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Since the Supreme Court upheld the Affordable Care Act nearly a year ago, states have been racing against the clock to set up the health care exchanges mandated by the law. Maryland is among those hailed as going "all out" to comply and make the exchange their own. Maryland Secretary of Health and Mental Hygiene, Dr. Joshua Sharfstein, is in studio to talk about implementation and other health issues the Old Line State is taking on.
MR. KOJO NNAMDIFrom WAMU 88.5 at American University in Washington, welcome to "The Kojo Nnamdi Show," connecting your neighborhood with the world. Whether you think of it as the Affordable Care Act, Obamacare or don't think much about it at all, change is coming soon to a health care system near you. Maryland has been hailed by many analysts and observers as a state that's been going all out to comply with the Affordable Care Act, with a goal of creating a health care exchange tailored to meet the needs of its population, while also planning for changes to Medicare and Medicaid programs within the state and dealing with the effects sequester cuts will have on the entire health care system.
MR. KOJO NNAMDIIf that sounds like a lot, it is. And here to help us get up -- here to help get us up to speed on it all is the man overseeing it. He is Joshua Sharfstein. He is the secretary of health and mental hygiene for the state of Maryland. He's also a medical doctor. Joshua Sharfstein, thank you for joining us.
DR. JOSHUA SHARFSTEINThanks for having me.
NNAMDIFeel free to join the conversation. Give us a call at 800-433-8850 if you have any questions or comments about the Maryland health benefit exchange or anything else having to do with Medicare or Medicaid. 800-433-8850. You can send email to email@example.com. Joshua Sharfstein, it's been about a year since we've spoke just after the Supreme Court upheld the Affordable Care Act. How far have you come since then in setting up the Maryland health benefit exchange? And please explain how it will work.
SHARFSTEINSure. We've come a long way. It's been quite a year, very busy. Right now, people can go online to marylandhealthconnection.gov. One of the things we've done is we've named our exchange Maryland Health Connection. Right now, we're looking -- we're planning very intensely for Oct. 1st, when that website will go from what it is now, just an information portal, to actually being a place people can go to sign up for insurance, both Medicaid, as well as private insurance, both for people who need extra health in the form of subsidies and for anyone.
SHARFSTEINAnd we're -- the coverage that is available on Oct. 1st will be kicking in on Jan. 1st. So we really have just a handful of days between now and then to get the system up and going.
SHARFSTEINIn order to do it, there's a lot of work. We are working with organizations around the state. We have six major partners in different regions, with 50 or more organizations clustered around those partners as part of an agreement with them. There will be a P.R. campaign to tell people about the new options available to them. So we're seeing just a huge amount of preparation going into this fall.
NNAMDIWhat dates should Marylanders should circle on their calendars as the exchange gears up to go online Oct. 1st?
SHARFSTEINOct. 1 is the day where they can get started. The open enrollment period will be through March. People can go online now, though, at marylandhealthconnection.gov and sign up for updates, and probably sometime in August, we'll have our call center up and going to answer people's question.
NNAMDIWho qualifies for the health benefit exchange among the uninsured?
SHARFSTEINSo people -- adults who have incomes up to about 133 percent of the poverty line, maybe $20,000 for an individual, are able to receive Medicaid through the health benefit exchange, the Maryland Health Connection. Between 133 and 400 percent of poverty, which is may be up to about $80,000, people can qualify for subsidies so that they can finally afford coverage. And then children actually have a higher eligibility for Medicaid in Maryland, up to about 300 percent.
SHARFSTEINAnd then anybody, even if their income is higher or they're not a citizen, can still go online and purchase coverage but maybe not qualify for the subsidies.
NNAMDIMaryland has been hailed as a leader in terms of compliance with the Affordable Care Act, getting to work on an exchange even when the constitutionality was still in question. What advantage do you think getting a head start and doing this on your own terms has given you?
SHARFSTEINWell, you know, the governor and the lieutenant governor got started really early. The day after the law passed, they announced a planning effort that involved dozens of meetings, hundreds of public comments. And the one thing that really came through in Maryland was that people in Maryland wanted to control their own destiny, and they've realized the best way to do that will be to set up our own state-based exchange.
SHARFSTEINAnd so people left their preconceptions about the Affordable Care Act behind. This is a law that had passed. It provided a set of tools for states and let's try to get it to work as well as possible for Maryland. And I think that attitude, that sort of coming together has really served as well. There have been three steps in Maryland. The first was in 2011. We set up the governance of the process, the governance of the exchange.
SHARFSTEINAnd it's a public corporation. I'm the chair of the board, and there are other state employees who are on the board, but there's six people who aren't state employees, one who is the former head of the Maryland Retailers Association, another who's a legal aide attorney. So -- and that board in that first year convened a whole range of public meetings. We had six reports that we wrote with literally over 100 Marylanders actively involved that first year from a wide array of backgrounds, brokers, doctors, hospitals, insurers and others.
SHARFSTEINBased on that input, in the second year, the second step was setting up the policy structure for the exchange, and we did that in a second piece of legislation. The governor and lieutenant governor were critical, and the legislature was very interested in getting this right. And pretty much all the recommendations that we came up, with working with everyone in that first year, got put into law.
SHARFSTEINThe third year, we kind of tightened up a few things, and we put in place the funding. And I think by going step by step, we've been able to build support and show that we're really open to trying to figure out how to maximize the benefits and minimize the risks. I think people who have started late have had to do everything at once, and I think that's harder.
NNAMDIOur guest is Joshua Sharfstein. He is the secretary of health and mental hygiene for the state of Maryland. We're discussing the coming changes to health care in that state and inviting your calls at 800-433-8850. Are you uninsured in Maryland, counting the days until the state's health insurance exchange becomes active, or are you dreading the impeding individual mandate?
NNAMDIGive us a call, 800-433-8850, or send email to firstname.lastname@example.com. Nationally, much of the focus on the Affordable Care Act was the mandate requiring people to buy health insurance, but you've been focusing more on making it affordable. Does a mandate help you to meet that goal, and what is it your plan for meeting that goal?
SHARFSTEINThe basic purpose of a mandate is to avoid the problem that people only seek to get insurance when they're sick, because if you do that, then the only people who have insurance are the people who are very expensive and the price becomes unaffordable. It'll be sort of like allowing people to get automobile insurance right at the point that they've had an accident. So there's a very strong logic in a mandate.
SHARFSTEINI think our initial focus right now is to really tell people what health insurance is about, explain that we think that there's gonna be an option that's going to fit their budget. And try to build as much of a interest in getting health insurance among as many people in Maryland as we can right off the bat. There are penalties. There are also exceptions to the penalties. And, you know, our goal is to try to encourage people to get insurance initially.
SHARFSTEINOne of the things that we've learned through some of the work that we've done is that people who are uninsured in Maryland, they want insurance. It's not that they've made a choice to put, you know, themselves and their families' finances at risk, they want insurance. But they may have been turned down in the past because they were sick or it was just too expensive. And they're feeling a little bit, you know, defensive about the fact that they're uninsured. And our initial goal is to get over that and really say it's a new day, that there are great options, and we want people to do it because it's the right thing to do.
NNAMDIAnd not just people in Maryland want insurance. People in other states want insurance and are still a little confused as to what will apply where. We've got an email question from Rita who says, "will Maryland's health exchange be available to residents in Virginia or only to Maryland residents?"
SHARFSTEINWell, it will only be available to Maryland residents, and I think that, you know, one of the things I read recently is that opponents of the Affordable Care Act have spent something in the order of $400 million, you know, and a lot of that information may have helped to -- or served to confuse people about what's actually gonna happen. And I think it's a big challenge nationally to really, you know, have people understand their options.
SHARFSTEINThe federal government is gonna set up a health insurance marketplace that will be available through healthcare.gov in a lot of states where there are not gonna be state-based exchanges like the Maryland Health Connection.
NNAMDIJust because a mandate is in place doesn't necessarily mean everyone will comply. How are you gonna be making people aware of the plans available and encouraging compliance?
SHARFSTEINSo it's a multipronged approach. So, for example, we're going to be doing some traditional advertising. We're also going to be doing some social media work, particularly among young people who may be uninsured. We have partners that we're calling connectors -- connector organizations. There are six major connector organizations in the state. In this region, Montgomery County Health Department is serving that role.
SHARFSTEINEach connector organization is getting funding, and they have an array of partners, and that could be local community organizations, it could be faith-based organizations, it could be local businesses or physicians groups that are partners, and they're gonna be getting support to be able to do direct outreach, particularly to communities that they know well. So in addition to all that, we're gonna have partners that are not directly related to their connector organizations that can go online to marylandhbe.com, which is our organizational website, download tool kits, videos, presentations.
SHARFSTEINWe want as much interest and enthusiasm as we can get. I think the insurers are gonna be advertising. I think the hospitals and medical systems, they're gonna have a big interest in seeing as many people insured as possible. And coming together as a state, I hope we're really able to make good use of the opportunities that are there in the law.
NNAMDIOn to Kate in Baltimore, Md. Kate, you're on the air. Go ahead, please.
KATEThank you so much for taking my call. I really appreciate it. I'm the mother of two young women who are -- have no insurance. One just graduated college, and her university insurance will run out shortly. And the other one has a year to go. And believe it or not, goes to a Maryland state school where no college insurance is offered, which is kind of a sad situation, I think, but any rate, I found out I couldn't get her on Medicaid -- she makes about three grand a year -- because she doesn't have any dependents. In other words, she's not a mother. So I thought that was interesting, and I was told that every state is not that way. Is that true?
NNAMDIWell, I'd also like to ask before I get a response from Joshua Sharfstein, how old is your daughter or your daughters?
KATEWell, one is almost 21, and the other one is 22. And it's the 20 -- almost 21-year-old who I applied for Medicaid for because her school doesn't offer an insurance policy. And those are very cheap. They have a high deductable, but they're much less expensive than, you know, going to Care First or Aetna and buying them a monthly plan.
NNAMDIOK. Here's Joshua Sharfstein.
SHARFSTEINWell, one thought would be whether they're able to be on your plan because under the Affordable Care Act, there are requirements that kids up to, I think, 25 or 26 can stay...
SHARFSTEIN...on their parents'...
KATEI don't have a plan.
SHARFSTEINWell, that's also something that, you know, obviously is important to address.
KATEBut -- well, I'm relieved to hear you say that it sounds as though at least the younger one will -- I can sign her up for this. And so I'm very relieved with that.
SHARFSTEINWell, and you too.
KATEAnd I'm happy that the state is going along with, you know, setting up an exchange. I think that's great.
SHARFSTEINYeah. Let me just tell you, and you as well, because for the first time, people can't be screened out or denied because of any health concerns that they may have had in the past. And in addition, you know, we hope that through the website, we'll have a much easier way to enroll, that will give choices to people, choices to your daughters, choices to you, to pick something that fits your budget. That's really what we're aiming for.
NNAMDIThank you very much for your call, Kate. You, too, can call us at 800-433-8850. If you live in a state that is adopting the federal health care exchange, how do you feel about that decision? And what are your thoughts on states' ability to opt out of that decision, 800-433-8850, if your state has decided not to adopt the federal health care exchange. 800-433-8850. In 2006, you told the Baltimore City Paper that the key question in public health is, compared to what? Do you continue to ask that question?
NNAMDIAnd if so, how does it play into the work you're doing with the Affordable Care Act? I know there has been a great deal of criticism of the Affordable Care Act. But in terms of Maryland, I guess one of the questions would be, compared to not having any health insurance?
SHARFSTEINOh, well, that's absolutely right. I continue to believe that that is a critical question in public health. And in a lot of different areas, I'm confronted with people who would say, well, my ideal world would be the following. And, you know, that's -- I may agree or I may disagree, but we're really confronted with an incredible opportunity whether or not it's written in a perfect way. I don't know anyone who thinks that the law is perfect. But it's an incredible opportunity.
SHARFSTEINAnd if we can get it to work as well as we can, we will be helping people get access to health care that they truly need, not just for themselves and their families but for their ability to work, their ability to contribute to society, their ability to feel dignity in their lives. It'll be a tremendous victory. So, you know, I view it as, you know, the alternative is us having a set of tools that we're not deciding to use.
SHARFSTEINAnd I'm really honored to be working in a state where there are just so many people, from the governor, the lieutenant governor, the attorney general, the state legislators, who've really encouraged us to use this law as best as we can.
NNAMDII guess I should have phrased my earlier question to the audience earlier. If you live in state that is implementing its own health insurance exchange, how do you feel about that as opposed to states that are adopting the federal health care exchange? Any advice for your counterparts in states now scrambling to set up exchanges in compliance with the law or those opting for the federally operated exchange such our neighbors in the commonwealth of Virginia?
SHARFSTEINWell, you know, we have very good discussions with people that are really apolitical. We'll share whatever information, advice, even computer code that we have. We learn from other states. You know, a lot of the challenges in health care are apolitical. While the Affordable Care Act, obviously, has its own kind of politics to it, the fundamental challenge in health care is to get better value, to improve health at lower cost.
SHARFSTEINAnd I'll go to meetings with Secretary Hazel in Virginia, where we all agree on 98 percent of what we're talking about, because we both want to see the citizens in our states be healthier, and we want to see it done in an affordable way.
NNAMDIGot to take a short break. If you have called, stay on the line. We will get to your call. We have still have lines open, 800-433-8850. If you have questions about other public health issues at play in Maryland, you can call that number also, or send email to email@example.com. Or send us a tweet, @kojoshow. I'm Kojo Nnamdi.
NNAMDIWelcome back. Our guest is Joshua Sharfstein. He is the secretary of health and mental hygiene for the State of Maryland. He is also a medical doctor. We are discussing changes coming to health care in Maryland under the Affordable Care Act and changes coming on to Medicaid and Medicare. Inviting your calls at 800-433-8850. Here is Gerald in Annapolis, Md. Gerald, you're on the air. Go ahead, please.
MR. GERALD LORNEGood afternoon, Dr. Sharfstein. This is Gerald Lorne (sp?) calling from Annapolis, and I'm very pleased to listen to you this afternoon. I feel that you're one of the few people in our state, perhaps in our country, who is a medical professional and is frankly very anxious and eager to make sure that the Affordable Health Care, as some people like to call it, Obamacare, works and reaches as many Americans as possible and brings better health to the country.
NNAMDIThank you very much for your call. Do you have any questions for Dr. Sharfstein?
LORNEI have no questions. I just want to make sure, Doctor, you keep doing what you're doing and make sure that it helps and you get the help from our citizens and we get this to be a success in Maryland.
SHARFSTEINThank you very much.
LORNEYou're welcome.
NNAMDIA committed Marylander. This is not, as they say, your first rodeo. You worked on the implementation of the Medicare Part D in Baltimore. How has that experience informed the work you're doing now?
SHARFSTEINWell, at the time, I was the health commissioner in Baltimore City. And -- so I wasn't working in the federal government. I wasn't even working at the state. But I was worried, if you remember, that was a big change, and a lot of patients, some very frail patients, were having their drug coverage switched over all on one day, just as I was starting as the health commissioner. And at the time, it was Mayor O'Malley, gave me some extra funds to try to set up a safety net system to help the people who were switching.
SHARFSTEINAnd we notified all the pharmacies, and 24 hours a day, they could call for assistance. And we gave some money to tide people over until whatever bureaucratic snafus were there got worked out. And I think I learned from that that, you know, these big transitions can offer a lot of coverage to people. But in the transition, you've got to really look out for the people who are most vulnerable.
SHARFSTEINAnd, you know, I do expect that even in Maryland, even where everybody's been trying to do everything right, we will have some bumps in the road. And I think our goal is to be able to be in a position to respond to them as quickly as possible, to fix problems as they come up, the attitude we've taken is we don't have all the answers. We may make some missteps, so we're gonna do our best to try to fix them as quickly as we can.
NNAMDIOn to the phones again. Ray in Salisbury, Md. Your turn, Ray.
RAYYeah. Hi. Look, I'm a small business guy. We got just over the 50 number of people that I should -- to get under whatever that level is. But anyway, let me give you a little bit of history. In fact, 15, 20 years ago, I worked with my health insurance company to get my people's health better. They -- and I worked with them. They sent vans down. We had everybody tested. Caught some people with high blood pressure. Caught some people with other things. Got everybody to quit smoking.
RAYAnd over a two to three-year period, my premiums went in half of what they were. My people were healthier. Everything was doing fine. Then Maryland passed some sort of law that said -- well, small business people, I guess, couldn't get insured. So they passed some sort of law, and all of a sudden, my premiums tripled the next year, and I couldn't figure out why. So I got a hold of the lady from California, I think, who was the mother of this, and I said, what did I do wrong here? She said, you didn't did anything wrong. Everything you did was right.
RAYBut the problem of it is that we put everybody together under one thing. And I said, so my premium is tripled. She said, that's right. So I am not a proponent of the government messing around with the healthcare. But, hey, we are what we are. The question is that how is this program -- I know it's gonna help a lot of people that are uninsured.
RAYHow is this program gonna help people that are insured and the businesses that help pay for this and the individuals who help pay for this. Some of the premiums are gonna have to be paid for them. Can you -- do you have any answer for that? And if you do, I'd sure like to hear to it.
NNAMDIRay, listen in, because we got an email from Lee in Frederick who says, "I'm in a plan with my employer which has less than 30 employees, and because of its size, is not able to negotiate a less expensive plan." That might be the satiation Ray finds himself from. "Will the exchange help my employer? If not, can I opt out with my employer and choose a plan on the network to get coverage on my own?"
SHARFSTEINSure. Well, I really appreciate both of those questions, and they're really two types of questions. One of which is, you know, nobody -- maybe it's a good idea to expand access to coverage. But what happens to the price? What happens to the price of coverage for people who are already insured? And that's a very important consideration, and I don't think the Affordable Care Act has all the answers for that. I do think that states have a lot of options.
SHARFSTEINAnd in Maryland, we're thinking very broadly about how we can, over the long term, curb the cost trends and reduce cost. I was out actually on the Eastern Shore with the National Federation of Independent Business Affiliate not too long ago, talking to small business owners about this. You know, Maryland has a very unique system of paying for health care.
SHARFSTEINWe're the only state that sets rates for hospitals, and that provides some very innovative tools to really change the trajectory of health care costs. And that's something that we're working on. Really, it's sort of in parallel with implementing the Affordable Care Act in the exchanges, but I think it's absolutely essential. If what we're doing is providing access to something that continues to grow out of control, in terms of costs, we won't be successful over the long term.
SHARFSTEINSo we've got to be thinking about getting better value in health care now as well. In terms of the exchange itself, I think that the -- there will be a small business side of the exchange. We've designed it to work very closely with the existing brokers who a lot of small business owners count on now for good advice, not only about health insurance, but about retirement and payroll and other things.
SHARFSTEINAnd people will be able -- it will serve the function of pooling buying power and will also provide access to tax credits for certain businesses and will provide the ability to allow employees to choose their own plans, which they are not allowed to do, if the employer wants them to. So I think that there may be some benefits. But over the long term, we won't do well as a state or really as a country unless we're able to get better control of health care costs. And that -- I think the Affordable Care Act is an important part, but it's not a magic solution, and we really have to think beyond that.
NNAMDISo the Affordable Care Act and the health benefit exchanges won't necessarily cause raised premiums to drop. But what you seem to be saying is that it will probably give both him and his employees more options.
SHARFSTEINI think that's true. Now in Maryland, there's about 7 percent hidden tax on every hospital bill. We all pay for the uninsured. As more people are getting insured through the Affordable Care Act, that tax will drop because there'll be less care provided for the uninsured. So every small business, every large business will get that benefit over time. So I do think that there are some direct benefits.
SHARFSTEINBut over the long term, I think that it's gonna require thinking about health care differently and really having the health care system pay for better value over the long term which I think is a trend that the Affordable Care Act is helping. But it's still gonna require everybody's efforts to really bend the cost curve.
NNAMDIRay, thank you very much for your call. Good luck to you.
RAYSure. Thanks.
NNAMDIOn now to Joanne in Ellicott City, Md. Joanne, your turn.
JOANNEOh, good afternoon. I'm calling because I am a person who has a preexisting condition. And years ago when Congress passed the HIPAA law, I was able to find a medical insurance policy because insurance companies were required to insure, I think, 10 percent of people with preexisting conditions. And it was my understanding that that was a one-time deal for me, so to speak. And since that time, my premiums have gone up every single year.
JOANNEAnd I'm wondering, am I allowed to shop around now to see if I can find coverage that perhaps may be equal to or even better than what I have now at lower premiums?
NNAMDIJoanne, I'm glad you brought that up because paying for health care is, as you probably know all too well, a process often mired in rigid regulations that can restrict doctors and restrict patients like Joanne's choices. How will the idea of flexibility play into these reforms and maybe be able to help someone like Joanne?
SHARFSTEINWell, I think what we're doing really is geared to help people like Joanne because starting October 1, you'll be able to go online or call our call center or reach out to one of the community agencies that's partnering with us and be able to be your own decision maker, look at a whole range of choices. We have more plans that are going to be participating in the exchange than are currently participating in the market.
SHARFSTEINAnd you'll be able to compare prices, you'll be able to compare quality scores, you'll be able to look at your budget at different levels and make a decision that's right for you. So you're gonna go to a lot more options, and really, it'll be up to you how to proceed. We wanna make that opportunity available to as many Marylanders as possible this fall.
NNAMDIJoanne, thank you very much for your call. Medicare is also a big part of this reform process. And Maryland currently gets a Medicare waiver that brings more federal money in. Can you explain that waiver for us and tell us whether that's about to change?
SHARFSTEINSure. So this relates to what I was saying before about the need to think more broadly about cost, even, you know, more broadly than just the coverage expansions of the Affordable Care Act. So Maryland is unique because we have an independent agency that sets the prices that each hospital may charge. Each hospital gets its own price structure, and every payer pays against the price structure, including Medicare, Medicaid, BlueCross, CareFirst, all the other private insurers. They pay against that cost structure that's set by this independent commission.
SHARFSTEINWhat we would -- and this has been a system that's worked very well in Maryland from a number of perspectives. What it does is it allows us to pull the uncompensated care for the uninsured and spread that over the system. So you don't have like one hospital that's overly burdened by having to -- or financially unsound because of care for the uninsured. It helps spread the educational payments. It helps reduce cost shifting between different payers. There are some strains in that system. And what we're thinking of doing and what we've been talking to the federal government about is modernizing it.
SHARFSTEINTaking this advantage that we have of being able -- or this system that we have of setting this commission that sets the prices, but orienting it to a challenge of getting better outcomes at lower cost. And let me give you a really concrete example. There are some innovations that are now going on right now that are kind of what we wanna promote even more in the future. But for example, there are 10 hospitals in Maryland that get a global budget across all payers set at the beginning of the year. It doesn't matter how many people come into the hospital.
SHARFSTEINIt doesn't matter how many MRIs they do. It doesn't matter how many ER visits. They know their budget at the beginning of the year. So instead of having to try to, you know, keep the numbers high to make money, this is a hospital that now wants to help people stay healthy and stay out of the hospital. So what are they doing? They're investing in home care. They're improving their partnerships with primary care. They're making better arrangements with long-term care facilities. They're working with community health.
SHARFSTEINThere's even a hospital in Maryland that has taken over the school health program in their county. And I talked to them, I said, you know, why would you wanna do that? I've never heard of a hospital doing that. And they said, well, we've noticed in our emergency room data there are too many kids coming in with asthma attacks. And so now, it used to be every time a child came in, we get paid. That'll be more money for us.
SHARFSTEINBut now, if we can keep them healthier by working on them in school, with their parents, they don't come to the emergency room, and we make money. That is the kind of thinking that will allow us to do a lot better in terms of the value we get out of the health care system.
NNAMDIOn to Anne in Kensington, Md. Anne, you're on the air. Go ahead please. Hi, Anne. Are you there? Anne?
NNAMDIThere you are.
ANNEHi. Thank you for taking my call. And I'm a retired federal public health expert. And I'm wondering how the Maryland Connector will ensure an outreach in partnership strategy reflecting the substance use in mental health coverage under the ACA. And how will Maryland work with SAMHSA's Behavioral Health Treatment Locator?
NNAMDIThere's a number of abbreviations there that our listeners might not be familiar with. But I'm pretty...
NNAMDI...sure Dr. Sharfstein is.
SHARFSTEINSure, no problem. Look, it's one of the great parts of the job. I think Maryland has a higher concentration of retired federal public health experts than any other state in the country. So I get a lot of extra help and advice along the way. It's a great question. Behavioral health is extraordinarily important.
SHARFSTEINAnd one of things that we're learning as we shift to value in health care, as opposed to just volume of services, is that people who have serious behavioral health problems, including mental illness and substance abuse are -- that can be very unhealthy, very sick and cost an awful lot of money. And paying attention to their behavioral health needs is great for them. They can regain control of their lives. They can get jobs. They can stay out of jail. They can be productive, and at the same time, really reduce the burden of excess health care cost. So it's a very important priority for us.
SHARFSTEINIn fact, Maryland probably invests more than any other state, I would guess, in terms of state funding particularly in a substance abuse system. So we've been working quite a bit right now to try to -- first of all, we -- there's been a major Medicaid expansion of benefits for behavioral health. And we've seen major improvements and access through that over the last couple of years under the governor and lieutenant governor. But as we're looking forward, we really wanna see the private health plans that people will be able to choose from on the exchange providing a strong set of behavioral health coverage.
SHARFSTEINAnd one of the things we're doing, we're calling mixers. Mixers are meetings between private insurers and Medicaid plans and providers who may previously have not been part of the network. It might be a substance abuse treatment program that has gotten a grant or they work with one payer. But now, all these new people may have insurance to pay for it, and we wanna introduce the plan on the one hand to the program on the other.
SHARFSTEINAnd so we're having these mixers across the state. Our goal is to really facilitate the ability of individuals to get these services and the ability of the programs to be paid for them through the benefits that are available under the law.
NNAMDIAnd thank you very much for your call. And since we're talking about phrases or acronyms that I didn't understand, a phrase you used in the break is plastic surgery compounding.
NNAMDIExactly what are we talking about here?
SHARFSTEINOK. Those are two phrases. So...
SHARFSTEIN...we've had a number of public...
NNAMDIPlastic surgery and compounding, yeah. (laugh)
SHARFSTEINRight, exactly. So, you know, this has been a very busy year in public health in Maryland, and there were a few very important laws passed in the general assembly, some terrific leadership by state senators and delegates, one of which expands our ability to regulate cosmetic surgical procedures. And what we found, there was a horrible situation where several people got very ill, and one actually died from plastic surgery, cosmetic surgery that had a bad outcome in Baltimore County.
SHARFSTEINAnd what we learned was that the regulatory structure was a bit like Swiss cheese. In fact, if people didn't bill insurance a certain way, then almost no licensing rules applied. And what the general assembly has done is given us authority to identify the higher risk procedures and apply licensing rules for the first time in Maryland to cosmetic surgical procedures. And we're -- we have just started that process. People can go to our website, dhmh.maryland.gov, and give us their input on which procedures they think we should cover. Compounding is...
SHARFSTEIN...an issue people may be familiar with from the, you know, horrible outbreak that happened. In fact, there's another one -- fortunately not, to our knowledge, in Maryland -- where people are mixing up medicines, and doctors have been injecting them. And it turns out that the medicines have had fungi in them, fungi, and people have gotten meningitis and very serious abscesses, and it's exposed a part of America's drug distribution system that is high risk.
SHARFSTEINAnd we had some very great leadership by Sen. Conway in the Senate and Delegate Hammond in the House to think through an approach in Maryland. And what we've done is created a -- you know, what's challenging nationally -- and this is challenging FDA quite a bit -- is that, you know, there are certain products that are fully FDA regulated, and there are certain products that your pharmacist might mix up right there.
SHARFSTEINBut what about the products that are in this middle gray area? They're made in big batches. They may be given in a clinic, and you'd have no idea that they weren't fully FDA regulated. What do you do? You might say, well, there shouldn't be any products like that. But it turns out the health care system depends, to a certain extent, on products in that gray area. The FDA right now is in front of Congress trying to get more authority over that gray area, and I completely support that.
SHARFSTEINBut in the meantime, what are states supposed to do? And what our law now says is that in that gray area, Maryland can grant a waiver. We can allow products into the state, but only when we know they're really meeting an important medical need, and only after we've done our due diligence that to the extent possible we can assure safety. So there's still gonna be risk there, but at least we'll be able to manage it better. And ultimately we hope that FDA gets the authority that it needs over those manufacturers.
NNAMDIAnd thank you very much for your call. We're gonna take a short break. When we come back, we'll continue our conversation with Joshua Sharfstein. He is the secretary of health and mental hygiene for the state of Maryland. If you'd like to join the conversation, you may wanna send us an email to email@example.com or send us a tweet, @kojoshow, if you have questions about other public health issues at play. Or you can call us, 800-433-8850. I'm Kojo Nnamdi.
NNAMDIWelcome back. Our guest is Joshua Sharfstein. He is the secretary of health and mental hygiene for the state of Maryland. He's also a medical doctor. We'll go immediately back to the phones to Laura in Arlington, Va. Laura, you're on the air. Go ahead, please.
LAURAHi, Kojo. Thanks so much for taking my call. I actually live in Virginia, but I have employer-based health care, health insurance, and last December -- or November, they told us they were gutting our plan. We went from maybe not something you might call platinum coated, but definitely a good plan, to the same plan, but now with a $9,000 out-of-pocket maximum huge deductibles for -- in network and out of network and an HSA.
LAURAUnfortunately, the health savings account is maxed out at $6,400. So we are likely to actually end up having to pay all the way up to that $9,000 out-of-pocket, which effectively is like a huge pay cut on our single income for our family. And we have a special needs child who has regular therapy. It's not a -- she doesn't have major special needs, but my heart goes out to those people who do. Because of the way they gutted this plan, effectively we have no health insurance unless there's something catastrophic.
LAURAWe've already used up our health savings account just on therapy bills alone, waiting to meet the deductibles. And so I was a supporter of the health care -- of the Obamacare. But I'm wondering what excuses -- this is a major corporation, and it seems like they're using this as an excuse to gut their health care plan. We're paying the same premium. I think we save maybe $10 a month out of several hundred on this new plan, and it could potentially bankrupt us with the cost of living in Virginia.
LAURAEven though we have good salaries, you know, a good income situation in theory, in practice, it's really difficult. And I wish I could, you know, somehow be in Maryland to take advantage of this. But I guess I'm wondering, for those of us out there who do have employer-based health care plans, is there any hope for how this thing is going to pan out? Because it seems to me if other plans are going in this direction, then health insurance is becoming meaningless.
NNAMDIJoshua Sharfstein.
SHARFSTEINFirst of all, you know, I totally appreciate the challenge that you're facing, and I'm very, very sorry to hear about it. You know, we've been looking in Maryland at the rise of these high-deductible health plans, which are just like you said. At a certain point, you have to ask whether it's meaningful coverage if people have to pay so much before the coverage kicks in. And if they don't have that money, how do they wind up, you know, getting coverage at all?
SHARFSTEINOne of the solutions that we have been working towards to this problem, including in the private sector and the large employer market, is instead of a broad-based high-deductible health plan, to encourage employers to move towards something called value-based insurance design where there are certain types of services that are really necessary that would be lower copay even with the deductible and other services that -- for which there may not be good evidence for, might be -- cost more.
SHARFSTEINAnd I think that you're seeing a lot of movement in that direction in the private sector. And it's the one thing that can -- as costs go up, maybe make it a little bit easier for families to get the care that they really need. Overall, I think, you know, what the biggest challenge that, or one of the biggest challenges we're facing is the general trend in health care cost.
SHARFSTEINAnd like I said before, if we're not able to get control of that, things will get worse in -- for large employers, it will get worse for small employers, it will get worse for the exchanges. So even as we're expanding coverage in Maryland, we're really trying to think about how to realign incentives so that we can get better outcomes and lower costs.
SHARFSTEINObviously, I think there may be some other specific answers for you in Virginia. But I do think that you're pointing out a very serious challenge in why we need reform so badly in the United States.
NNAMDILaura, thank you for your call. In the aftermath of last year's Supreme Court ruling, some 13 states have chosen to opt out of the Medicaid expansion program with many citing the associated cost. Why is Maryland opting in?
SHARFSTEINSo it is -- first of all, in Maryland, there is wide recognition, I think, that expanding access to health care is not just important for the people who get health care but it makes them more productive and reflects well on Maryland. It respects the dignity of individuals and families, and at the same time, it makes the economy more productive. Maryland was expanding Medicaid before the Affordable Care Act kicked in. The governor and lieutenant governor led a major expansion effort.
SHARFSTEINSo I think from that perspective compared to other places, we've seen Medicaid as part of the solution, and so it's not surprising. But there was other factor. We had an independent group of economists look at the impact of the Medicaid expansion to Maryland. And, you know, in 100 percent of the people who are nearly eligible, 100 percent of their costs are paid by the federal government initially, and then it just dwindles down to 90 percent. It is a hugely advantageous deal for states.
SHARFSTEINIt overwhelmingly helps the state's economy even when you count in the fact that some people might sign up who are eligible now under different rules. And so counting all that, the UMBC -- University of Maryland Baltimore County economists, you know, they found just a huge advantage. So you combine the belief that health insurance is important, it helps our economy, it helps working parents, helps people stay employed and stay healthy with the fact that it helps to stay down the state budget, and that was a really easy call.
NNAMDIOn now to Anna in Bowie, Md. Anna, your turn.
ANNAHi. I'm live in Bowie as you said, and I am on the Maryland health insurance plan. And I'm right now actually leaving the physical therapy clinic, where I do physical therapy, so you can hear me. The situation I'm in is that we're transitioning in Maryland off of the support for Maryland health insurance plan plus onto not having that, or, and going over to whatever other options there are out there. My concern is that my cost is gonna go up. But I'm using a PPO.
ANNAAnd I can't even afford the monthly payment for that. My aunt's paying for me. And I'm very worried that as of the end of our support, when Maryland stops paying into the health insurance in that plus program for us poor people, then I'm not gonna be able to afford my insurance anymore. And I'm gonna have to do whatever I can to have a huge, huge giant deductible in order to have the, you know, required insurance and not be able to use it. So do you have any answers for me?
NNAMDIAnd, Anna, thank your call. I think we have the same question from Libby in Colesville, Md. Libby, your turn.
LIBBYYes. Hello. My daughter is 28. She has Crohn's disease, so she was turned down for insurance, but she was able to get her insurance through the Maryland health insurance program for which we are very thankful. And I am also wondering what happens with her plan if that's still gonna be available after the Affordable Care Act kicks in.
NNAMDIJoshua Sharfstein.
SHARFSTEINSure. So the Maryland health insurance plan is the high-risk pool that exists in Maryland. Maryland has had one of the most generous high-risk pools historically, and it's been added to by some federal funds that will be sunsetting as 2014 gets closer. This has basically been the last ditch, last opportunity for insurance, for people who are turned down on the individual market. And it's been very expensive for -- to be able to subsidize and almost getting to the point of unaffordable.
SHARFSTEINSo now that people who have preexisting conditions can't be denied, it makes sense for them to participate in the market, in the exchange market. And if they're low income, just like the first caller, they would be eligible for some subsidies. And, in fact, it's likely for most individuals who are now getting -- if not all actually -- who are now getting subsidies at the health insurance that they can get, on the other side, may be less expensive than what they're getting now.
SHARFSTEINI can tell you that I know that there is definitely anxiety because people who had been turned down for health insurance, and they finally got into the high-risk pool, are very nervous about any changes. And I totally understand that. We will have a team of people who will be working directly with them to make sure that it's a smoother transition as possible.
SHARFSTEINBut ultimately, what we're doing is trying to actually, you know, provide a more stable, lasting solution to the health care system than just, you know, waiting for people to be turned down and then getting them into kind of a last measure insurance plan because during that period, it is enormously stressful, and people can get sicker and sicker and sicker. We want people to be able to get and afford coverage earlier and be able to stay healthy.
NNAMDILibby, thank you very much for your call. Good luck to you. Hard as it may be to believe, there are other public health issues you've been working on including a ban on crib bumpers and parts of a so-called patient safety packet of bills that made it through the Maryland General Assembly recently. What changes are coming on those fronts?
SHARFSTEINSo actually, it wasn't through legislation but rather through regulation that we have adapted that starting this Friday, the sale of baby bumper pads in Maryland will be banned. That followed about a two-year process where we had experts weighing in. And one of the things that we learned was that these pads, like in the inside of the crib, can suffocate babies, can reduce the airflow, can potentially contribute to the development of sudden infant death and really provide very minimal, if any, benefit.
SHARFSTEINAnd so when you look at the potential for a very serious risk -- and, well, you know, we heard from medical examiners talking about autopsy cases and experts in the field against, you know, a benefit that may not be there at all, the state moved forward to ban their sale. And it's something that we've been talking about for a while. We've certainly been advising, and it's not just our recommendation, it's CDC's recommendation, the National Institutes of Health and the American Academy of Pediatrics.
SHARFSTEINBabies sleep best and safest when they're alone on their back and in a crib without pillows, stuffed animals or crib bumper pads. And by following that message, we've actually seen a decline in infant mortality in Maryland.
NNAMDII was about to ask, have you been seeing results from that?
SHARFSTEINYeah. So from, you know, the ban is about to take effect, but the message has really been out there, particularly in the city of Baltimore where I was health commissioner. I remember when we had 20 babies a year dying in unsafe sleep conditions. And that number has really dropped. There has been a terrific public education campaign that has featured moms who lost their babies, looking right the camera. And it's really made a big difference. And we're hoping to avoid mixed messages and have a strong effort on safe sleep.
NNAMDII'm afraid we're almost out of time, but we've had the pleasure of having two guests in our studio this hour, two young gentlemen by the name of Sam and Isaac, who, it is my understanding, have led an exemplary life...
NNAMDI...and have been behaving really well in the studio. It's my understanding that they are here in order to make sure that you really do work for a living. You know these young men?
SHARFSTEINYou know, I do know them. I really appreciate your openness to hosting them and showing them around the control room. It's summer vacation, and they didn't get -- they get to see what their dad does today.
NNAMDIThey are, in fact, Joshua Sharfstein's sons. Joshua Sharfstein is the secretary of health and mental hygiene for the state of Maryland. He's also a medical doctor. Thank you so much for joining us.
SHARFSTEINThanks for having me.
NNAMDIAnd thank you all for listening. I'm Kojo Nnamdi.
The suspect accused of murdering a Muslim teenager in Fairfax County, Va. was an undocumented resident. What role does his immigration status have when we discuss his crime?
The abduction and killing of Nabra Hassanen, a 17-year old Muslim from Reston, shocked people across the country. Members of Northern Virginia's Muslim community join Kojo to reflect on Nabra's life, how her death has affected their community and offer their perspective on Muslim life in the region.
D.C. Police Chief Peter Newsham discusses the ACLU lawsuit against MPD officers for their actions during Inauguration Day protests. And Democratic candidate for Maryland Governor Alec Ross is in studio.
Creative industries like film and television are represent different viewpoints and upbringings. Now, children's literature is getting into the game.


text:
WRAPUP 2-Japan tech firms signal no recovery yet
* Fujitsu Q2 oper profit down 42 pct vs consensus 46 pct fall
* Retains annual outlook - still above market forecast
* NEC Elec sees bigger annual oper loss, more than mkt fcast
* Demand still a big worry for sector - analysts
* Taiwan's UMC sees weaker Q4 wafer shipments
(Recasts lead, adds UMC results, fund manager comment)
By Mayumi Negishi and Mariko Katsumura
TOKYO, Oct 28 (Reuters) - Results from Japanese technology groups such as Fujitsu (6702.T: Cotización) and NEC Electronics (6723.T: Cotización) indicated the worst is not yet over for the struggling sector as the sector grapples with sluggish demand.
NEC Electronics (6723.T: Cotización), Fujitsu's rival in high end chips, expects a slowdown in chip output, while Taiwan's UMC (2303.TW: Cotización), the world's No.2 contract chip maker, forecast weaker wafer shipments in the fourth quarter. Continuación...

subset: commoncrawl


text:
Related Publications
- Related by Author
- Related by Topic
Related Links
Anna O., Bertha P., Jewish Feminist
Eugene Borowitz, December 10, 1980
Topic: Feminism, Leadership, Jewish Organizations
Name of Publication: Sh'ma: A Journal of Jewish Ideas
Editor: Borowitz, Eugene B.
Volume/Issue: Vol.11/no.203
Page Number(s): 17-19
Genre: Article
Coverage: Germany , United States
Language: English
Copyright Holder: Publisher
Copyright Information: Download for personal use, freely distribute link
Bibliographic Information:
Cardin, Nina Beth. Anna O., Bertha P., Jewish Feminist. Sh'ma: A Journal of Jewish Ideas. Eugene Borowitz. 10 December 1980: 17-19. http://www.bjpa.org/Publications/details.cfm?PublicationID=7673
» View Publication
(PDF, 3.16 Mb)


text:
Gators Drafted in 4th and 5th Rounds
It's been 29 years since the Florida Gators had seen this type of futility in the NFL draft. But on Sunday, a few Florida players got the school back in the right direction. Defensive tackle Jaye Howard was selected 114th overall in the fourth round to the Seattle Seahawks, and running back Chris Rainey followed him in the fifth round, 159th overall, to the Pittsburgh Steelers.
Florida State also had to wait a while to see players from its school selected in the NFL draft. Outside linebacker Nigel Bradham (105) and offensive tackle Zebrie Sanders (144) were picked in the fourth and fifth rounds by the Buffalo Bills, respectively. Cornerback Mike Harris was selected in the sixth round by the Jacksonville Jaguars (176). Offensive tackle Andrew Datko was picked by the Green Bay Packers in the seventh round (241).
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text:
Alabama Hands Georgia A 6-3 Loss
March 23, 2013
Final Stats | Photo Gallery | Final Stats (PDF)
ATHENS, Ga. ---- Georgia's defense committed three errors Saturday helping Alabama to a 6-3 victory over the Bulldogs at Foley Field.
Georgia (8-15, 0-5 SEC) entered the weekend ranked third in the league in fielding at .979, but the Bulldogs have committed five errors during the series and stranded 18 runners to drop their seventh in a row. Alabama (15-9, 4-1 SEC) has made a number of exceptional defensive plays to thwart potential big innings.
Georgia threatened to get on the board first for the second day in a row after Nelson Ward and Curt Powell reached on back-to-back singles in the bottom of the first. However, Alabama starter Jon Keller was able to escape by forcing Jared Walsh to fly out to center field with two outs and the bases loaded. Powell's single extended his hit streak to five games.
The Bulldogs loaded the bases again in the bottom of the second inning, but this time ended with one run. J.T. Phillips led off the inning with an infield single then later scored on a sacrifice fly by Powell to put Georgia up 1-0.
Alabama was able to get on the board in the top of the fourth inning thanks to a two- run single by Cameron Carlisle. Ben Moore led off the inning and reached base on a throwing error by Curt Powell from third. The Tide were then able to load the bases thanks to a single by Brett Booth and a one out walk by Kyle Overstreet before Carlisle's single that scored Moore and Booth.
The Tide weren't done there as Mikey White followed Carlisle with an RBI single into right center field, scoring Overstreet for the third run of the inning with just one out. The Bulldogs were finally able to end the inning on a terrific catch and throw double play by left fielder Cody Sheedy that caught Carlisle at home trying to tag up from third.
Alabama then was able to extend their lead again in the top of the sixth in a bizarre play. After leading off the inning with an infield single, Booth advance to second on a passed ball. Austen Smith then hit a routine grounder to Kyle Farmer at short, who elected to throw to third in an attempt to retire Booth who was trying to advance. Powell then threw to Ward at second, who threw back to Farmer at third; however, Farmer was unable to make the tag as Booth stumbled into third. Booth then sprinted home and scored after noticing that the catcher, Brett DeLoach, had come to third base to back up the run down and no one was covering home.
After allowing the next batter, Overstreet, to single into right field and advance Smith to third, Georgia starter Patrick Boling was pulled in favor of reliever Jarrett Brown. Boling finished the day allowing five runs, just two earned, on five hits with one strike out and four walks through five and a third innings pitched. He got the loss to fall to 1-3.
The Tide were able to tack on one more run in the top of the sixth thanks to a throwing error from DeLoach on an attempt to catch Smith in a pickle after trying to tag up on a pop out to right field by Carlisle. The two-run sixth gave Alabama a 5-1 lead, with only three of their five runs coming from errors by Georgia's defense and a mental miscue on the failed rundown attempt.
The Bulldogs offense was able to threaten the Alabama lead in the bottom of the seventh inning after Keller walked three straight batters to load the bases with just one out and Powell and Farmer due up. Alabama elected to pull Keller for reliever Keaton Haack who struck out Powell, then forced Farmer to ground into an inning ending fielder's choice. Keller ended his day with a win, allowing just one earned run on six hits, with four strikeouts and four walks through six and a third innings pitched. He improved to 3-2.
For the second game in a row, the Bulldogs put together a late offensive charge in the bottom of the ninth in hopes of completing a comeback. After retiring the first two batters of the inning, Haack surrendered a single to Ward and then walked Powell. Farmer then laced a double down the left field line that scored Ward, and also extended his hit streak to nine games. Hunter Cole then lined an RBI single up the middle to cut the lead to three. Unfortunately Haack was able to stop a comebacker from DeLoach and make the throw to first to record the final out of the ball game. Haack notched his first save.
"We made some mistakes again today, and what's concerning me is we're leaving to many guys on base and our starters this weekend are walking to many," said Georgia coach David Perno. "Alabama does a good job of two-strike hitting and has made some great plays defensively in the series. Some of their hits are finding holes too, but we've had our opportunities the past two days too. I think Sean (McLaughlin) and Patrick (Boling) have tried to go for the strikeout and Alabama battles at the plate. I was encouraged how Jarrett Brown and Luke Crumley came in out of the bullpen."
The Bulldogs look to avoid a sweep and capture their first conference win of the 2013 campaign Sunday at 2 p.m. at Foley Field.
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text:
Now I know this is not going to be a comfortable discussion. But I recently discovered that Thomas Harris is NOT a son of Sir William Harris (b.1556) of Crixie, Essex, England.
As collaborators and managers of these profiles, I open this discussion to see what protocols we might consider when we make this discovery. This is a reality that is going to happen from time to time. It's nobody's fault. The discovery might not have happened were it not for a researcher who happened to discover the will of the unmarried and sickly Thomas Harris in an old vault. See the information below:
"I used to hold to the belief that Captain Thomas Harris of Jamestown, VA was the son of Sir William Harris, b. ca. 1550 Creeksea, Essex Co., England, d. 14 Nov. 1616 Creeksea, Essex Co., England who married 1582 to Alice Smith, b. ca. 1556 Weston Hanger, Kent Co., England, d. ca. 1615 Creeksea, Essex Co., England.
This view was supported by records published by Olive and Joe Cletus Harris of Florence, Alabama. Also by John Bennett Boddie and by William Ligon. However, recent research has uncovered the will of Thomas Harris of Creeksea, Essex Co., England, who died in 1617 unmarried and without issue. All of his property was willed to his brothers and sisters. For a typed copy of this will go to The Will of Thomas Harris of Creeksea, County Essex, England, 1617.
Thus the Capt. Thomas Harris of Virginia is NOT a son of Sir William Harris and Alice Smith. That also means there is no proven Royal descent in my line of Harrises. The Harrises of Essex intermarried with the House of Percy, the Nevilles, and many other noble families, but this is now proven not to be my direct line of descent.
More research is being done on this. Current discussion on the HARRIS-VA discussion list is that Captain Thomas Harris was still a close relative of Sir William Harris of Cricksey/Crixe/Creeksea County, Essex because of his association with the Virginia Company of London that helped to establish Jamestown. Sir William Harris and his brother-in-law, Sir Thomas Smith, were heavily involved in this enterprise in the New World."
What do we do? I've been enshrouded in sackcloth and ashes for two days over this.
I've edited and merged some of these accounts. (Though I don't actually manage any of them, I collaborate with many who do and I'm on the auto-approve list of several.) I certainly want to help correct the information and ensure I'm not propagating bad information! I haven't had time to fully investigate the situation, but I will soon. This is just a note to say I intend to help.
And this is something that we will all grow in investigating. You're quite right, none of us want to continually propagate the same errors over again. As I said in "collaboration pool," the problem is that is a fluid project. It is not static like a single family tree, wherewith soft research of compromising quality will create a Family Tree with royalties and anything you can think of. Add to it, no one is to "dare" question it's authenticity.
The energy spent with us online shows that we ARE interested in knowing our family's truth, whether good or not-so-good. Truth is our intent. I think the biggest hurdle is consensus. and source. We likely could be the ones that can research and find the correct ancestors to these branches.
I think this Thomas Harris is a close relative, whether nephew or cousin to Sir William, since they are from the same location. It's a matter of doing the research. But it's not my intent to place a person in my tree, to delude myself and others over royalty.
I don't think we'd want to merge the two Thomases. I guess it would be more like first finding the correct parents for Capt. Thomas Harris, and then see how they may relate or not relate to Sir William Harris. Most researchers conclude he must be a relative to Sir William, but how.
I will provide you the tree here:
This Captain Thomas Harris is NOT the son of Sir William Harris and ALyce Smith as shown in this tree diagram. The point is that many people who have included this family in their tree now have an error as to this Thomas Harris' ancestors. We have no information as yet who are the real ancestors. But we will discover such errors from time to time. We need to determine how to correct these errors.
Hope I'm clearer. If you haven't included this person in your tree, be careful not to include the erroneous information.
When I click on http://www.geni.com/family-tree?ref=ph#6000000003962613089 it tells me it can't fulfill the request.
Hi Michael,
Sorry about the confusion. Are you a Geni Pro subscriber? I'm saying that because I think there may be some limitations on being able to see the Family Tree if you're not subscribed. I have two accounts, one free and one not. So I think that's why you're not able to see the tree.
So sorry for the confusion.
Not to spoil the fun here, but I cannot see anything in the William Harris will that at all warrants or even hints at your conclusions. Anyone who has done much colonial genealogy will tell you that old wills almost never mention children who have left the county (and far less the continent!) to reside elsewhere since it was unlikely the legatee would ever return to the ancestral home to claim it and any legacy would wind up going to the king. His not mentioning a wife merely suggests he died a widower. Additionally, such wills were often written hastily near the time of death and there was not much motivation for including historical information not pertinent to the legal business of the document.
Ann and Patrick, my reading of the evidence as presented is that while William Harris did have a son Thomas, that son died around 1617 and therefore was not the same Thomas Harris as the one who died in 1682. While this first Thomas was named in his father's 1616 will, he was not named in his brother's 1622 will, and Ligon's own statement is, "Between the dates of the two wills before mentioned, 1616, and 1622, no will nor administration of any Thomas Harris of this family is found, so he evidently was not deceased." The subsequent finding of the proven 1617 will at Chelmsford of Thomas Harris, son of the above-named William, would seem to clearly make Ligon's assumption disproved.
I suspect I was involved in part of this (the dating system in the display name appears to be the one I use).
I'd agree with Pam in that the best thing to do to prevent this sort of mistake is to insert pertinent information in the About Me page, so that if there are mistaken merges, etc., attention can be given to the mistake right away, and further mis-merging halted. Ideally, there should be information not only about important dates (birth, baptism, marriages, death), but also the relationships (parents, siblings, spouses, children). Biographical information wouldn't hurt, either.
It's frustrating to run into situations where there is no such information to work from, particularly when faced with merging profiles with widely varying information (same name, same relationship to a nearby family member, but the dates being off, etc.). And if the information isn't in the About Me, whether this is correct or not, I tend to feel like the profile was placed with not so much research. So the window for variation that I tolerate becomes broader. I'm probably not the only merger that feels that way.
But I'm always willing to assist with corrections on mistakes like this, where they are pointed out, and of course where the help is welcome.
With much documentation connecting Captain Thomas Harris to so many of the families in Essex also involved in the colonization of Virginia it is very difficult to accept that he is not closely related to Sir William Harris. Has the will of Thomas Harris in 1617 been truly authenticated? Odd that it only recently appeared when these things were so well documented by royals. Are there any cross references such as church documents, other family papers, etc to support this issue? If he was very sickly then there should be medical notations in journals. I do not mean to be a nay-sayer; I simply want to know for sure before I change my husband's tree.
This discussion is about Capt. Thomas Harris, I
This same subject has come up again
I've had a few nasty surprises like that - for instance, finding a verified list of the children of Rev. Haute Wyatt, and (surprise!) Nicholas Wyatt is NOT on it. So despite widespread belief that Nicholas was the Rev.'s son - he wasn't.
(It was always suspicious that Nicholas was a Dissenter who became a convinced Quaker, while the Rev. was definitely Church of England albeit with Low or Broad leanings - but people can change as they grow up. On the other hand there are lots of Wyatts in Devonshire, including a fair number of Nicholases, and the area was a hotbed of Dissent. So the most promising place to look for ancestors of Nicholas would be there.)
Then there was Frances White Wells...there was just enough circumstantial evidence surrounding her that I wound up splitting the difference and treating her as the daughter of Sir Richard White by his first wife, Anne Gray. But primary documentation is still missing.
The siblings named in the 1617 Will of Thomas Harris in England match the names of the children of Sir William Harris of Crixie shown on the 1612 Visitations of Essex and the unpublished records of the heralds at the College of Arms in London who hold a Crown Warrant to keep records of all families of nobility. This is the body that grants new coats of arms or revised one to sons inheriting a title, also for Burke's Peerage listings. The only sibling not named is his sister Alice who had committed suicide in 1615 over her unhappy marriage to Sir Henry Mildmay. This will was published in 1994 in "The Virginia Genealogist"
so it is not something that just suddenly appeared. yDNA from lining direct male Harris descendants show a possible match to the line of Sir William Harris d1616, but back 5-6 generations.
So all the children of Sir William Harris of Crixie are accounted for, and Capt. Thomas Harris is *not* one of them.
Negative findings, even when disappointing, are still informative.
Sounds as though he's maybe a scion of a cadet line - the Visitations, even when they're accurate (and they aren't always), are generally not much help with that sort of thing.


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X5 xDrive35d catastrophic engine failure
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Resident Curmudgeon
Location: Sierra foothills, California USA
Join Date: Jul 2009
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Mein Auto: '12 X5 35d/E39M5/996TTX50
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Hi Jerry-
Thanks for the thorough update.
So some quick comments:
1. I suspect that both new and remanufactured engines ship from Germany. Just FYI. I am actually not as concerned as others may be about a 'reman' that comes out of a BMW plant, but if you are, make sure you know what you are getting. The dealer may be shorthanding it, but maybe not.
2. I would (and I do/did, every time I have a dealer visit for warranty work) insist on a copy of every single document in my service record- all the juicy stuff that is usually stapled to the work order packet and filed away or copied to BMWNA. They will have you sign some cover sheet, and you get a ridiculously short "official" record .... but you want the entire record (well, I do). I want the DME print outs, everything. I simply say, sweet as pie to the gal processing the paper. "Could I just get a copy of all this before I sign for it?". I've never been refused. Think of it like medical records- it is your car, you have a right to it. If issues come up later with tranny, etc, your having the work history might be invaluable...
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Navigation: Previous Page | Contents
Section 28 of the Intelligence Services Act 2001 (the IS Act)
establishes the Parliamentary Joint Committee on Intelligence and Security. The
Act governs its size, structure, functions, procedures and powers. This report
is made in compliance with section 31 of the Act which states that:
As soon as practicable after each year ending on 30 June, the
Committee must give to Parliament a report on the activities of the Committee
during the year.
This report covers the period from 1 July 2011 to 31 June 2012.
Section 28 (2) (3) of the IS Act stipulates that the Committee is a
joint Committee of Parliament comprised of eleven members, five of whom must be
Senators and six of whom must be members of the House of Representatives. A
majority of the Committee's members must be government members.
Members are appointed by resolution of the House or the Senate on the
nomination of the Prime Minister or the leader of the Government in the Senate.
Prior to nomination, consultation must take place with the leaders of
recognised parties in each of the Houses.
Under section 29 of the IS Act, the Committee is charged with reviewing
the administration and expenditure of all six intelligence agencies: ASIO, ASIS, DSD, DIGO, DIO and ONA. Other matters may be referred by the responsible Minister or by a
resolution of either House of the Parliament.
In addition to this function, the Committee is required to review the
operation, effectiveness and implications of:
Amendments made to the Criminal Code Act 1995 (the Criminal
Code), made in March 2004, further tasked the Committee with reviewing
regulations which specify organisations as terrorist organisations for the
purposes of section 102.1 of the Criminal Code. The Committee's findings on its
reviews of these regulations are to be tabled before the end of the
disallowance period, 15 sitting days from the tabling of the regulation.
Two reports reviewing regulations which specify organisations as
terrorist organisations were tabled during the reporting period.
The Committee is a statutory committee. Section 29 of the IS Act
outlines the oversight capacity of the Committee. However unlike other
statutory or standing committees of Parliament there are specific limitations
in this section with regard to the Committee's capacity to inquire into
operational matters and the intelligence gathering and assessment priorities of
the relevant intelligence agencies.[1] Again the Committee
reiterates that, due to this limitation, balancing national security and
parliamentary scrutiny remains a challenge for the Committee.[2]
Despite these constraints, the Committee is ever mindful of its critical role
in ensuring that Australia's intelligence agencies remain accountable through
continuous public scrutiny.
Authority to inquire into special cases and operational matters lies
with the Inspector General of Intelligence and Security (IGIS) under the Inspector
General of Intelligence and Security Act 1986. In conjunction with the IGIS
the Committee provides essential bi-partisan oversight of the AIC.
Specific prohibitions on the Committee's activities include the
The IS Act also specifies the Committee's powers in relation to
requesting witnesses and the production of documents. Clause 2 of Schedule 1
specifies that the Committee may give a person written notice requiring the
person to appear before the Committee with at least 5 days notice, as well as
notice of any documents required by the Committee.[4]
The Minister may prevent the appearance of a person (not an agency head)
before the Committee to prevent the disclosure of operationally sensitive
information either verbally or in a document. To achieve this, the Minister
must provide a certificate outlining his opinion to the presiding member of the
Committee, to the Speaker of the House of Representatives, the President of the
Senate and the person required to give evidence or produce documents.[5]
There were no cases where this power was exercised during the year in review.
The IS Act also contains a protection, under subclause 7(1) of Schedule
1, against the disclosure in Committee reports of operationally sensitive
information, namely:
Unlike the reports of other parliamentary committees which are
privileged documents which may not be disclosed to anyone outside the committee
itself until after tabling, the Intelligence and Security Committee must obtain
the advice of the responsible Minister or Ministers as to whether any part of a
report of the Committee discloses a matter referred to in subclause 7(1) of
Schedule 1. A report may not be tabled until this advice is received.[7]
Lastly, to protect the national security status of the Committee's work
and to maximise the Committee's access to information, the IS Act requires that
staff of the Committee must be cleared for security purposes to the same level
and at the same frequency as staff members of ASIS.
In addition to the security requirements for staff all new members of
the Committee in 2010-11 were informed of the main legislation governing
information regarding the AIC.
This information to members specifies that Section 92 of the ASIO Act
1979 makes it illegal to divulge the names of employees or former employees of
ASIO. Section 41 of the IS Act makes it illegal to divulge the names of
employees of ASIS. Sections 39, 39A and 40 of the IS Act make it illegal to
divulge the names of employees or former employees of ASIS, DIGO and DSD. These
sections also make it illegal to divulge information connected with functions
of or information that relates to performance of functions of ASIS, DIGO and DSD. Members were also informed that this prohibition extends to information
Committee members receive at briefings by these agencies.
Reviewing administration and expenditure on an annual basis is one of
the primary functions of the Committee. Section 29 of the IS Act stipulates
that the Committee has an obligation to review the administration and
expenditure of ASIO, ASIS, DSD, DIO, DIGO and ONA including the annual
financial statements.
On 18 June 2012 the Committee tabled its Review of Administration and
Expenditure No. 9, 2009-2010.
This review, tabled on 18 June 2012, examined a wide range of aspects of
the administration and expenditure of the six intelligence and security
agencies, including the financial statements for each agency, their human
resource management, training, recruitment and accommodation. In addition the
review looked at issues of interoperability between members of the AIC.
Submissions were sought from each of the six intelligence and security
agencies, from the Australian National Audit Office (ANAO) and from the
Inspector General of Intelligence and Security (IGIS).
The submissions from ANAO and the six intelligence agencies were all
classified Confidential, Restricted or Secret and were therefore not made available
to the public. As has been its practice for previous reviews, ASIO provided the
Committee with both a classified and an unclassified submission. The
unclassified version was made available on the Committee's website.
Each of the Defence intelligence agencies provided the Committee with a
classified submission. The agencies marked each paragraph with its relevant
national security classification. This enabled the Committee for its 2009-10
review to directly refer in this report to unclassified information provided in
the Defence agencies submissions.
The Committee also received five submissions from members of the public
or public organisations which included:
These submissions all dealt with ASIO security assessments of refugees.
On 25 March 2011 the Committee held a private hearing at which ASIO,
ASIS, DSD, DIGO, ONA and DIO appeared before the Committee. On 16 June 2011 the
Committee held a public hearing — its first since July 2006 — and heard from
representatives of the Refugee Council of Australia, RISE (Refugees, Survivors
and Ex-Detainees), the Asylum Seeker Resource Centre and ASIO in relation to
visa security assessments.
The Committee noted the request by some advocacy groups for ASIO to
declare its non-statutory criteria for making visa security assessments. The
Committee found that making non-statutory criteria publicly available could compromise
national security because applications from potentially hostile individuals
could be tailored to meet these criteria. The Committee therefore did not
support this suggestion.
The Committee noted that since its previous administration and expenditure
inquiry, ASIO's visa security assessment workload has increased significantly.
Processes for undertaking visa security assessments have been placed under
considerable strain and, in some cases, assessments have taken longer than is
The Committee took very seriously the concerns put before it by various
refugee and asylum seeker advocacy groups but it also recognised that the job ASIO
has is a very difficult one. Therefore, the Committee welcomed the efforts,
introduced by ASIO on 1 March 2011, to streamline the process of security
assessments in an attempt to clear the backlog and to process future assessments
in less time. The Committee was satisfied that the current regime for visa
security assessments is the correct one and noted that the IGIS has stated that
ASIO is doing its job in a "proper and legal manner".
Overall, the Committee was satisfied that the administration and expenditure
of the six intelligence and security agencies is sound.
However concerns raised in relation to the Efficiency Dividend's impact
on agencies during the Committee's Review of Administration and Expenditure:
Australian Intelligence Organisations, Number 8 were specifically raised in
the evidence the Committee took for this review. This was extremely concerning
to the Committee.
The Committee was pleased with the level of information given to it in
relation to interoperability and will continue to monitor this area to ensure
that interoperability management and budgetary structures are in place across
the AIC.
This report, tabled on 22 August 2011, reviewed the initial listing of
the terrorist organisation known as Al Qa'ida in the Arabian Peninsula
and the re-listing of six previously listed terrorist organisations, namely:
Due to the dissolution of the 42nd Parliament and the 2010
Federal election, advice to the Committee from the Attorney-General's
Department of the new listing and the re-listings was unavoidably delayed and
the Committee was therefore unable to review these organisations and report to
Parliament within the disallowance period. However, the Committee resolved to
review the new listing of Al Qa'ida in the Arabian Peninsula and the re-listing
of six other terrorist organisations and report to Parliament, albeit outside
the disallowance period.
The Committee would not have recommended disallowance of the regulations
for any of these seven organisations had the Committee been able to complete
its review within the disallowance period.
As with previous Committee reports on listings and re-listings of
terrorist organisations, this report identifies issues relating to the current
nature and reach of each of the organisations, with particular emphasis, in the
case of the six re-listings, on developments since the Committee last reviewed
these organisations.
As mentioned above, this was the first listing of Al Qa'ida in the
Arabian Peninsula – also known as AQAP. The Committee took evidence that AQAP has
been involved in a number of terrorist attacks in the Arabian Peninsula, both
within and outside Yemen.
Terrorist attacks which AQAP has recently claimed responsibility for include:
This was the fourth re-listing of Al-Qa'ida, Jemaah Islamiyah, Al-Qa'ida
in the Lands of the Islamic Maghreb, Jamiat ul-Ansar and the Abu Sayyaf Group;
and it is the third re-listing of Al-Qa'ida in Iraq. In each case the
Committee was satisfied that each of these groups continued to engage in
terrorist activities which could be a threat to Australians or Australian
interests either here in Australia or overseas.
This review was tabled on 28 May 2012
Ansar al-Islam (AAI) plans and conducts attacks against foreign forces,
Shia, Kurdish and Iraqi government interests. AAI's attacks most commonly
target US and Iraqi security forces in Iraq using Improvised Explosive Devices
(IEDs) and Indirect Fire (IDF) attacks.
The Statement of Reasons listed over fifty attacks for which AAI has
indicated responsibility, by posting a video or media statement, in the period
since the last review. Their methods have included assassinations, the use of
small arms, thermal grenades, and IED and mortar attacks against Iraqi police
and military personnel and against US military patrols, bases and vehicles.
The Committee recommended that the regulation in relation to Ansar
al-Islam not be disallowed.
The Islamic Movement of Uzbekistan (IMU) is a militant Islamist group
based and operating in Central and South Asia. The group established relations
with the Taliban and Al-Qaeda, and allegedly became extensively involved in narcotics
trafficking. One of its founders, Namangani, was killed during the US-led
invasion of Afghanistan in 2001, and the remnants of the IMU fled across the
border to the Federally Administered Tribal Areas (FATA) of Pakistan.
Although its capabilities were severely degraded, the following years
saw the IMU regroup in the South Waziristan area of the FATA, where it
established close links to a number of Pakistani Taliban groups and reportedly
participated in cross-border attacks on the International Security Assistance
Force (ISAF) in Afghanistan.
Notwithstanding increasing pressure from ISAF and Pakistani security
forces, reports throughout 2010 indicated that the IMU had re-established an
operational presence in northern Afghanistan, and the group also claimed
responsibility for a series of attacks in Tajikistan.
The Committee recommended that the regulation in relation to the IMU not
be disallowed.
The statement of reasons indicated that Jaish-e- Mohammed (JeM) is based
in Pakistan and operates primarily in Indian Administered Kashmir (IAK). JeM
operatives have been involved in attacks against civilian and military targets
in Afghanistan, India and Pakistan. JeM attacks have included suicide bombings
in 2001 and 2003 with most attacks since that time involving grenades and
JeM continued to concentrate its efforst against Indian security forces
(military and police), government installations and civilians in the disputed
territory of IAK. In addition, JeM has broadened its operational focus to join
the Afghan Taliban in attacks against government and Coalition forces in
The Committee recommended that the regulation in relation to JeM not be
Jane's Terrorism and Insurgency Centre states that Lashkar-e Jhangvi (LeJ) activities
have been curbed following the arrest of key leaders and the particular focus
of the military and police authorities on the group, resulting in the arrest of
hundreds of activists.
Following the killing of Al-Qaeda leader Osama bin Laden in May 2011,
the LeJ vowed to conduct a series of retaliatory attacks. To this end, a
spokesman for the LeJ, identifying himself as Ali Sher Haidri, released a
statement in mid-May 2011 threatening to avenge Bin Laden's death by targeting
not only government ministers and security force personnel but also Shia Muslims
from the ethnic Hazara community in Pakistan.
The LeJ followed through with these threats with a series of significant
attacks in and around Quetta between May and July 2011.
The statement of reasons listed twelve acts of terrorism attributed to or
suspected of being perpetrated by the LeJ.
The Committee recommended that the regulation in relation to LeJ not be
On 15 September 2011 the Committee received a private briefing on
Parliament's IT Security.
On 21 November 2011 the Committee received a private briefing from Mr
Brett Walker SC, the Independent National Security Legislation Monitor.
On 19 March 2012 the Committee received a private briefing from the AFP
Commissioner Tony Negus and AFP Deputy Commissioner, National Security, Peter
On 22 March 2012 the Committee received a private briefing on the Independent
Review of the Intelligence Community from Dr Margot McCarthy, National
Security Adviser and Mr Richard Sadleir, First Assistant Secretary, Defence and
Intelligence Division of the Department of Prime Minister and Cabinet.
On 28 June 2012 the Committee received a private briefing from the
Attorney-General, the Hon Nicola Roxon MP in relation to the proposed terms of
reference for an inquiry into potential reforms of national security
legislation. As the inquiry had not commenced within this reporting period the
Committee's conclusions will be reported in the Annual Report of Committee
Activities 2012-2013.
Since 2002, the Committee has sent representatives to the biennial
conference of oversight agencies. In 2002 the conference was held in London,
in 2004, in Washington, in 2006, in South Africa, in 2008, in New Zealand and,
in 2010, the conference was hosted by the PJCIS and the IGIS in Sydney.
The 2012 conference was held in Ottawa, Canada between Sunday May 27 and
Wednesday May 30.
Attending on behalf of the PJCIS were:
The program was as follows:
The delegation found the IIRAC Conference invaluable and meetings with
like Committees of other jurisdictions in the host country were worthwhile.
These should continue to be organised around subsequent IIRAC Conferences.
No issues of particular concern arose during 2010-11.
To fulfil its statutory and other obligations the Committee is reliant
on secretariat staff. In the reporting period the Committee was supported by
four full time parliamentary officers. This consisted of a secretary, an
inquiry secretary, a senior research officer and an office manager.
All staff are required under the Intelligence Services Act 2001
(Schedule 1 Part 3 section 21) to be cleared to the 'level of staff members of
ASIS' or a top secret positive security clearance (TSPV). Two staff were
cleared to this level. These staffing and clearance levels were sufficient for
the work of the Committee.
Other staff of the House of Representatives have been cleared to the
required level.
The Hon Anthony Byrne, MP
Back to top


text:
UN warns Somalia killings threaten food aid
By Wangui Kanina
NAIROBI (Reuters) - The United Nations will be forced to end food distribution in Somalia unless armed groups stop attacking U.N. staff, the World Food Programme (WFP) said on Thursday.
Humanitarian workers have been targeted during a two-year-old rebellion by Islamist insurgents that has killed more than 16,000 civilians and uprooted one million others.
Four WFP staff have been killed since August last year.
Peter Goossens, WFP country director for Somalia, said in neighbouring Kenya the U.N. agency was distributing about 57,000 metric tonnes of food to southern and central regions that should feed some 2.5 million people until around mid-February.
"That is it basically," Goossens told a news conference.
"Unless we get positive assurances from the population, authorities and whoever is in control of such areas that our staff can safely function, we will have no choice but to stop distributing food in those specific areas."
Underlining the risks to aid workers, an unknown group dropped leaflets in the central town of Badme, warning humanitarian workers to leave the area.
Various Islamist rebel factions control most of south and central Somalia, while feuding militias hold sway elsewhere and 3,500 African Union (AU) peacekeepers are based in Mogadishu. Continued...


text:
Thumbelina: (pauses for dramatic effect – then makes a sweeping hand gesture) "FIREBLADE."
Mom: "That may be the most awesome thing I have ever heard."
Thumbelina: 'Yeah. I know. I love that name." (whispers in awestruck voice) "FIREBLADE."
Hawk (age 5): "When I'm in band when I'm older, do you know what I'm going to call it?"
Mom: "I love it."
Hawk: "We are the Champions" and other awesome songs like that.
Mom: (pauses to let this idea sink in) "I think you're both going to be rock stars."
Hawk and Thumbelina look at each other and shrug.
Hawk: "Duh."
(c)Herding Turtles, Inc. 2009 - 2010


text:
|Thread Tools
41 top and overheat problems
Please accept my sincere apologies if this should have been posted in "exterior" section...
I am a newbie to this forum but by reading some of the posts there seems to be more than just a few extremely knowledgeable folks here, so here goes.
Dad an I built 3 cars when I was growing up (32 Ford, 48 Chevy, and a 65 Mustang) but after college I got away from cars. Dad built his last car, a 41 Ford Super Deluxe Convertible, after I went to school. Subsequently I have had very little knowledge of how this car was put together (since I usually helped in the dismantling prior to assembly). He passed suddenly four years ago and the car sat in dry heated storage during that time.
Last weekend and a couple of hundred miles later, it sits in my garage. I changed all the fluids, dropped the gas tank and purged the fuel line, changed the battery, and of course Henry would not be surprised to hear that the flathead started and idles like a kitten.
Two questions: 1. How does the top go down? I know there are two top motors in Mom's basement that have to be rebuilt, so they are not installed on the car as of yet. I also know that Dad had the top down because there are pictures of it! There does not seem to be ANY corrosion on the top linkage. Should it not just lift from the front bow and collapse back? Or is there a release latch somewhere I am not aware of?
2. It seams to run hot....the temp gauge works, and the top hoses are hot to the touch so I think fluid is circulating but how do I know the water pumps are actually working?
Thanks for any information that you folks can give and I will be posting pics as soon as the girl gets a well deserved bath....
Hi and welcome to Hotrodder's. Exterior is for painting and body work questions, and Interior is for seats and other parts of a car's interior. Lets put this in General Rodding Tech to answer the hot hose question.
The top should latch in the front by the windshield, and if the motors are not connected, you should be able to just lift the top manually and it will fold back with no problem.
No one lives forever, the trick is creating something that will.
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text:
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Nathan Jahnke of ProFootballFocus.com joins the show to discuss, Lacy's replacement—James Starks—among other Packers topics.
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