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Endorse This: A Kiss From John Boehner?

Endorse This: A Kiss From John Boehner?

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Speaker John Boehner (R-OH) gave a, well, very interesting response when reporters asked him what he’s going to do in the current standoff on President Obama’s executive actions on immigration and funding for the Department of Homeland Security.

Click above to watch Boehner really play hard-to-get with the press corps — then share this video!

Video via CNN.

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Ebola ‘Czar’ Urges Congress To Authorize Emergency Funding

Ebola ‘Czar’ Urges Congress To Authorize Emergency Funding

By Matt Hansen, Tribune Washington Bureau (TNS)

WASHINGTON — The Ebola outbreak can only be successfully contained if the U.S. takes the lead and provides funding to fight the deadly virus at home and in West Africa, the man tapped to coordinate the federal government’s response to the disease said Friday.

“In this case, America has to lead, and it has led,” said Ron Klain, the nation’s Ebola “czar,” reiterating the administration’s appeal for more money from Congress to fight the disease.

Klain called on lawmakers to pass an emergency spending request put forth by President Barack Obama that would authorize $6.18 billion for domestic readiness as well as efforts on the ground in West Africa. Of that amount, $1.54 billion would be used as reserve funding in case of a resurgence of the disease or a worsening outbreak in the United States.

Klain said that though U.S. efforts have had an effect in fighting the outbreak, dedicated funds need to be set aside for recurrences, even as public attention in this country has drifted from the threat.

“No one, a year ago, had Ebola response in their budgets,” he said during a talk at Georgetown University alongside Dr. Anthony Fauci, director of the National Institutes of Health. “Those resources are running out. The only way we can keep up the response — let alone expand it — is to get this emergency funding request.”

Both men said that in addition to stopping the current outbreak, increased funding could have a significant effect on devastated health care systems in West Africa and other parts of the world where insufficient or nonexistent health care can exacerbate the spread of disease.

“If something good comes out of this, it is a realization that if you do not have a minimum modicum of health care infrastructure, how vulnerable you are to so many things,” Fauci said.

More than 17,000 people are now infected with Ebola in West Africa, according to the World Health Organization, and more than 6,000 people have died. Though cases have slowed in Liberia, they have jumped in neighboring Sierra Leone and moderately increased in Guinea, the WHO said.

Klain noted the deaths of other patients from medical complications, including malaria, because doctors have been overwhelmed by the Ebola outbreak.

The federal government’s response to the epidemic accelerated after a Liberian man visiting the United States became the first person to die of the disease in this country. Later, two nurses who treated the man were hospitalized with the virus, but they recovered. Since then, an American doctor returning from Guinea has also recovered from the virus, but a surgeon from Sierra Leone who was transferred to an American hospital has died.

Klain, who has been criticized by Republicans for his lack of medical experience, said he was tapped for the job because of his experience handling complicated projects involving multiple government agencies. He said the Ebola response was particularly challenging because it involved multiple layers of government, including state departments of health and local hospitals.

“I never feel as un-czar-y as when I’m trying to deal with this complicated patchwork of federal, state and local systems,” he told the audience.

Five U.S. airports that handle much of the incoming traffic from Ebola-stricken countries now screen for the virus, and state health departments have established 21-day monitoring programs for travelers returning from West Africa. The Department of Health and Human Services has announced that 35 hospitals across the country have established Ebola treatment wings, saying that 80 percent of returned travelers at risk for Ebola infection now live within 200 miles of a designated hospital.

More than 3,000 U.S. personnel are also active in West Africa, focused on building treatment centers and conducting training and testing.

Fauci said the public’s response to the disease has calmed as more information about the nature of the outbreak was made available. He said it reminded him of the panic over HIV/AIDS in earlier decades, when he was a lead researcher into the disease.

“Fear is a raw emotion,” he said. “I saw it in spades in the HIV/AIDS epidemic. We go through risks every day of our lives … but you don’t like a new risk even if you are living with many, many risks.”

AFP Photo/Chip Somedevilla

With Funding For Training Set To Expire, Rural Doctor Shortage Persists

With Funding For Training Set To Expire, Rural Doctor Shortage Persists

By Rob Hotakainen, McClatchy Washington Bureau

WASHINGTON — After two years as a medical school resident for the Puyallup Tribe of Indians, Aaron Rhyner sees 14 patients a day, works 50 to 80 hours a week, and earns roughly $50,000 a year.

Rhyner, 29, of Tacoma, Wash., calls his work “something special,” a chance to make a difference. He’s also doing his part to help fix a growing national shortage of primary-care physicians, which is expected to approach 52,000 by 2025, hitting rural regions and Indian reservations the hardest.

Experts say the national shortage is fueled by more doctor retirements, an aging and more rapidly growing population, and more people having health insurance. Many worry that if the government doesn’t intervene, too many low-income Americans will be locked out of the U.S. health-care system.

“If you call up and you can’t get an appointment because there aren’t any primary-care physicians, you’re not getting access to health care,” Democratic Sen. Patty Murray of Washington state said in an interview.

Rhyner owes his job to Congress, which four years ago included $230 million in the Affordable Care Act to pay for training 550 graduate residents in 24 states.

With that funding set to expire next year, Murray wants Congress to spend $495 million more to keep the training going until 2019.

Murray, the head of the Senate Budget Committee and a veteran Senate appropriator, said her home state is expected to be nearly 1,700 doctors short by 2030.

She called the Puyallup tribe in western Washington state “a prime example” of a community that needs government help.

When the tribe created its residency program for medical school graduates three years ago, it had only two medical residents, including Rhyner.

This year the tribe is training 10 doctors, using $1.5 million in federal grant money. Its facility opened as the first osteopathic family medicine residency in the country with a Native American focus. Now there are two, with Oklahoma’s Choctaw Nation running a similar program. In Washington state, federal officials this year also paid for training programs in Yakima, Spokane, and Toppenish.

Nationwide, 60 graduate programs are operating in two dozen states this year, including California, Florida, Idaho, Illinois, Kentucky, Mississippi, Missouri, North Carolina, Pennsylvania, and Texas.

Rhyner said most of his medical school classmates at Pacific Northwest University wanted to work in specialty fields that pay more, but he wanted to focus on family medicine and “get a chance to do everything.”

He grew up in Alaska but traveled extensively. He said he liked the idea of working on a reservation and joining a startup residency program he could help shape.

“I have kind of an eclectic background in the sense that my mom is from Pakistan and my dad is from Minnesota,” Rhyner said. “So I’ve lived all over the world. … I’ve experienced Third World countries and areas where they don’t have an opportunity to get access to good health care. It makes such a huge difference when we are there and we can help them.”

When he came to the reservation, Rhyner said, he wanted to “experience the community.” He has done just that, attending powwows, and participating in sweat-lodge ceremonies.

While the Affordable Care Act that expanded health-care coverage has become a political target for many Republicans, ridiculed by many critics as “Obamacare,” Murray said the teaching program deserves to be extended.

“Look, this was part of the bill that has turned out very successful,” she said. “We are expanding on that.”

On July 31, Murray introduced a bill — the Community-Based Medical Education Act of 2014 — to keep the program running at its current level through 2019. At that point, her bill would establish permanent funding under Medicare to train primary-care physicians in community-based settings, creating 1,500 more residency slots nationwide.

Murray has her work cut out for her, even though no opposition has emerged. She introduced her bill right before Congress left Washington for its long summer recess. So far, she has yet to line up any co-sponsors, and no similar legislation has been introduced in the Republican-led House.

Photo: Joe Shlabotnik via Flickr

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More Lawsuits Are A Foregone Conclusion For California High-Speed Rail

More Lawsuits Are A Foregone Conclusion For California High-Speed Rail

By Ralph Vartabedian, Los Angeles Times

LOS ANGELES — When California voters approved $9 billion in funding for a bullet train in 2008, the ballot measure included the strictest engineering and spending controls ever placed on a major state project.

Voters were told that the high-speed trains had to hit 220 mph, get from Los Angeles to San Francisco in 2 hours and 40 minutes, operate without subsidies and obtain funding and environmental clearances for entire operating segments before construction.

The idea was to protect taxpayers from an abandoned project or one that would require indefinite taxpayer support.

Now, as state officials seek to begin construction on the $68 billion project, those conditions have become a fertile breeding ground for lawsuits over the meaning of the language voters endorsed in the ballot proposition.

One key case hinging on these issues is working its way through state appellate court after a Sacramento judge ruled in November that the high-speed rail agency had not complied with 2008’s Proposition 1A. The decision, state attorneys wrote in their appeal, could be “catastrophic” for the project.

Dan Richard, chairman of the high-speed rail authority, said the state would deliver a system that meets all legal requirements of the ballot measure.

“We are not trying to parse words and hide behind legal technicalities,” he said.

But critics and opponents, including some key players from the project’s past, say the rail authority is trying to circumvent the basic intent of the protections because the existing plan for the Los Angeles-to-San Francisco line can’t meet them.

The unusual specificity of Proposition 1A has been cited by bullet train promoters and critics to bolster their positions. And both sides have put the language and procedures set out in legislation underlying the ballot measure under an interpretive microscope. One example: Does a requirement to “design” the train so it can travel from L.A. to San Francisco in 2 hours and 40 minutes mean the state has to provide such service?

When the restrictions were written, they were considered unprecedented.

“This bond issue was extraordinary,” said Quentin Kopp, a former state senator, state court judge and former chairman of the high-speed rail authority, when the restrictions were written. “I can’t recall any general obligation bond issue that incorporated legal provisions to the extent this one does.”

In Kopp’s view, the state legislation and subsequent ballot measure were a conscious effort by the Legislature to place binding safeguards on the biggest infrastructure project in California history.

U.S. Rep. Alan Lowenthal, D-Calif., a former state senator who wrote many of the restrictions, said: “We didn’t put them in as guidelines. … It was really clear what we wanted.”

But high-speed rail supporters say the conditions were never intended to be a legal straitjacket, allowing opponents to gum up the purpose of the bond measure: building a bullet train.

“The conditions were unnecessary and ill conceived,” said Rod Diridon, another former chairman of the state’s rail agency and now executive director of a San Jose State University transportation institute. The language in the law provides “guidelines, not hard and fast rules,” Diridon said.

Richard Katz, a former authority board member and state legislator, agreed the conditions should not be taken too literally.

“People voted for the concept of high-speed rail,” he said. “You have to view this in the larger context of whether the high-speed rail authority is substantially complying with the requirements.”

The main court battle is being waged by Central Valley farmers and Kings County.

In addition to the suits over the bond act, the project has been hit with multiple environmental lawsuits. Last Thursday, Central Valley opponents filed suit to obtain a restraining order on the project, citing errors in the authority’s environmental impact statement for the Fresno-to-Bakersfield section.

Two powerful potential opponents, Union Pacific Railroad and BNSF Railway, also are standing in the wings. Both freight railroads have filed extensive objections to the bullet-train plans, arguing that its construction could interfere with their operations and violate their property rights.

Last month, Union Pacific attorneys appeared before the appellate court and asked that any decision permitting the state to sell additional high-speed rail bonds not support the state’s contention that it met the requirements of Proposition 1A.

At that hearing, the appellate court justices were reviewing two decisions by Sacramento County Superior Court Judge Michael Kenny.

He ruled that the state violated the law by not adopting a funding plan that had the necessary environmental clearances and identified all of the sources of money needed for the initial usable segment of the rail line from Merced to the San Fernando Valley.

Kenny told the rail authority to submit a new funding plan.

At the appellate court hearing, Deputy Attorney General. Ross Moody did not address whether the state has the money or the environmental clearances. Instead, he delved into the arcane language of Proposition 1A and the steps that must be taken before the state can actually spend money on the project.

Proposition 1A, Moody argued, requires two funding plans: an initial one intended for the Legislature to decide whether to appropriate funds, and a second version before the money can be spent on construction.

Moody said the courts have no authority to challenge the Legislature’s decision on the first plan. If the opponents want to challenge the project, they must wait for the second funding plan, he said.

Stuart Flashman, an attorney for the plaintiff farmers and Kings County, argued that the first funding plan is crucial because that’s where the state must show it has all environmental clearances needed for construction.

“The risk is you begin a system that cannot be completed,” he told the three-member appellate panel.

A decision on the appeal is expected no later than this summer.

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Another trial this year will examine whether the state is not complying with prohibitions on taxpayer-funded operating subsidies and requirements on the bullet train’s end-to-end travel times.

The state rejects both of those allegations and points to projections saying the system will be highly profitable.

As with many issues, the travel time controversy is fraught with conflicting legal interpretations. In the official ballot pamphlet in 2008, proponents said riders would “travel from Los Angeles to San Francisco in about 21/2 hours for about $50 a person.”

But the language of the bond act says the system must be “designed to achieve” a trip time of 2 hours and 40 minutes between the cities.

So, will the state have regular service that meets those trip times? Or is the state required only to build a system able to provide such service?

Richard recently said the bullet train will be capable of making the trip in the required time, and that it is the intent of the state to provide such service. Actual operating schedules will be determined by a private company contracted to operate the system under the supervision of the state, he added.

Flashman maintains that with the current design plans, no train will be able to meet the 2-hour-40-minute requirement and such service will never be available to travelers.

The issue of trip times and whether the future system can operate without a subsidy could go to trial this year, part of a long line of expected litigation.

“There are still a lot of fights to come,” said attorney Michael Brady, who works with Flashman in representing Central Valley plaintiffs.

Moody, the deputy state attorney general, said there ultimately could be as many as half a dozen suits stemming from issues in Proposition 1A.

“I think litigation is a foregone conclusion,” he said in court.

Photo via Flickr