One hundred thirty-two Missourians lost their lives, and 164 have been injured during the first 3 months of 2017 due to gun violence. Nine of the deaths were children, five of them from St. Louis.

Why do I know this? As a member of the Common-Sense Gun Solutions Committee for Women’s Voices Raised for Social Justice, I monitor the on-line Gun Violence Archive to report on the number of people who have died as the result of gun violence. I learn their names. I find their photos. I gather information on their lives.   Where did they go to school? Where did they work? What impact did they have on their friends, family and co-workers?

Women’s Voices is more widely known in the community as an organization that attends community health fairs to distribute gun safety information and gun locks to families with unsecured firearms in their homes. And that is a good thing; more than 1,500 locks are now with St. Louis area families. But we do more. We advocate for gun violence prevention.

When our elected officials and the public read a crime report that a 25-year-old woman was shot to death in Columbia, or that a 12-year-old in Otterville was killed by a bullet to his head, they may skim the article and move on. But if they see a photo of the proud, smiling young woman in her Hardee’s uniform and learn she had worked her way into a management position and leaves behind two young children; or if they learn the boy from Otterville played summer baseball, loved the outdoors and dinosaurs, they may take a few more moments and ask themselves: why did this happen, and how could it have been prevented?

When we read one day that a six-year-old killed herself with a gun left loaded and unlocked, but we never learn where she went to school or see a photo, how can we have any empathy for her grieving family? When a 15-year-old is shot down in a blaze of bullets and an eight-year-old is critically wounded, and the following day the story is dropped, what are we to understand?

Has gun violence become so common that just reporting when and where it happens and giving the number of dead and injured is enough?

We believe readers need and deserve more. We believe in vigils where people remember the victims. We believe in marches with posters of those lost. We believe the lives of the victims matter and their stories should matter to all of us.

If the print news media would give us a glimpse into their lives, tell us their stories, perhaps more of us will work to end the violence.

The post Seeing the faces and knowing the lives of gun violence victims appeared first on Occasional Planet.

The Centers for Medicare and Medicaid Services (CMS) has just released new rules, the first in over a decade, for Medicaid managed programs. These rules “would cap insurer profits, require states to more rigorously supervise the adequacy of plans’ provider networks, encourage states to establish quality rating systems for plans, allow more behavioral healthcare in institutional settings and encourage the growth of managed long-term care.”

Changes also include a new rule that would create a Medical Loss Ratio of 85 percent, similar to regulation imposed on private insurance plans. This requires insurers to spend at least 85 percent of their revenue on medical care—not for administrative costs or profits.

Sounds good, right? Well not exactly!

Under the new rules, Medicaid plans would not be required to rebate the difference if they spend less than 85 percent on patient care. And how many plans currently meet this benchmark? According to the Kaiser Family Foundation, only one in four plans came close to spending 85 percent on actual care.

The new rules would require Medicaid plan provider networks to have time and distance standards. Patients would need to have access to hospitals, primary-care physicians and OB-GYNs. Why should we be concerned? As a Modern HealthCare article states, “The CMS mostly punted the task of overseeing network adequacy to the states, despite their history of lackluster oversight.”

What does this mean for Missouri and for health care advocates? Currently, three managed-care companies provide services to approximately 400,000 Medicaid participants in Missouri. Under the new budget passed by the Missouri legislature, nearly 200,000 additional Medicaid patients will be moved to managed-care plans.

As managed-care plans expand in Missouri, including to our rural communities that already lack sufficient services, it means we need to be vigilant. We need to pressure our Missouri state officials and our legislators to insist that care comes before profits and that quality services are available to patients.

We welcome the new rules, but we must work to see that they are implemented.

The post New rules for Medicaid managed care: What do they mean for Missouri? appeared first on Occasional Planet.

The St. Louis Post-Dispatch correctly identifies problems with the Missouri Medicaid program (“Medicaid missteps,” May 10). But citing the system as “broken” as a reason to deny Echo Garrett the health insurance she deserves is a red herring.

For three years we have talked with legislators, advocating on behalf of the 180,000 low-income Missourians denied coverage because of their refusal to expand Medicaid. The most common response from the deniers has been, “We can’t expand coverage until we fix the broken system.” When we suggested that the legislator meet with his/her caucus and propose legislation to fix the problems, we were told, “I am not a policy person.” In other words, “It’s not my fault, not my responsibility.”

Our Legislature delayed funding for the computer system that processes applications for coverage with the result of a large backlog in applications. To be “more efficient,” our state social services department closed processing centers where clients could meet with counselors. The result has been that clients wait to get called back from counselors and sometimes give up entirely. Our Legislature has a responsibility, a responsibility to fix the system and at the same time provide insurance for Ms. Garrett and the others who are pushed aside while our legislators delay taking action.

[This post originally appeared as a letter to the editor in the St. Louis Post-Dispatch, on May 12, 2015. It is reprinted with the author’s permission.]

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Nicolas Kristof, columnist for the New York Times, encourages his readers to express their views on his commentaries. But where are the women? How many post their opinions?

Recently Kristof suggested that his readers look at a blog posting on his site by Emma Pierson, “How to get more women to join the debate.”  (Pierson is a student currently studying statistics at Oxford University as a Rhodes Scholar with a bachelor’s degree in physics and a master’s degree in computer science from Stanford University). She has discovered a major gender gap when reviewing comments made on The New York Times website.

Women were clearly underrepresented in my data. They made only a quarter of comments, even though their comments got more recommendations from other readers on average. Even when they did speak up, they tended to cluster in stereotypically “female” areas: they were most common on articles about parenting, caring for the old, fashion and dining. (Women got more recommendations than men on most of the sports blogs, but they still made, for example, only 5 percent of comments on the soccer blog.)

It seems unlikely that these effects are confined to The New York Times; studies of online commenting find broad signs of inequality. (While women are well-represented on some websites, like the image-sharing site Pinterest, these sites do not tend to focus on expressing and defending opinions. Online forums that do often have mostly male commenters: examples include Wikipedia edit pages, the social news site Reddit, and the question-answering sites Quora and Stack Overflow.)

These differences, according to Pierson, “may have profound implications for media, gender equality, and even our democracy.” She says, “When one gender is underrepresented, the views that are heard will not fairly represent the views that are held.”

She notes that even when the topic is sexual assault, the majority of comments come from men and the reason may be that women fear being harassed online. When women do comment, it tends to be in reference to typically “female” subjects such as parenting, fashion or caring for the elderly. But when people share a remark made by another, the comments from the women, even those written on a sports blog, are highly recommended and receive positive responses.

Pierson notes that most online comments do not win prizes for “profundity, and that

“…while we focus instinctively on how to get women to talk more, there’s another possibility: that men should talk less.”

She also offers some practical ways to encourage more women to add their comments to online forums:

There are also ways online newspapers specifically might increase female participation. Increasing the number of women writing articles might increase the number of women commenting on articles. Women are underrepresented among newspaper reporters, and in my data, articles written by women had a higher percentage of comments from women, even when I controlled for the section of the newspaper in which the article appeared. Telling women that their comments received more recommendations might also encourage them to comment more; previous studies have found that women are less likely than men to persist in commenting when their comments do not receive positive responses.

So women, follow Pierson’s advice, start tapping on those computer keys and “don’t worry too much about whether your comment is worthy of Cicero” or whether “your comment is inane.”

The bottom line: “Our democracy will function better if we get a gender-balanced sample of stupidity.”

The post Women’s voices are missing in online comments. Speak up! appeared first on Occasional Planet.

The St. Louis Post-Dispatch recently published an editorial titled, “A defining moment.” The editorial states that by creating a Ferguson Commission,,Missouri Gov. Jay Nixon “has set the table for important, potentially groundbreaking conversations.” The governor says that the commission “will need to be led by the region’s great academic institutions, by professionals who will let the research lead them …” but that it “can’t be an echo chamber.”
My ears are already beginning to throb. I know from dozens of “groundbreaking” studies conducted in the past that there is no new ground to be broken. We know many of the things that are wrong; they have been identified time and time again.

During the past few years, St. Louis has become proficient at doing studies. Some have been conducted by institutions of higher learning; some have been sponsored by government entities or local organizations. No matter how “groundbreaking” or definitive or intelligent or resourceful these studies have been, most of them have one thing in common: They have been taking up shelf space.

Gov. Nixon set out three charges for the Ferguson Commission. The first is to “conduct a thorough, wide-ranging and unflinching study of the social and economic conditions underscored by the unrest in the wake of the death of Michael Brown.”

Last spring a truly groundbreaking study, “For the Sake of All,” was released. This study, conducted by a group headed by Jason Q. Purnell, assistant professor at the Brown School at Washington University, definitively identified conditions that have created the staggering social and economic racial disparities in St. Louis.

“For The Sake Of All” recommends investing in quality early childhood education, creating economic opportunities for low- and moderate-income families, investing in coordinated school health programs, investing in mental health programs, investing in neighborhoods, and enhancing disease prevention and management.

This study was truly thorough, wide-ranging and unflinching. We don’t need to do it all over again.

Another important study has been conducted by ArchCity Defenders, a small law firm that “strives to prevent and end homelessness among the indigent and working poor in the St. Louis region by providing holistic criminal and civil legal services.” Attorneys with ArchCity conducted research that has been published and verified showing how our municipal courts exploit the poor. As a result of that study, the U.S. Department of Justice has launched a study of how small municipalities conduct and benefit financially from their courts.

The governor’s second charge is to tap the expertise needed to address the concerns identified by the commission — from poverty and education, to governance and law enforcement. Again, much of this work is already being done. Professionals from a variety of disciplines are conducting both public and private conversations with community leaders and others throughout the region who have the ability to make changes.

The governor’s final charge is to offer specific recommendations for making this region a stronger, fairer place for everyone to live. Again, previous studies have included many specific recommendations. ArchCity Defenders, St. Louis University Law School and others have called on municipalities to correct the problems with their courts. “For the Sake of All” is now preparing and distributing action packets to address the problems of economic, health, housing and educational disparity in our region. Various reports by Focus St. Louis, Vision for Children at Risk, the RCGA and other organizations have made recommendations for years.

In addition to the great academic institutions and professionals that the governor has called for, we need to remember that the St. Louis area is blessed with many wonderful organizations — some large and well-funded, others volunteer, and some led by grassroots activists. These groups support and work for quality education, child health, keeping our neighborhoods safe, creating economic opportunity, and on and on. Many advocate with our legislators in Jefferson City to pass laws to protect our children, to provide health care for all Missourians, and to fully fund our schools.
We don’t need another commission and we don’t need any more studies. We know the problems. Let’s listen to the professionals who have already studied them and already made thoughtful recommendations. Many solutions have already been identified. It’s time to stop studying. It’s time to act.

This post originally appeared on the Op-Ed page of the St. Louis Post-Dispatch.

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[by Mary Clemons]

St. Louis is known for the Gateway Arch and toasted ravioli. We are also known for being one of the most racially divided cities in the country. During the last century, reports consistently pointed out the disparities and called for change. As early as July 1915, The St. Louis Argus newspaper declared, “The campaign against segregation starts Monday.”

But fast forward to 1989, and a study conducted by Confluence St. Louis was calling for an end to racial polarization. More than ten years later, in 2000, Focus St. Louis convened 30 citizens for a task force to assess why the 1989 report recommendations fell short. But as recently as 2012, our British friends released a documentary showing the stark contrast of how people live on both sides of the “Delmar Divide.”

Can you blame my friend for being skeptical when I touted this year’s study, “For the Sake of All: A report on the health and well-being of African Americans in St. Louis“? Even the Focus St. Louis report of 2000 noted that “as reports continue to be published on different challenging issues facing the St. Louis region, they are often met with the shrug of shoulders and sighs of ‘here comes another report’.”

If the facts have changed at all, they have probably changed for the worse. The Delmar divide? The area directly north of Delmar Blvd. is 99% African-American, and the homes there are a quarter of the value of homes south of Delmar. Life expectancy in the predominantly black 63106 zip code, north of downtown St. Louis, is 67 years; in the 63017 mostly white suburban zip code, life expectancy averages 82 years. 25% of African-Americans in the city are unemployed; 1 in 10 drop out of school. 15 African American infants die per 1000 in the city; compared with 5 white infants. Chronic diseases are more prevalent in the African-American community.

So why shouldn’t we be skeptical of this study? What makes it different from those in the past?

Recently, the auditorium at the Missouri Historical Society was filled to capacity at a conference seeking public comment on the study. The seats were taken by whites and blacks, Hispanics and Asians. Those who attended were young, middle-aged and old. They came from the city and the county. Many represented community organizations, social service agencies and maintained rapt attention for the four hours of the meeting.

Panelists told of work they are doing in the areas of education, health, and housing, and they presented positive recommendations for moving forward. They described programs that make a difference. These are community leaders who work in our public schools, with our youth, who provide housing services and treat our children and adults at health centers. They aren’t “studying” the problems; they work to solve them.

And we can’t overlook those who conducted the study. Jason Purnell, PhD, MPH from the Brown School at Washington University, is a principal investigator, and his colleagues at St. Louis University haven’t written a report just to leave it sitting on a table. They have made it clear that there is a cost to all of us, that “the loss of life associated with low levels of education and poverty among African-Americans was estimated at $3.3 billion.” They are determined to make this known widely and are developing study guides that will be broadly distributed.

Purnell hasn’t just produced a report; he has made recommendations and calls to invest in early childhood development, school health programs, disease prevention, quality neighborhoods and to create economic opportunities. On June 5, 2014, the St. Louis American, said that the Brown School is in it “for the long haul,” and then declared, “We’re in too, also for the long haul. How about you?” Join me in answering with a resounding, Yes!

The post Not just another study of racial inequality—this one includes real community action appeared first on Occasional Planet.

After the St. Louis Cardinals won the [2013] National League Championship Series, it was reported that a rookie player, Seth Maness, said, “It’s a team concept. … Putting the team first is expected of you.” I am optimistic that “the Cardinal Way” will be the attitude in our Legislature with regard to expanding/transforming our Missouri Medicaid program.

What is my basis for optimism?  This summer and fall, three interim committees composed of Republicans, Democrats and ordinary citizens met frequently and heard a wide range of testimony concerning Medicaid eligibility, transformation and reform.

These three committees didn’t leave anyone out. As the management team, they sought information from the veteran players but gave the rookies a chance, too. Everyone was given an opportunity to be heard. Now they have to consider next year. Whom will they keep and whom will they trade? What contracts will they offer?

There are 34 senators and 163 representatives in the Missouri Legislature who are major participants in our league. We say it is time to play the Cardinal Way; put the team first.  Reform Medicaid to resolve some of the issues the committee members heard about. Expand Medicaid to provide care for our uninsured, low income Missourians. The stakes are high. As many as 168,000 Missouri adults will remain without health insurance unless you act.  We are counting on you to bring home a winner!

Reprinted, with permission of the author,  from the St. Louis Post-Dispatch

The post The “Cardinal Way”: A model for MO legislature, and others, too appeared first on Occasional Planet.

What could be better on Constitution Day than a traditional American town meeting?  What a perfect way to celebrate the document that is a testament to our liberties and that ensures our rights such as the right to freedom of speech.

On Constitution Day, September 17, 2013 I attended the Obamacare town hall meeting sponsored by St. Louis radio station 97.1 and Americans for Prosperity [Koch brothers].

So what free speech were we subjected to?  Dr. Randy Tobler, a physician and radio personality, showed slides depicting President Obama in doctor scrubs, smiling broadly and holding an oversize syringe. The label?  “This is going to hurt!”

Another slide had a caricature of President Obama, a large figure, looming over the shoulder of a doctor who was leaning down toward a young child in diapers with a thermometer in his mouth. The label?  “Oh, don’t mind me….”

One graphic Dr. Tobler presented showed pieces and parts of what we learned was a medical device from the last century. Apparently it was some sort of pipe used to clear the lungs. Dr. Tobler said that Obamacare is like that pipe, “blowing smoke up your arse.”

Those slides may have been in bad taste but we can all agree with his right to show them. Certainly the 500 or so people in the auditorium enjoyed them; the slides were received with laughter and cheers.

Dr. Tobler showed the slides while freely expressing his view of the horrible “truths” about the effects of Obamacare, “the worst bill ever passed by the United States Congress.” Tobler said:

…with Obamacare we will have insurance but no access to care. The law will “take the wind out of the sails of medical care in the U.S. Doctors will be so overburdened that patients will get fewer services. Patients will only be seen for 7 minutes when and if they can get an appointment. Electronic medical records are costly and doctors will spend too much time dealing with regulations.

He even said that doctors (whom he earlier said care about their patients welfare) would have an incentive to withhold care.

We will be like Canada and Great Britain with patients having to wait months for hip replacements and  even for mastectomies.  And remember those death panels?  There is one – under Obamacare we will experience the death of medical ingenuity in this country. And what about Medicare?  Reimbursements will go down by 750 billion dollars.

One woman, a member of the progressive group, Women’s Voices Raised for Social Justice, and Vice President of Missouri Health Care for All, took her opportunity to voice her objection to Dr. Tobler’s remark about the 750 billion dollars. She went to the microphone and said that the $750 billion is being removed from overpayments to private Medicare Advantage plans that charged 14% more than traditional Medicare. She reminded the audience that even Paul Ryan accounted for this removal in his proposed budget.

How were her comments received? Her free speech was booed, and the moderator of the panel made fun of her. On her way back to her seat a man stuck out his foot as though he was stretching, trying to trip her. After she sat back down in her seat on the aisle a woman walked by, punched her hard in the arm and said, “There’s a liberal in every crowd.”

Another woman took the microphone to refute the claim that the majority of Missourians voted against the individual mandate in the health care law. She remarked that the majority of the small number who voted opposed the mandate. Her remarks were not only jeered, but the microphone was turned away so she could no longer speak.

The Missouri legislature’s Speaker of the House, who hosted the town hall meeting, talked about the “facts that shape his policy,” calling on the audience to continue the work of dismantling Obamacare to rid ourselves of that “free plastic health insurance card.” [It doesn’t exist.] Missourians, he noted, voted by a margin of 11.5 percent for Romney, thereby agreeing that the law should be overturned. He told the audience that “We don’t know what is in the law, because “tens of thousands of regulations are being drafted every day.”  He called Obamacare “the largest entitlement in the history of the United States” and complained that every state is doing something different. He even blamed President Obama for funds being taken from hospitals for uncompensated care.

No microphone was available to let the audience know that the hospital funds are  being lost because Missouri refused to expand Medicaid. If more people are given care under Medicaid, hospitals would receive payments for these patients and have less need for the funds.

One voice of reason among the panelists was Vince Blair, an insurance agent. Blair presented a factual account, with explanatory slides, of what people need to know about how to purchase insurance on the new marketplace. He even encouraged people to go to the online exchange if they are uninsured. He assured the audience that if they are on Medicare they will not lose their benefits but will be unaffected by the new law.

What format should a town hall meeting take? One simple definition describes it as an informal public meeting where everyone in the community is invited to attend and participate in the discussion. Our Constitution Day town hall was a 90-minute, scripted program to present the “facts” as represented by the Speaker of the Missouri House of Representatives and a physician who opposes the Affordable Act.

At our town hall, only one side of the issue was presented by the speakers. When the audience jeered those who disagreed with the speakers, and the moderator and panelists mocked the questioners, and the microphone was kept from an audience member, the real mockery being made was that of our tradition of fairness and discussion at a public forum.

The post Blue voices in a red room: Notes from an Obamacare “informational” town hall appeared first on Occasional Planet.

In the national response to the Zimmerman trial, at rallies across the country, we hear from the bullhorns the outrage over police profiling minorities in traffic stops, the injustice displayed in our criminal courts and the fear of parents for the safety of their black and Hispanic children.  There have been calls, even from President Obama, for a national discussion of race relations in the United States.

Here in St. Louis, a scandal over dried-out asparagus may offer another symbol of racial inequality.

Recently, a member of the University City Human Rights Commission questioned whether the dried-out asparagus in the produce section of a local supermarket had any relationship to the store’s location in a black neighborhood. The accusation  resulted in a flurry of denials, articles and commentary in the St. Louis Post-Dispatch, a talk-radio discussion, letters to the editor, and a call Sunday, July 21, 2013 from the Post-Dispatch editor Gilbert Bailon to “please keep some perspective,” that “asparagus rights do not hold cosmic life lessons.”

What lessons can we learn from what is now termed “the asparagus scandal”?

Whether the dried produce at the supermarket in question was only the result of a tray of water that had tipped over or not, the fact remains that the availability and quality of produce, meat and groceries in minority neighborhoods does not resemble that of our more affluent communities. The radio talk-show host [John Carney] said that this issue “got me thinking about the vast difference in produce” between a supermarket in an affluent suburb and another in the City of St. Louis.  A panel member on the radio show remarked that, though some of her colleagues called the asparagus story “silly,” there is a real issue of unequal maintenance of stores depending on where they are located.

Going to the only grocery store convenient to your home and finding a lack of quality produce or meat might not be as “cosmic” as being stopped and having your car searched, or receiving a jail sentence inappropriate to the crime, but it is important nonetheless. Knowing that when you go to a store, you’re getting lower quality food than shoppers in more affluent neighborhoods can make you feel undervalued, unequal, and lesser as a human being.

So, are we making a mountain out of a mole hill with the asparagus story?  The mountain might not be there, but the molehill still exists.  And as moles continue to burrow, they make more hills.  We need to be mindful of the damage that moles cause and make every effort to flatten these hills and create a level playing field for us all.

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Recently, Ron Pollack, executive director of Families USA, wrote about the “practical effects of the Affordable Care Act. His remarks clarified for me that Missouri legislators are readying themselves for a role as a Greek chorus, where they can affirm, “Yes, we were right, Obamacare is a disaster! It just doesn’t work.”  But what isn’t working effectively is our legislature, which is passing laws that hinder the implementation of the Affordable Care Act. For details on how obstruction of Medicaid expansion promises to affect poverty-level citizens in Missouri, check out the St. Louis Post-Dispatch article, “A Big Medicaid Gap Looms in Obama Healthcare Law.”

Pollack suggests that “states that accept generous federal funding to expand Medicaid coverage for low-income families will show remarkable improvements in reducing uninsured rates.” Our Missouri legislature has chosen to not expand Medicaid.  Up to 300,000 low income Missourians will remain uninsured. When they need care we will bear the expense and our legislators will be in the chorus chanting, “We were right!  Obamacare, government takeover of our health system, didn’t reduce our health care costs!”

Beginning October 1, 2013, more than 500,000 Missourians will begin purchasing health insurance through online exchanges. Pollack says that “states with larger numbers of on-the-ground helpers, sometimes called navigators or assisters, will help their citizens much more effectively secure premium subsidies to obtain coverage that is most responsive to their families’ needs.”  But Missouri has created barriers, imposing unnecessary fees and regulations to make it difficult and even prevent social services agencies from giving assistance to their clients who are eligible to purchase health insurance in the new marketplaces. If SB262 is signed into law, individuals and small businesses purchasing policies will only receive information on coverage from insurance brokers and our legislators will thunder, “We were right!  Health insurance exchanges are too burdensome for our citizens.”

And what of the Missourians who try to purchase insurance under the exchange and learn they are not eligible for insurance subsidies because their income is too low?  They fall into a black hole, not allowed on Medicaid and unable to receive subsidies in the exchanges.  In our play, they fall off the stage into the orchestra pit, where the legislators are drumming to the tune of “It doesn’t work!”

Pollack says that “states that implement active oversights of their insurance marketplaces will do appreciably better in decelerating decades of premium increases.” In Missouri, our insurance commissioner has been given minimal authority to enforce the federal law and protect the consumer. If SB262 is enacted, our legislators will have created the set for a scene where consumers purchase policies that have high deductibles and that do not meet the needs of their families. And, yes, our legislators will be in the wings with an aside, “We were right!  Obamacare does not work.”

Pollack comments that when the states that have not expanded Medicaid see the improvements in care and costs being made in states that have fully implemented the Affordable Care Act, they too will want to the follow the lead of Arizona, New Jersey, New Mexico, Nevada, North Dakota et al and do the right thing for their citizens.

I am not a health policy expert.  I am just a concerned citizen who urges our legislators to read the reviews and acknowledge the critics are giving Missouri a thumbs down.

To our legislators:  Go back, edit the script, and write a play which will have a happy ending with a standing ovation from your grateful constituents for moving us closer to affordable, quality health coverage and care for all Missourians.

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