program already in place: the IHS Community Health Representative (CHR) program. The CHR deploys trained and medically guided health care workers that provide medical services, including health education, case management, patient transport, and patient advocacy.
Tribal communities in Alaska also benefit from the Dental Health Aide Therapist (DHAT) program, which brings dental education and routine dental services to rural Alaska Native communities. DHATs provide dental services to 40,000 Alaska Native people since 2004. Many rural Alaskan Native villages also have Community Health Aides (CHA). CHAs serve as a primary provider for many individuals, providing emergency first aid, patient examinations and follow-ups in conjunction with the treating physician, and carrying out treatment recommendations, education and instruction, and conducting preventive health programs. Behavioral Health Aides (BHA) work within Tribal communities to address behavioral health needs, including substance abuse and mental health problems. BHAs address these needs by serving as counselors, health educators, and advocates.
With a low access to care in many Tribal communities and tremendous success in existing programs, the Indian Health Service is committed to expanding the Community Health Aide Program. In the draft policy statement Mary Smith, Principal Deputy Director of the IHS, states, "Not only do CHAPs contribute to the overall health care team, but the additional advanced training they receive often leads to improved health and quality of life for the communities they serve. CHAPs are proven partners in health, and the IHS is committed to seeing them expand outside of the State of Alaska."
In the coming weeks, NIHB will be reaching out to Tribes and Tribal organizations for their input on what they would like to see in the policy. Based on this input, NIHB will create a template comment and briefing memo for Tribes to use in submitting their own comments. If you would like a copy of these materials or more information, please contact NIHB's Director of Federal Relations, Devin Delrow at 202-507-4072 or [email protected].
Comments are due to IHS on Friday, July 29, 2016.
Comments may be submitted to [email protected], with the subject IHS Expansion of Community Health Aide Program Draft Policy Statement Consultation.
Mail your comments to:
Alec Thundercloud, M.D.
Director, Office of Clinical and Preventive Service
Indian Health Service
5600 Fishers Lane Mail Stop: 08N34-A
Rockville, MD 20857
ATTN: IHS Expansion of Community Health Aide Program Draft Policy Statement Consultation
While you may be tempted to forget all about your taxes and your premium tax credit once you've filed your tax return, don't give in to that temptation.
When you applied for assistance to help pay the premiums for 2016 health coverage through the Marketplace, the Marketplace estimated the amount of your premium tax credit. Advance payments are based on an estimate of the premium tax credit that you will claim on your federal income tax return. You may be receiving the benefit of monthly advance payments to lower what you pay out-of-pocket for your monthly premiums. Doing a PTC check-up now will help you avoid large differences between the advance credit payments made on your behalf and the amount of the premium tax credit you are allowed when you file your tax return next year...
Dear Tribal Leaders, Tribal members and Advocates:
We encourage you to contact your Representatives to urge them to sign onto a letter requesting that Tribes be included in any supplemental funding for Zika virus mitigation. The closing date for the letter is Wednesday, May 11, 2016.
The incidence of the Zika virus is reaching high levels in certain areas close to the United States. The Zika virus is spread by the Aedes mosquito and has been found recently in areas of Central America, the Caribbean, and South America. Zika in pregnant women is thought to be associated with microcephaly in infants which is a sign that the baby is born with a smaller brain which can result in medical programs and impaired development. The Centers for Disease Control and Prevention (CDC) estimates that Zika inflected mosquitos could reach the lower part of the United States in 2016, and there are efforts underway to ensure that communities in the United States can accurately respond to the disease...
Date: Friday, May 13, 2016
Time: 3:00PM EDT
Call-In Number: 888-390-0682
Passcode: 6432
For more information on the ACA Employer Mandate or the Tribal consultation call with Treasury, please feel free to contact Devin Delrow, NIHB Director of Federal Relations at [email protected] or 202-507-4072.
The 2014 Report to Congress highlights the Special Diabetes Program for Indians (SDPI) ongoing and outstanding accomplishments in improving the quality of diabetes care and health outcomes for American Indian and Alaska Native (AI/AN) people. The report is published by the Indian Health Service and is available on the Division of Diabetes Treatment and Prevention website...
The Indian Health Service Principal Deputy Director issued a letter to Tribal leaders on April 11 to open a 60-day Tribal Consultation with Tribes and Tribal Organizations to consult on the IHS Contract Support Costs (CSC) Policy...
The incidence of the Zika virus reaching high levels in certain areas close to the United States. The Zika virus is spread by the Aedes mosquito and has been found recently in areas of Central America, the Caribbean, and South America. Zika in pregnant women is thought to be associated with microcephaly in infants which is a sign that the baby is born with a smaller brain which can result in medical programs and impaired development. CDC estimates that Zika inflected mosquitos could reach the lower part of the United States in 2016, and there are efforts underway to ensure that communities in the United States can accurately respond to the disease...
Last week, the Director of the Centers for Disease Control and Prevention (CDC), Dr. Thomas Frieden, appeared before the House Appropriations Subcommittee on Labor, Health and Human Services (HHS), Education, and Related Agencies. This subcommittee provides annual funding for most HHS agencies (besides the Indian Health Service).
During the hearing, Subcommittee Chairman Tom Cole (R-OK), asked Dr. Frieden what the CDC is doing to support issues on a wide range of public health issues in Indian Country such as suicide, motor vehicle accidents, cancer, HIV and others. Dr. Frieden noted that CDC is proposing in its FY 2017 budget to strengthen capacity through the Tribal Epidemiology Centers and hopes to build on traditional practices that are healthy. He also discussed ways that CDC can support families and communities. In response, Chairman Cole said that CDC often works "directly with state and local health departments, and quite often Tribes do seem left out of that equation by states. So having federal involvement to make sure there is some equity in those communities ... I think is very important."...
On Thursday, March 17, National Indian Health Board Secretary Lisa Elgin presented testimony to the House Appropriations Subcommittee on Interior, Environment and Related Agencies on the FY 2017 Indian Health Service Budget (IHS). The testimony was delivered as part of the subcommittee's American Indian and Alaska Native public witness hearings which heard testimony from over 70 representatives from across Indian Country.
Ms. Elgin delivered the recommendations of the Tribal Budget Formulation Workgroup for full funding of IHS at $30 billion, with a FY 2017 recommendation of $6.2 billion. She reiterated the Workgroup's top priorities of Purchased/Referred Care; Hospitals & Clinics; Alcohol & Substance Abuse Services; Mental Health; and Dental Services...
On Friday, March 18, 2016, the Indian Health Service (IHS) announced that it will be implementing a new regulation that gives IHS, Tribal, and Urban Indian health programs (I/T/Us) the ability to cap payment rates at a "Medicare-Like rate" to physician and other non-hospital providers and suppliers who provide services through the Purchase and Referred Care (PRC formally CHS) program. The final "Medicare-Like rate" rule can be accessed here.
The new rule says that I/T/Us can negotiate with certain Indian health care providers, who provide services through Purchased and Referred Care (PRC), for payment at Medicare-like rates. This is good news because for years, IHS and Tribal healthcare programs paid higher payment rates than private health insurers and other Federal programs, such as Medicare and the Veterans Health Administration. The proposed rule is an opt-in and not a requirement, which gives I/Ts more flexibility. This is in recognition of Tribal sovereignty and self-determination as Tribes have the right to negotiate with providers and determine how best to meet the needs of their community when providing health care. This flexibility means that in some individual cases, it is better for I/Ts to be able to negotiate higher rates than what Medicare provides. However the ability to negotiate higher rates for Tribally-operated facilities must be a reasonable pricing arrangement and in the best interest of the I/T.
IHS recognizes that this rule will have significant Tribal implications so in order to ensure that all concerns are taken into account, it will be implemented as a final rule with another 60 days for the public to provide comment on the rule. In addition, IHS will be conducting outreach and education to PRC administrators and participating providers and suppliers. NIHB will be discussing the new rule during its next Medicare, Medicaid, and Health Care Reform Policy Committee (MMPC) Monthly Call this upcoming Wednesday, March 23, 2016 at 2 PM EST. We encourage you to attend and participate.
For more information or if you have any questions, please feel free to reach out to NIHB's Director of Federal Relations, Devin Delrow at [email protected].
WASHINGTON, DC - On Tuesday, March 8, 2016, the National Indian Health Board (NIHB) was pleased to sponsor the participation of Wiyaka Little Spotted Horse in a Congressional Briefing on Native Children's Mental Health. The briefing was hosted by the American Academy of Pediatrics and co-hosted by NIHB, the American Academy of Child and Adolescent Psychiatry; the Center for Native American Youth; and the School-Based Health Alliance...
On February 26, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a letter to states and Tribes providing guidance about an update to CMS policy regarding the circumstances in which 100 percent federal funding would be available for services furnished to Medicaid-eligible American Indians and Alaska Natives (AI/AN) through facilities operated by the Indian Health Service (IHS) or Tribes under the Indian Self-Determination and Education Assistance Act, P.L. 93-638. Through this letter, CMS is re-interpreting its payment policy with respect to services "received through" an IHS/Tribal facility, and is expanding the scope and nature of services that qualify for this matching rate. CMS will be holding an All Tribes' Call to walk through the policy and provide time for questions and answers. NIHB will provide the call-in information as soon as it is available.
Dear State Health Official Letter (PDF)
On February 9, 2016, the President Released his FY 2017 Budget Request to Congress. This yearly process kicks off the annual budget process in Congress. Republican leaders in Congress have noted that this proposal will be considered "dead on arrival," as they consider many of the proposals contained in the budget to be too progressive. However, funding for Tribal programs, and especially Tribal health, continue to garner bipartisan support in Congress and the National Indian Health Board (NIHB) will advocate that many of the important policy and funding proposals that are specifically targeted to benefit Indian Country will remain in the final FY 2017 enacted budget...
The Senate Committee on Indian Affairs (SCIA) held an oversight hearing yesterday on "Re-examining the Substandard Quality of Indian Health Care in the Great Plains." Immediately following the oversight hearing, SCIA held a listening session on "Putting Patients First: Addressing Indian Country's Critical Concerns Regarding the Indian Health Service (IHS)." During the oversight hearing, there were ten U.S. Senators in attendance. The oversight hearing consisted of three panels before the SCIA designed to address all of the issues that plague the Indian health care system.
NIHB attended this hearing and participated in the listening session, calling IHS to account, but also calling on Congress to enact solutions that will ensure meaningful changes for Indian health. You can read the whole statement of NIHB's Board of Directors Member, Charles Headdress here....
Washington, DC. In response to a health care delivery crisis among Tribes in the Great Plains, the National Indian Health Board's Board of Directors unanimously approved resolutions to investigate, evaluate and offer reform strategies to the Indian Health Service (IHS). This move came in response to the reports by Members of the Omaha, Winnebago and Rosebud Sioux Tribe Tribal Councils attending the Board meeting, held January 20 and 21, 2016.
These tragedies include the preventable deaths of at least five Tribal members under the care of trained medical professionals at the IHS-operated hospitals in the Great Plains Area. The Centers for Medicare & Medicaid Services (CMS) rescinded its accreditation of the Winnebago-Omaha IHS hospital in July 2015, limiting the chronically under-funded hospital's ability to bill for essential services. In November 2015, CMS notified the IHS that they would rescind the Rosebud Indian Hospital's CMS accreditation, because they determined the hospital was not in compliance with regulatory requirements, and patient care was being severely impeded. IHS since submitted a satisfactory corrective Action Plan for the Rosebud Hospital, but the emergency room remains closed. Reports from across Indian Country confirm that poor quality of care at IHS facilities that prompted these CMS findings is not limited to the Great Plains Area. Several at the board meeting also shared their stories of how IHS care has negatively impacted them or their loved ones...
THE year I started legislative efforts to bring basic dental-care services to native communities, more than 1,800 Indian children were born in Washington state.
That was 2006. Ten years later, the data show us that at least 75 percent of these children already will have experienced tooth decay and many more have experienced pain or had infections.
Generations of native children before have faced the same barriers to oral health care. For too many, their introduction to oral hygiene was waiting in line to have teeth pulled if a dentist happened to be visiting the reservation...
The Senate Committee on Indian Affairs will hold a hearing titled: "Reexamining the Substandard Quality of Indian Health Care in the Great Plains." Due to blizzard conditions in Washington, DC the hearing has been postponed to Wednesday, February 3, 2016 at 2:15PM EST...
The Daily Signal
Native American tribes are pushing back against a provision of Obamacare mandating that tribal governments provide health insurance to their employees. Tribal leaders say it's a "misinterpretation" of the law that will cost millions of dollars.
When Congress passed the Affordable Care Act in 2009, lawmakers exempted Native Americans from the individual mandate, shielding them from having to pay a fine for not having insurance. Native Americans could, however, purchase health insurance on the federal exchange, HealthCare.gov, and have access to substantial tax credits, driving down the cost of their plans...
Read full article at dailysignal.com
CMS has released an Essential Community Provider (ECP) Petition to collect more complete data from providers who qualify as an ECP and wish to appear on CMS's ECP list for the 2017 benefit year.
Indian health care providers (IHCPs) need to take action by 11:59 p.m. ET on January 8, 2016, to revise an existing entry or obtain placement on the list of ECPs maintained by the federal Department of Health and Human Services (HHS ECP List) for benefit year 2017.
The ECP petition form is a web-based questionnaire that is available here. Please note if you are on the 2016 benefit year ECP list you still must update your information for the 2017 benefit year.
Qualified Health Plan (QHP) Issuers are required to include within their network, Essential Community Providers (ECPs) that serve their community members. Under the Affordable Care Act (ACA), QHP issuers are required to contract with at least 30 percent of the available ECPs in their service area.
Dental health for the poor is a big problem in Washington state. Some see dental therapists — licensed professionals who can perform simple procedures — as a route to less expensive care. But the powerful state dentists association has thwarted efforts to allow the therapists...
SWINOMISH, Washington – Leading the effort to address the oral health crisis in Indian Country, the Swinomish Indian Tribal Community on Monday became the first tribe in the Lower 48 states to employ a dental therapist to provide basic oral health services.
There are too few dentists in Indian Country," said Brian Cladoosby, Chairman of the Swinomish Indian Tribal Community. "We cannot stand by any longer and allow Native people to continue to suffer tooth decay at a rate three times the national average. We have developed a tribal approach to solve a tribal issue. This solution will help our people immediately address their oral health needs in ways that have not been possible until today."
On December 16, 2015, the House and Senate Appropriations Committees unveiled their final FY 2016 spending bill (H.R. 2029). The bipartisan agreement is expected to pass Congress by the weekend in order to avoid a government shutdown. The large spending bill will provide $1.15 trillion in discretionary appropriations to keep the federal government funded through September 30, 2016. This legislation contains annual discretionary appropriations for the Indian Health Service (IHS), Bureau of Indian Affairs (BIA) and the Bureau of Indian Education (BIE) and other federal programs at the Department of Health and Human Services (HHS) for Indian Health. Many of the health-related programs are unfortunately flat-funded or have nominal increases for FY 2016...
WASHINGTON, DC - On November 18, 2015, the Congressional Public Health Caucus and the Coalition for Health Funding organized a briefing entitled "Public Health 101- Opportunity Lost: Struggles to Meet Health Demands in an Era of Austerity." The National Indian Health Board (NIHB) was also a co-host of this event. During the briefing, panelists discussed how federal funding cuts have impacted health outcomes across the country. Among the panelists was Lisa Pivec, Senior Director of Public Health at the Cherokee Nation, who highlighted public health needs in Indian Country. NIHB was pleased to sponsor her participation in this event. Other panelists included Sandy Eskin, Pew Charitable Trusts; Jessica Hayes, Illinois Alcohol and Other Drug Abuse Professional Certification Association; Dr. Clarence Lam, The Johns Hopkins Bloomberg School of Public Health; and Dr. Benjamin Margolis, University of Michigan Medical School...
The National Indian Health Board (NIHB) will participate in several events this week in recognition of the Native American Affordable Care Act (ACA) week of Action. This week all American Indians and Alaska Natives (AI/ANs) are encouraged to learn more about the health insurance options available under the Affordable Care Act. Many IHS, Tribal and urban Indian clinics will also be hosting outreach, education and enrollment events. Make sure to tell your family, friends and community members about the Affordable Care Act so that everyone is afforded the opportunity to improve their health...
On Friday, November 12, the National Indian Health Board, Northwest Portland Area Health Board, Affiliated Tribes of Northwest Indians and the National Congress of American Indians sent a letter to the American Dental Association (ADA) in response to a recent blog post by the Washington State Dental Association (WSDA). A few weeks ago, WSDA added a post to their website that that took aim at the Swinomish Dental Health Aide Therapist (DHAT) project and generally at Indian Country's ability to act as sovereign nations with respect to providers on Tribal lands.
The WSDA post claimed that Tribes do not know how to access the dental industry and assumed that dental care provided by a DHAT is not of a highest standard. The Tribal organization letter disputed these claims by noting that, "Tribes will not accept anything less than a single, high standard of care for our citizens." The letter also emphasized the strong track record of DHATs in the United States and elsewhere around the world. You can view the whole letter and the original blog post here.
Please join Secretary Sylvia Burwell from the U.S. Department of Health and Human Services and Raina Thiele from the White House Office of Intergovernmental Affairs for a discussion on Affordable Care Act outreach and education in Indian Country. There will also be sharing from tribal and urban Indian communities on successful outreach and enrollment events across the country.
We anticipate time for questions about best practices to enroll your community in Insurance options.
DATE: November, 16 2015
Call: 888-945-5896
On November 18, 2015, Congressional Public Health Caucus will sponsor a Congressional Briefing entitled "Public Health 101: Opportunity Lost: Struggles to Meet Health Demands in an Era of Austerity." The National Indian Health Board is a Co-Host of the briefing, along with other partner organizations including the Coalition for Health Funding.
The event will feature five panelists including Lisa Pivec the, Senior Director of Public Health at the Cherokee Nation. Ms. Pivec will discuss the role of public health in Indian Country and unique challenges that Tribes experience as they navigate jurisdictional competition and strive to find resources for public health programs.
When: November 18, 2015, 12:00PM- 1:30PM EST
Where: 2168 Rayburn House Office Building
RSVP: [email protected]
(Lunch will be provided)
For more information on the briefing click here.
The week of November 9th is Women's Week of Action.
November is American Diabetes Month! In an effort to raise awareness of this disease and its negative impacts on Indian Country the National Indian Health Board will be sharing Local Impact Stories and Diabetes Prevention Resources throughout the month to highlight the successes of one of the most comprehensive and effective diabetes treatment and prevention program in the U.S. - the Special Diabetes Program for Indians. Today, we release three (3) new stories on the "Diabetes in Indian Country" website and a digital story created by Native youth on her experience with Type 1 diabetes:
On Monday, November 2, President Obama signed the Bipartisan Budget Act of 2015 into law. As NIHB reported last week, the deal would add an extra $80 billion to the federal discretionary budget in FYs 2016-2017. In FY 2016, non-defense discretionary spending (the funding that Congress appropriates every year) will see a $25 million increase beyond what is originally established.
Work now moves to the House and Senate Appropriations Committees to craft a final appropriation for FY 2016. Congress must pass FY 2016 by December 11 when the current continuing resolution funding the government expires. IHS currently has $4.8 billion in both House and Senate draft Appropriations bills. Also contained in the draft appropriations bills is important language for Tribal behavioral health, Tribal Epidemiology Centers and Definition of Indian in the Affordable Care Act.
If you have any questions on the Bipartisan Budget Act or FY 2016 appropriations, please contact NIHB's Director of Congressional Relations, Caitrin Shuy, at [email protected] or (202) 507-4085.
Please join representatives from the Department of Health and Human Services (HHS) and the Indian Health Service (IHS) for an Open Enrollment Kick-Off Call. The Open Enrollment period for the Health Insurance Marketplace begins November 1, 2015 and ends January 31, 2016. Please join Mr. McSwain, Principal Deputy Director, IHS, Mary Smith, Deputy Director, IHS, and Geoffrey Roth, External Affairs, Office of Intergovernmental and External Affairs, HHS, for a call to discuss important topics related to Open Enrollment and the Affordable Care Act for American Indians and Alaska Natives.
When: Monday, November 2nd at 12:00pm ET
Call In: 1-800-369-1837
Participant passcode: 7616818
For additional information about the Affordable Care Act and AI/AN please visit: www.healthcare.gov/tribal or www.ihs.gov/aca
A new report detailing affordability and plan choice in the Health Insurance Marketplace finds that with applicable tax credits, more than 7 in 10 current Marketplace enrollees could find plans for $75 a month in premiums or less, and almost 8 in 10 could find plans for $100 a month in premiums or less.
Consumers who return to the Marketplace to comparison shop could save money. According to today's report, more than 8 in 10 returning Marketplace consumers could save an average of about $50 per month and $610 annually in premiums before tax credits for the same level of coverage by returning to shop. If all consumers switched from their current plan to the lowest-cost premium plan in the same metal level, the total savings - to consumers and taxpayers (in premiums and tax credits) - would be $4.5 billion. In 2015, about one-third of consumers who reenrolled in a Marketplace plan switched to a new plan.
In addition, nearly 9 out of 10 returning consumers will be able to choose from 3 or more issuers for 2016 coverage. And on average, consumers can choose from plans sold by 5 issuers for 2016 coverage, just as they could for 2015 coverage. Previous research shows that price competition typically intensifying with three or more competitors in a market.
Read the full press release here.
The report can be found here.
Questions or Concerns? Contact [email protected].
Health and Human Services Secretary Sylvia M. Burwell announced today that more than $2.2 billion in Ryan White HIV/AIDS Program grants was awarded in fiscal year (FY) 2015 to cities, states and local community-based organizations. This funding supports a coordinated and comprehensive system of care to ensure that more than half a million people living with and affected by HIV in the United States continue to have access to critical HIV health care, support services, and essential medications...
The Prevention and Public Health Fund (PPHF) is a program of the Centers for Disease Control and Prevention. Although, it has been funding important public health activities in Indian Country, it is often targeted for elimination by some in Congress. NIHB helped provide background and information to some members of the Senate and make sure that they were aware how important this funding stream is to Indian Country, The Senate Democratic Caucus recently released a letter that was signed by nine senators that details the importance of the Public Health Prevention Fund (PPHF) to Indian Country.
Click here to read the letter.
U.S. Health and Human Services (HHS) Secretary Sylvia M. Burwell announced today that she expects 10 million individuals to be enrolled in coverage through the Health Insurance Marketplaces and paying their premiums – so-called effectuated coverage – at the close of 2016. As part of that goal, HHS believes more than 1 out of every 4 uninsured Marketplace-eligible consumers will select plans during Open Enrollment.
Today, the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) released a demographic analysis of the uninsured individuals who are likely eligible for Marketplace coverage, along with its methodology for estimating the number of individuals it expects to have effectuated Marketplace coverage at the end of 2016. According to the reports, nearly 8 in 10 of the approximately 10.5 million uninsured individuals likely to be eligible for qualified health plans (or the "QHP-eligible uninsured") may be eligible for financial help through the Marketplaces...
Health and Human Services (HHS) Secretary Sylvia Burwell today announced more than $240 million – including about $176 million in Affordable Care Act funding – to support the National Health Service Corps (NHSC) and NURSE Corps scholarship and loan repayment programs to increase access to primary health care in the communities that need it most.
"The most critical step in connecting people to quality health care is a primary care provider," said Secretary Burwell. "These awards provide financial support directly to health professionals, including physicians, registered nurses, and physician assistants, to help individuals -- particularly the 17.6 million uninsured who have recently gained coverage -- find the primary care services they need."...
With the surprise resignation of House Speaker John Boehner (R-OH) last week, it is expected that Congress will pass a short-term funding measure, known as a "continuing resolution" or "CR," to keep the federal government funded until December 11, 2015. Many conservative Members of Congress have argued for the stopgap measure to exclude funding for Planned Parenthood after a series of videos was released that allegedly show the organization illegally profiting from the sale of tissue from aborted fetuses. However, as of the time of this writing, it looks like efforts to derail the funding measure over the issue will not be successful. Congress is expected to clear the CR sometime on Wednesday, September 30, just hours before the end of the fiscal year.
If Congress does pass the CR, Congress must finalize the rest of FY 2016 appropriations by December 11. Many in Congress, on both sides of the aisle, are calling for a compromise that can raise the "caps" on spending set forth in the Budget Control Act of 2011. Without an agreement on higher spending levels, there could be the risk of devastating across-the-board sequestration cuts. Legislation has been introduced in both the House and the Senate to exempt Tribes from sequestration. You can click here to learn more about these bills.
In less than 24 hours, Valerie Davidson has 50 people coming to her house for dinner.
She had planned to catch and cook enough salmon for the main course. But early in the morning, Alaska opened the Kuskokwim River to commercial fishing, which means subsistence fishermen like her can't fish on it.
So Davidson and I are in her bright orange 1983 Chevy pickup stalking the "free fish" container where state biologists deposit their test catches after conducting studies after each high tide.
We have been here for an hour, but Davidson is patient and persistent. It's the same approach she used as Alaska's health and social services commissioner while working to expand Medicaid in the state...
On Thursday, July 9, the White House hosted the first White House Tribal Youth Gathering for over 1,000 Native Youth representing 230 Tribes from 42 states. Native youth leaders from across Indian Country engaged Cabinet officials, non-federal partners and an audience favorite - First Lady Michelle Obama. The First Lady assured everyone of the Administration's faith in today's Native youth by saying, "I know that you may have moments in your lives when you're filled with doubts, or you feel weighed down by history or stifled by your circumstances - every single one of your lives is precious and sacred, and each of you was put on this earth for a reason... you definitely have a President and a First Lady who have your back."
The Great Lakes Inter-Tribal Epidemiology Center (GLITEC), a program of Great Lakes Inter-Tribal Council, Inc. (GLITC), is pleased to announce that Kara Schurman has been selected as the Director of the Midwest Area Tribal Health Board (MATHB). Though the new area wide Health Board was launched through the efforts of the Midwest Alliance of Sovereign Tribes (MAST) about two years ago, a Health Board Director and administrative home was needed. Bemidji Area Tribal leaders have long recognized that other Indian Health Service Areas across the country have benefitted from their Health Boards in numerous ways to address long standing health issues...
Today, the Swinomish Indian Tribal Community announced steps it will be taking to bring an innovative mid-level dental provider model to its Nation.
National Indian Health Board Executive Director Stacy Bohlen applauded the Tribe's actions and shared, "Indian Country suffers from a severe shortage of dental care providers with many Tribal citizens going without regular and preventive care. Given these barriers to access, it is no surprise that American Indian and Alaska Native communities experience higher rates of disease than many segments of the general population. Today, Swinomish Indian Tribal Community took action to address the situation. We congratulate them on these steps, and we congratulate their Tribal citizens on what promises to be better oral health for all."
On June 29, 2015, the Acting Director of the Indian Health Service (IHS), Mr. Robert McSwain, issued a Dear Tribal Leader Letter (DTLL) and an Urban Indian Organization Leader Letter (UIOLL) regarding the Special Diabetes Program for Indians (SDPI) FY 2016 funding distribution and formula.
SDPI is now entering its 19th year of providing diabetes treatment and prevention to hundreds of programs across Indian Country. After conducting a nationwide Tribal Consultation period March 19-April 20, 2015, and meeting with the Tribal Leaders Diabetes Committee (TLDC) in May, the IHS Acting Director has made the following decisions for SDPI FY 2016...
On Wednesday, June 24, 2015, the Senate Committee on Indian Affairs held a hearing entitled "Demanding an End to Native Youth Suicides." The Committee was seeking information and answers on how Congress might be able to act in order to end the prevalence of youth suicide in Indian Country. During this hearing, the Committee heard from representatives from Indian Country and the Indian Health Service (IHS). The witnesses included: Acting Director for the Indian Health Service (IHS) Robert McSwain, Oglala Sioux Tribe Councilman Collins "C.J." Clifford, Red Lake Band of Chippewa Indians Chairman Darrell G. Seki, Sr., and Stanford Professor Dr. Teresa D. LaFromboise. The National Indian Health Board also submitted testimony...
Acting Indian Health Service Director Robert McSwain writes to Tribes to provide an update on how the IHS will move forward with Methamphetamine and Suicide Prevention Initiative (MSPI) and the Domestic Violence Prevention Initiative (DVPI) programs over the next five years.
Read Dear Tribal Leader Letter (PDF)
CDC's latest addition to its Public Health Practice Stories from the Field describes how pharmacists on the Yakama Nation Reservation in Washington are helping improve the health of patients with diabetes. The pharmacists help patients manage their diabetes and stay current on lab tests and health checks, thus easing the workload of overburdened primary care providers. Patients who are enrolled in the program are more than twice as likely to have their glucose, blood pressure, and cholesterol under control as nonenrolled patients. Read Pharmacists Help Improve Health of Yakama Indians Living with Diabetes to find out how Yakama achieved this success.
Public Health Practice Stories from the Field is a collection of stories showcasing success and innovation in public health practice by state, tribal, local, and territorial (STLT) health agencies. The stories are featured on the STLT Gateway, a web portal for STLT health professionals created by CDC's Office for State, Tribal, Local and Territorial Support. You might also be interested in these other stories promoting heart health: Clinic Takes Team Approach to Controlling Hypertension in Ellsworth, Wisconsin, Public Health and Primary Care Partner in South Carolina to Address Cardiovascular Health, Schenectady County Program Lowers Sodium in Menu Items for Seniors, and Sodium Reduction Campaign Encourages Healthy Choices Among Consumers.
WASHINGTON, DC--June 3, 2015--On May 29, 2015, the Alaska Native Tribal Health Consortium (ANTHC) Dental Health Aide Therapist (DHAT) Program was recognized with the Indian Health Service (IHS) Director's award for 2014 for its innovative public health and clinical strategies to provide quality dental care to Alaska Native communities.
The IHS Director's Award recognizes individuals or teams whose service significantly advances the Indian Health Service's mission and goals. The Dental Health Aide Therapist Program received an award for its "innovation, perseverance and leadership in improving access to safe and culturally competent dental care and addressing the significant oral health disparities across the Indian Health Service Areas."...
WASHINGTON, DC--June 3, 2015--On May 29, 2015, the Indian Health Service (IHS) Acting Director Robert McSwain presented long-time National Indian Health Board (NIHB) Board Member Andy Joseph, Jr. with the 2014 IHS Director's Special Recognition Award for his significant contributions and unwavering leadership to advancing the health agenda in Indian Country.
"I am deeply honored and grateful to receive this award from the Indian Health Service. Through my many years and work on the Northwest Portland Area Indian Health Board, and the National Indian Health Board, I have witnessed many struggles in Indian health but also many victories. The work that Tribal health professionals do across the country is needed to keep our Peoples healthy and strong, and I'm thankful that the work is recognized," said Mr. Joseph, who is in his fifth term on the Confederated Tribes of Colville Tribal Council representing the Nespelem District...
The National Indian Health Board (NIHB) and the Centers for Medicare and Medicaid Services' (CMS) Division of Tribal Affairs joined forces to create Affordable Care Act (ACA) educational materials specifically for the Native youth population. The materials, highlighting the Fast Five Facts that Native youth need to know about the ACA, include three Public Service Announcements (PSAs), a poster and brochure. All materials are available for immediate download at NIHB's Tribal Health Reform Resource Center website. Tribes, Tribal organizations, I/T/Us, and other ACA stakeholders are encouraged to use the materials in their communities to help educate and empower youth, so that they in turn, can share information about the ACA with their families.The Five Fast Facts that Native youth need to know about the Affordable Care Act are:
For more information, contact Francys Crevier, NIHB Tribal Health Care Reform Education and Outreach Program Coordinator, at 202-507-4082 or [email protected].
House Labor HHS Appropriations Subcommittee Holds Hearing on American Indian/Alaska Native Priorities
WASHINGTON DC - On April 23, 2015, the House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies held a Budget Hearing on Programs Serving Native Americans. This subcommittee is responsible for allocating annual funding for agencies of the Department of Health and Human Services (HHS) (with the exception of the Indian Health Service (IHS) which receives funding from the Interior and Environment Appropriations Subocmmittee) and the Departments of Education, Labor and related agencies. The hearing represented a historic opportunity for Tribal advocates to describe challenges that Indian Country faces when it comes to accessing federal programs at HHS and other federal agencies...
Last week, the Department of Health and Human Services (HHS) announced a funding opportunity for organizations and individuals to operate as Navigators in Federally-facilitated Marketplaces (FFMs), including State Partnership Marketplaces (SPMs). As they have done over the past two years, and as they are doing now, Navigators will assist consumers in various ways, including providing information about available coverage options through the Marketplace during open enrollment.
Navigators have been an important resource for the millions of Americans who enrolled in coverage over the past two years. This funding announcement ensures this important work will continue over the next three years in states with a FFM, including during Marketplace open enrollment periods. Applications are due on June 15, 2015. For more information about the grant opportunity click here.
Last night, the U.S. Senate passed a two (2) year renewal of the Special Diabetes Program for Indians (SDPI). The renewal was contained in a larger bill called: "H.R. 2 - The Medicare Access and CHIP Reauthorization Act of 2015." The measure was passed the Senate by a bipartisan vote of 92-8. This follows action by the U.S. House of Representatives on March 26, 2015, which also passed the legislation by a bipartisan vote. President Obama is expected to sign the legislation into law...
Projects to help long-term and behavioral health care providers
National Coordinator for Health Information Technology Karen B. DeSalvo, M.D., M.P.H., M.Sc., announced today the availability of $1 million in grant funds to support community projects for the Community Interoperability Health Information Exchange (HIE) Program. The funding will help support and enable the flow of health information at the community level, leading to better care and better health.
Read more about this announcement
|California Rural Indian Health Board
|Centene Corporation
|The Pew Children's Dental Campaign
The Centers for Medicare & Medicaid Services (CMS) recently announced a special enrollment period (SEP) for individuals and families who did not have health coverage in 2014 and are subject to the fee or "shared responsibility payment" when they file their 2014 taxes in states which use the Federally-facilitated Marketplaces (FFM). Between March 15th and April 30th, those individuals and families who were unaware or did not understand the implications of this new requirement, can enroll in 2015 health insurance coverage through the FFM.
Enrolled members of federal recognized Tribes, including shareholders of Alaska Native Claims Settlement Act (ANCSA) Corporations, are eligible for enrollment on a monthly basis and do not need to wait for the SEP. Others eligible for services from an Indian Health Care Provider (Indian Health Service (IHS), Tribal or Urban Indian program) can enroll in this SEP.
This year's tax season is the first time individuals and families will be asked to provide basic information regarding their health coverage on their tax returns. However, those individuals who are members of federally recognized Tribes and shareholders of ANCSA corporations, as well as those who are eligible for services through an Indian health care provider, including IHS, can receive an exemption for 2014. There are two ways to apply for an exemption: by submitting an application through the Health Insurance Marketplace or claiming an exemption on the 8965 Tax Form.
Failure to claim an exemption and not having health coverage in 2014 will result in a fee - $95 per adult or 1 percent of their income, whichever is greater - when they file their taxes this year. The fee increases to $325 per adult or 2% of income for 2015.
This morning, HHS Secretary Burwell announced that Acting IHS Director Yvette Roubideaux, MD, MPH, will immediately begin serving as Senior Advisor to Secretary Burwell on American Indians and Alaska Natives. Robert McSwain will serve as Acting Director of IHS, effective immediately. The move comes as a result of Appropriations Act rules limiting the time that a nominee may serve in an "Acting" position. The Administration will resubmit Dr. Roubideaux's nomination to serve as IHS Director.
To read the announcement from Secretary Burwell, CLICK HERE (PDF).
Tribal leaders took to Capitol Hill on February 3, 2015 to provide outreach and education to Congress on the Special Diabetes Program for Indians (SDPI). Over 15 individuals participated in visits to 9 Congressional offices. The group met with members of both the House of Representatives and the Senate and included representatives from Cowlitz Indian Tribe; Cow Creek Band of Umpqua Tribe of Indians; Navajo Nation; Sault Ste Marie Tribe of Chippewa Indians; Pueblo of Zuni; Astariwi Band of Pit River Indians; the Santa Ynez Band of Chumash Indians; and the Tohono O'Odham Nation.
SDPI will expire on September 30, 2015, unless Congress acts. The legislation that typically serves as the legislative vehicle for SDPI, the Sustainable Growth Rate Fix (aka the "Doc Fix"), which governs the rates physicians are paid by Medicare, expires on March 31 2015. It is still unclear if Congress will find a way to pay for the overall bill which is estimated to cost over $150 billion. If there needs to be another short-term patch for the Doc Fix Tribes are asking that SDPI be included in that reauthorization.
Please visit www.nihb.org/sdpi for more information on how you can be involved in SDPI renewal for 2015!


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Date: December 04 2012
Melbourne Heart has become the first Australian club to enter negotiations with David Beckham's US-based management team after holding a teleconference.
It is understood the club offered a deal worth about $1.5 million.
The Heart would contribute about $600,000 and the remainder topped up by a third party.
Beckham's previous salary with Los Angeles Galaxy was worth more than $3.8 million a season.
This material is subject to copyright and any unauthorised use, copying or mirroring is prohibited.
[ The Age | Text-only index]

subset: commoncrawl


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If criminals rule the streets, businesses will fail and residents will flee the city.
The Northwest Ohio Building & Construction Trades Council had its way with Toledo City Council and Mayor Paula Hicks-Hudson last week, and its executive secretary, Shaun Enright, again showed that he is the man to see at Government Center.
ProMedica's research, the first of its kind to be done in Toledo, could help unlock mysteries of the brain.
Symbols and metaphors matter. They telescope messages and values. Sometimes they embody visions. Animals can stand as powerful metaphors and symbols. Who would not like to be known as a "lion of a man?" Or even a "bear of a man?
The U.S. Supreme Court on Monday refused to let stand an egregious violation of a citizen's right to a fair trial. In a 7-1 ruling, the Supreme Court agreed with defense attorneys for Georgia death row inmate Timothy Tyrone Foster that
So what happened to Egypt Air Flight 804, which vanished with 66 passengers and crew members on board while approaching Alexandria on a flight from Paris? We still don't really know. A member of the team examining found body parts said they
The administration needs to clean house and bring in a professional management team.
Millions of dollars are raised in secret and spent to suppress the vote.
In the seven volumes of Harry Potter, J.K. Rowling told millions of readers a story about the power and triumph of love. Last week, addressing a PEN American Center gala, she issued a reminder about dealing with hatred. It was a reminder even a few
Robbery is threatening, felonious, and menacing behavior.


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Posts Tagged 'Inland Port'
Folks, when it comes to economic development, options in southern Arizona we are somewhat limited. Let's face it, we aren't in the running for the next Intel or Boeing. We probably aren't on the short list for a lot of jobs that require educated and skilled labor.
Why do you think TREO's predecessor, GTEC, did such a great job with low skilled, low paying call center jobs?
What happened to us you ask?
Leadership Failures
We are running out of options because the past generations of business and elected leaders failed to act. We are at this spot today because they failed to plan, failed to put aside self interests, failed to look beyond the next election cycle.
Transportation Failures
We missed the boat on our transportation system (we shot down the RTA 5 times). Phoenix passed their RTA program 20 years ahead of us and have been spending $300m per year on infrastructure.
Education Failures
We have an out of control TUSD school district that resists reforms and has major admin issues. Parents are flocking away from their product because they aren't a quality operation.
Too Many Service and Government Sector Employees
Southern Arizona has way to many service and government sector employees. We lack industries that make things, build and ship things (Raytheon is an exception but with 11,000 employees our of 1m population it's not enough). One service sector employee goes out and shops at another service sector business and the cycle continues. Add in the stress of maintaining a bloated government sector (our single largest employer class) and a couple construction booms and busts and you can see how it all happened.
Political Failures
The people elect candidates that promise greater perks and end up making promises they don't keep. The neighborhoods are given all the power to stop any type of progress or vision.
Environmental Opposition
Mining, which has been an income generator in Arizona for generations, faces opposition at every turn.
Killing The Golden Goose
Tourism is probably our only real sustainable industry that brings in FRESH money. What are we doing to our golden goose? We are taxing their industry right out of town. What are we doing with the increased bed taxes? How about a cool $900k in the form of a pass through to Tucson/Pima Arts Council.
Completely Ineffective Business Leadership
Go and check out the chart…
Now that I set the stage…… a potential game changer:
INLAND PORT! – check out Carli Brosseau's story in today's Tucson Citizen. HERE.
Key components of TREO's plan involve building an I-10 bypass, setting up a larger rail yard near Marana and improving infrastructure connecting Tucson to the seaport of Guaymas, Mexico.
The report also recommends the development of food processing plants because of the tons of Mexican agricultural products shipped daily through the city.
Most of the related development is anticipated along Valencia Road.
Smallhouse said the project is realistic despite the recession and should be the domain of business owners, not government.
The inland port is the low hanging fruit, the call centers of our generation.
We are in the right place at the right time to really change the course of Southern Arizona. This port concept could create high paying jobs. It will spin off small businesses and light manufacturing.
The port could truly be a game changer. I've studied it, met with TREO, done the background, met many of the players and I got to tell you it's one of the most exciting things I things our region has.
What's a little concerning is that when I speak to elected officials very few understand the full impact and need for immediate and sustained action to see this opportunity become a reality. Our business and elected leaders are busy with bus fares and rental taxes or park fees. Who's watching out for our future?
I tell you what, if we make this too complicated or put up too many road blocks the industry will find greener pastures.
A story came out today about a major $200 million investment in the port of San Luis – HERE. You've read in this blog that perhaps the one bright spot in our regions economic development future is creating an inland port. Long beach is over run, deep sea ports are being planned in Guaymas Mexico and Tucson is smack dab in the middle of what is being called the Cana-Mex logistics pipeline.
Other communities are jocking for their share. The pipeline could through mid Texas, New Mexico or head out of Yuma and bypass Tucson all together. If we can pull together a plan, roll out the welcome mat and let the world know we are serious we could enjoy warehouse jobs, light manufacturing facilities and thousands of mid level paying jobs that are much needed in our region.
For this opportunity to materialize we'll need to court the railroads, relieve traffic on the I-10 (which may include an I-10 bypass through environmentally sensitive areas). We'll need to fast track the building process for companies looking to set up light manufacturing. In short we'll have to show the world that we are ready for the chance to change our future. I for one don't want to be looking back in 10 years and see the opportunity passing us by….literally.
About San Luis HERE
From the Yuma Sun;With more than $200 million being invested in infrastructure improvements to the area, San Luis is beginning to shine with its potential as a logistical hub for the region, said Andrea Bereznak, border area project manager for the Greater Yuma Economic Development Corp.Those investments include construction of the new commercial San Luis 2 port of entry and area service highway, both of which are expected to be completed by next fall. Other projects include an Arizona Department of Transportation facility at the new port; the Gary Magrino Industrial Park, to be developed next to the new port; planned improvements to the existing San Luis 1 port of entry; and expansion of the city's existing industrial park."Congestion at the ports is such a huge issue," Bereznak said. "But there are only two new ports being built in the U.S. One is in Donna, Texas, and the other is San Luis 2, so there is a lot of excitement from companies doing international business."That includes U.S. companies that have been having goods assembled in Asia because of cheaper labor there, she said. With the rising cost of shipping the goods back to the United States, "it's making more sense to do the assembly work in Mexico," where the savings in transportation more than make up for the higher cost of labor there than in Asia.That will bring more jobs to both sides of the border, Bereznak said — jobs that are badly needed in San Luis, with its high unemployment rate. Yuma County had a seasonally adjusted unemployment rate of 19.8 percent in November 2008, the Arizona Department of Commerce reported, compared with 13.4 percent in November 2007.Another project with the potential to affect the San Luis area is the planned development of a port at Punta Colonet, Sonora, and a railroad to carry goods from the Mexican seaport to the United States, Bereznak said."That project could have an impact on the area, but it's unknown how much," she said. "It will depend on what route the rail takes."Bereznak also had praise for the "pro-business, pro-community attitude" of the San Luis City Council, calling it positive for the city's future."It's exciting to work there, with the confluence of elements that support growth and development."
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-Boyfriend asked me if he should cut his hair or grow it out. I was thinking about him with long hair (when he donated it in high school) recently and thought I wouldn't mind if he grew it out again. I think he's handsome all the time, so I don't know what to tell him! I love a fresh haircut, but I wouldn't mind playing with some ginger locks. I started cutting his hair at home a few months ago. It takes a while, but I'm getting better/faster at it, and it looks pretty good. I should get better shears if we're going to continue trimming at home.
-Okay, I think I can fairly blame the Vitex for this one. Boyfriend & I talked about babies & I've done the math/thinking. To be safe, we would need at least 3 months full rent, grocery, and utility payment saved up before having a baby, and I would probably need to sign up for short-term disability at the start of the year to have a few months at home. I'm nowhere near even one month for my portion of rent right now. My hormones don't care. SHUT UP, UTERUS, BABIES ARE NOT PRACTICAL RIGHT NOW. I try to tell myself, "We could make it work, if we had to," but we would have to ask to borrow money/ask for a lot of gifts from family and I'm not comfortable with that. Makes me feel like a child. Anyway, maybe I should back off to just one Vitex/day.
-I realized that even though I'm not saving $30/mo from dropping my FSA, I *am* saving $40 a month from only going to therapy biweekly. Every little bit helps.
*Edit* They're also very expensive and you won't want to take them out just anywhere because you think they're easily broken. They're also very loud and annoying to people who are not baby/model airplane lover. Wow, I think babies are just like RC airplanes.
Last edited by justyouraveragecavemen; 01-10-2013 at 10:48 AM.
If I just said LOL, I lied. Do or do not. There is no try.
Your analogy had me laughing. I think Boyfriend wants to be a SAHD, which I'm surprisingly okay with. I've gotten pretty used to working 5 days out of the week at this point. This, of course, means I'd need to be able to support us on my income alone, which could not happen at my current salary. At $40k, I think we could make it work, if he was also working, which means I need to be $40k+ if it's just going to be me. Ssiiigghh. Probably not getting there anytime soon as a Help Desk Specialist.
Hence why I'm looking into A+ and Network+ certification. Security+ would be good for gov't gigs, but first things first. I'm not good at exams.
Some thoughts on how expensive it is to spawn...
You can get away with spending nearly zero in the first two years. Honest. We got a cot and a crib, a pushchair, baby clothes, fabric nappies and some other bits (baby bath, bouncer...) from Freecycle. We got a top-of-the-range car seat from friends who had finished spawning, we didn't have a car, but it came in handy for when we visited my parents. We also got given a gently used moses basket. If you are breastfeeding and attachment parenting, there is no need to buy bottles/steriliser etc (this might not apply if bf is the primary carer as you'll need a breastpump - electric - and bottles) and baby/toddler does not need their own room. If you are doing baby-led weaning, there is no need to either make or buy slops for the little un (ours barely ate solids anyway). Everyone buys you clothes and - as they grow so fast - there are always stacks of nearly new clothes in thrift/charity/op shops. Ditto with toys.
However, after the two-year mark, things do start to get expensive. For example, even with a stay-at-home parent, at two and beyond, some form of childcare is a good idea: playschool, kinder etc or swimming lessons or kindergym - something to get them used to wider socialisation, which costs. Now, how expensive is more or less up to you. Also, clearly, if you want to have more than one child costs - bigger house, bigger car, schooling, shoes, for me airfares to visit the maternal side of the family - add up very quickly.
Since you and the bf are stellar planners, I would suggest factoring in this jump in costs at the two-year mark, but don't be put off from starting a family now if you can with a degree of certainty see that in a year or two your financial situation will improve.
My journal: http://www.marksdailyapple.com/forum/thread60211.html Into RPG table top games? Check out FateStorm and (in development) Vanguard! 3D printed miniatures for sci-fi RPGs.
Yeah, I thought about the initial costs & that wouldn't be bad. Right now we are not in a place that it would be possible. 9 months from now? Maybe, as long as Boyfriend's debts are in order, but by that time, he will be back in school, so neither of us would be available to care for a baby. We could not afford childcare. Until he's at least out of school, it's not a possibility at all. That gives me a year+ to get my health together, and then we can talk more about it. I tell myself this everyday so we don't go and do something foolish. I wish I could keep the sex drive, but lose the baby drive!
I am also hoping he'll be on board with my ideas on food & caring etc. Considering all my digestive issues, I don't think I'll have too hard of a time convincing him to feed the baby primal foods, as it is more likely to take on my digestive intolerances, but he might not like the prep required.
But again, I'm just being an absurd planner right now. No need to worry about this yet. I used to fear the future and now sometimes I think too far ahead. And I look forward to it .
Longer term, after we are married, we need to be sure of where we want to live & buy a house. Mortgage payments even for a 4br in our area, on a 30yr mortgage, would be cheaper than our current rent for a 2br apartment. Who knows what our job situation will be like in a few years.
It's a bit silly, but I'm starting to get used to thinking of us as engaged. It won't be a big transition for me to call him Fiancé, though I'm sure I'll have a shit-eating grin on my face (wtf is with that expression?) for a while when I say it. But when I talk to him about "after we get married," I get a little quiet & feel kind of shy & nervous about it. I don't know what that's about. I'm excited, but it's also a little scary. Nobody talks about the scary aspect of linking yourself to another person for (hopefully) the rest of your life all that much. I guess that means I'll get through my cold feet well before the wedding.
Just saying, the cost of living is a lot less in this part of the world.
If I just said LOL, I lied. Do or do not. There is no try.
How's the humidity?
You have your way. I have my way. As for the right way, the correct way, and the only way, it does not exist.
~Friedrich Nietzsche
And that's why I'm here eating HFLC Primal/Paleo.


text:
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and found 1 items
tammie, 04 September 2008 18:24
i was looking after two horses one a full QH gelding named hobbie he was western ridden by his owner as for the other it was a QH x TBcalled mole i named him mo he was a stunning lite bay gelding and he was going to be my payment of riding wenever id like in me helping the owner ...
04 September 2008 18:24
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Rapiscan Systems Named Winner of UK's 2011 EEF Future Manufacturing Award
February 09, 2012 Hawthorne, CA
Rapiscan Systems, the world's leading security screening provider, has today announced that the Rapiscan Systems Cargo and Vehicle Inspection division (CVI) has been announced as a the national winner of the Business Growth awards at the 2011 EEF Future Manufacturing Awards gala dinner event in London, UK, on 26th January 2012.
Rapiscan was announced as the North West regional winner of the award in November 2011 from an entry list of over 400 companies that entered this year's EEF awards. Throughout the judging process Rapiscan were able to demonstrate clear examples of continued business growth through export links, employee empowerment and knowledge transfer, whilst showcasing a broad CVI product portfolio, strong implementation of a business plan and extensive partnerships within the local community that has led to its success.
The EEF is the UK's manufacturing organisation, which is dedicated to helping manufacturing businesses evolve, innovate and compete within the world. With manufacturing industry being central to the UK's economic future, the EFF provides a combination of business services, government representation and industry intelligence to give the skills, knowledge and networks that businesses need to thrive. Working with manufacturers and policy makers to help ensure that the industry continues to flourish and meet the demands for innovative and responsibly-produced manufactured goods, around a quarter of all of the UK's manufacturing businesses are member of the EEF.
Ajay Mehra, President of Rapiscan Systems, commented: "This is an exciting accolade for Rapiscan Systems and is a testament of the hard work from the CVI team and our commitment to UK Manufacturing. We constantly strive to meet the growing needs of our customers and will continue to develop our manufacturing processes and presence as our business continues to grow."
Rapiscan's Cargo and Vehicle Inspection Unit (CVI) manufactures and develops innovative stationary and mobile inspection technologies to offer customers superior threat detection in complex of security scanning environments, including seaports, border crossings and critical facilities. The solutions, which can be customised to adapt to changing operational requirements, provide superior x-ray images to combat smuggling and find hidden contraband, including explosives, weapons, narcotics and weapons of mass destruction. With customers in the aviation, government, customs and border control and events industries, Rapiscan's CVI solutions are renowned for the exceptional threat detection, speed, reliability, cost-effectiveness, and ease-of-use provided, all backed with a global support network.
About Rapiscan Systems
Rapiscan Systems, Inc., a division of OSI Systems, Inc. is a leading global supplier of security inspection solutions utilising X-ray and gamma-ray imaging, and advanced threat identification techniques such as neutron and diffraction analysis. The company's products are sold into four market segments; Baggage and Parcel Inspection, Cargo and Vehicle Inspection, Hold Baggage Screening and People Screening. The company has an installed base globally of more than 70,000 security and inspection systems. The Rapiscan Systems product line is manufactured at four locations and supported by a global support service network. As the world's leading security screening provider, Rapiscan Systems provides state of the art products, solutions and services that meet our customers' most demanding threat detection needs --- while improving their operational efficiency.


text:
Nellie Cline
Nellie Cline was born December 7, 1886, in Larned, Kansas. Cline graduated from Baker University and went on to earn her law degree. She followed her father's footsteps. G. Polk Cline was a respected trial lawyer in western Kansas. In 1912 she was admitted to the bar and in 1918 was the first woman to present oral arguments before the Kansas Supreme Court. After the Suffrage Amendment, Cline became was among the first four women to serve in the Kansas House of Representatives from 1921 to 1924. Cline introduced and passed the Threshermen's Lien Law, which gave protection to farm labor in Kansas. Cline moved to Idaho in 1935 after the death of her husband and father. She was the first woman to serve in the Idaho Senate. Cline was successful in getting many laws passed in Idaho concerning pensions, social health, and sanitation, among others. Cline died April 1, 1984, in Pocatella, Idaho.
Entry: Cline, Nellie
Author: Haydan Vosburgh
Date Created: May 2012
Date Modified: July 2012
The author of this article is solely responsible for its content.


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From 0 ratings
Flower colour
Fruit, Dramatic foliage
Half hardy
Skill level
This is an evergreen shrub that stands out because of its young leaves, which have a broad central blotch of bright yellow that gradually turns creamy white. Being upright and bushy, it's typically grown as a hedge, especially in seaside gardens, or as a well-clipped specimen in long borders where it makes an effective divider.
Family: Celastraceae
Genus: Euonymus
Species: japonicus
Cultivar: Bravo
Flower colour: White
Foliage colour: Mid-green
Feature: Fruit, Dramatic foliage
Sun exposure: Full sun
Soil: Well-drained/light, Clay/heavy, Chalky/alkaline, Moist
Hardiness: Half hardy
Skill level: Beginner
Height: 200cm
Spread: 200cm
Time to prune: August to August
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Items where SHU Author is "Cook, Sarah"
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Number of items: 12.
COOK, Sarah, MUNDY, Timothy, KILLASPY, Helen, TAYLOR, Deborah, FREEMAN, Lara, CRAIG, Thomas and KING, Michael (2015). Development of a staff training intervention for inpatient mental health rehabilitation units to increase service users' engagement in activities. British Journal of Occupational Therapy. (In Press)
CHAMBERS, Eleni, COOK, Sarah, THAKE, Anna, FOSTER, Alexis, SHAW, Sue, HUTTEN, Rebecca, PARRY, Glenys and RICKETTS, Tom (2015). The self-management of longer-term depression: learning from the patient, a qualitative study. BMC Psychiatry, 15 (172), 1-16.
BRIAN, Helen, COOK, Sarah, TAYLOR, Deborah, FREEMAN, Lara, MUNDY, Timothy and KILLASPY, Helen (2015). Occupational therapists as change agents in multidisciplinary teams. British Journal of Occupational Therapy, 78 (9), 547-555.
KILLASPY, Helen, MARSTON, Louise, GREEN, Nicholas, HARRISON, Isobel, LEAN, Melanie, COOK, Sarah, MUNDY, Timothy, CRAIG, Thomas, HOLLOWAY, Frank, LEAVEY, Gerard, KOESER, Leonardo, MCCRONE, Paul, ARBUTHNOTT, Maurice, OMAR, Rumana Z and KING, Michael (2015). Clinical effectiveness of a staff training intervention in mental health inpatient rehabilitation units designed to increase patients' engagement in activities (the Rehabilitation Effectiveness for Activities for Life [REAL] study): single-blind, cluster-randomised controlled trial. The Lancet Psychiatry, 2 (1), 38-48.
FEGAN, Colette and COOK, Sarah (2014). The therapeutic power of volunteering. Advances in Psychiatric Treatment, 20 (3), 217-224.
SPRANGE, Kirsty, MOUNTAIN, Gail A., BRAZIER, John, COOK, Sarah, CRAIG, Claire, HIND, Daniel, WALTERS, Stephen J, WINDLE, Gill, WOODS, Robert, KEETHARUTH, Anju D, CHATER, Tim and HORNER, Kath (2013). Lifestyle Matters for maintenance of health and wellbeing in people aged 65 years and over: study protocol for a randomised controlled trial. Trials, 14 (1), p. 302.
BARBER, Rosemary, BOOTE, Jonathan D., PARRY, Glenys D., COOPER, Cindy, YEELES, Philippa and COOK, Sarah (2012). Can the impact of public involvement on research be evaluated? : a mixed methods study. Health Expectations, 15 (3), 229-241.
FEGAN, Colette and COOK, Sarah (2012). Experiences of volunteering: a partnership between service users and a mental health service in the UK. Work (Reading, Mass.), 43 (1), 13-21.
COOK, Sarah and CHAMBERS, Eleni (2009). What helps and hinders people with psychotic conditions doing what they want in their daily lives. The British journal of occupational therapy, 72 (6), 238-248.
COOK, Sarah, CHAMBERS, Eleni and COLEMAN, Julie (2009). Occupational therapy for people with psychotic conditions in community settings: a pilot randomized controlled trial. Clinical Rehabilitation, 23, 40-52.
COOK, Sarah, HILL, Cathy, MUNDY, Timothy, KILLASPY, Helen, HOLLOWAY, Frank, CRAIG, Tom, TAYLOR, Deborah and FREEMAN, Lara (2012). GetREAL Intervention Manual. A staff training intervention for inpatient mental health rehabilitation units aimed at increasing patients' engagement in activities. Manual. Sheffield, Faculty of Health & Wellbeing, Sheffield Hallam University and UCL Mental Health Sciences Unit, University College London.
COOK, Sarah (2006). Intervention schedule, occupational therapy for people with psychotic conditions in community settings. Manual. Sheffield Hallam University. (Unpublished)


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Ever feel like you're living in a vacuum? Or a fishbowl? Or fighting your way through a mob scene in a horror movie? Let me tell you, I can relate. Been there and done that. But those feelings are easy to overcome. How? The answer is simple, inexpensive and no appointment is necessary: get out and commune with nature. Missouri …Read More »
Tag Archives: trails
Conservation Atlas a Valuable 'Staycation' Tool
Bird watching, hunting, angling, camping, hiking, cycling, horseback riding, nature photography – what more could an outdoor enthusiast want in a summer vacation? If you live in Missouri, these and other outdoor adventures are never far away, and the Missouri Department of Conservation (MDC) can help you find them. More than 1,000 conservation areas (CAs) let Missourians discover nature on …Read More »


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Red-Eye to Havre de Grace is now playing at New York Theatre Workshop to sold out audiences. This play created with Edgar Allan Poe's poems is the most unique show seen in NYC this season. What does it take to get Edgar Allan Poe's famous poems reincarnated, sung with original music, staged to clever moving set pieces with award winning actors? Broadway Global will tell you! It takes a World Premiere in Philadelphia by Lucidity Suitcase and the 2012 FringeArts Festival as well as support by The Pew Center for the Arts & Heritage, New England Foundation for the Arts' National Theater Project, with lead funding from The Andrew W Mellon Foundation.
Let's just say that the road to Red-Eye to Havre de Grace was long, but well worth the wait. From March 1849 Edgar Ellen Poe's final work Eureka to 1996 where Thaddeus Phillips and Jeremy Wilhelm outlined ideas for this theatrical work. The journey included a staging in October 1997, a collaboration with internationally acclaimed multilingual theater director Tea Alagić in Colorado Springs, a 2002 Poe's Own Twilight Zone which was another version of work based on Poe, and 2004 when Phillips and Wilhelm decide to rework Poe's material on condition that Phillip's would stop playing Poe and direct. David Wilhelm, Jeremy's brother, joins as composer. Poe's Eureka text and last accounts from his last days are added to the material from the prior pieces and turned into outline for Red-Eye to Havre de Grace.
"Stunningly creative sets by Red-Eye to Havre de Grace Director Thaddeus Phillips are incorporated in the moving, staging and pace of the show. Even if Edgar Allan Poe's iconic poems sung to original music don't entice you to purchase a ticket, the staging and creative use of moving set pieces should! The cast Alessandra L. Larson, Ean Sheehy, David Wilhelm and Jeremy Wilhelm bring Poe back to life. The most unique theatre piece of the season, Red-Eye to Havre de Grace is a must see! Broadway Global.
Red-Eye to Havre de Grace is Poe refresher course, for those who may not remember how young Poe's wife was, how she died, how she inspired his writing... and his sad tragic end. Red-Eye to Havre de Grace Scenic Design by Thaddeus Phillips, Costume Design Rosemarie McKelvey, Lighting Design by Drew Billiau, Sound Design Robert Kalowitz, Choreography Sophie Bortolussi, Production Stage Manager Lindsey Turteltaub. Red-Eye to Havre de Grace was created by Thaddeus Phillips, Jeremy Wilhelm, Geoff Sobelle, David Wilhelm and Sophie Bortolussi with Ean Sheehy for Lucidity Suitcae International, and Music by Wilhelm Bros. & Co.
New York Theatre Workshop is located on the famed theatre 4th street in the heart of NYC. for tickets visit 79 E 4th Street New York, NY 10003 or call 212-789-9037. Red-Eye to Havre de Grace is a great way to re- introduce yourself to America's most prolific poet Edgar Allan Poe and his iconic poems. Red-Eye to Havre de Grace is a Theatre Chat and Broadway Global top pick.


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By CVN Staff
May 5, 2011
As many of you know, Poppy Day was May 1. Poppy cans are placed around town, at local businesses, from May 1 until July 1. The poppies, which grew wild on the battlefields of Flanders, became a symbol of the sacrifice shown by the doughboys of W...
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The Flashflight was designed by a professional Ultimate player, so it performs beautifully. Made of lightweight, durable materials, with true balance and long, straight flight, it weighs in at 185 grams and looks, feels, and flies like the highest quality non-illuminated discs. In other words, you'll want to reach for it even during the day.
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Nite Ize Comment: John, please contact our customer service department. 303-449-2576. It sounds like someone may have turned it on in the store, and the batteries may have died. We'll be happy to help you. Thanks!
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You may have seen chef Jet Tila on Cutthroat Kitchen, Iron Chef America, and Anthony Bourdain's No Reservations. Soon you can chat with him through the open kitchen at Pakpao Thai in the Design District. Tila replaces opening chef Eddy Thretipthuangsin who is now at Bite in Fort Worth. Tila will join Richard Ellman, co-owner along with his wife Tiffanee of Apheleia Restaurant Group as chef/partner.
"Team Tila" (which consists of Jet and two of his protégés) will bring their A-game later this month. The menu will change to reflect some of team will guide changes to the Tila's signature dishes such as Khao Soi Noodles, Sticky Rice with Mangoes, Moo Palo (five spiced pork belly), and Roti Dessert (Indian flat bread with coconut ice cream and condensed milk).