A Greek Summer Hit Fills A Generation With Hope

Marina Satti and dancers rehearsing for the music video to “Mantissa,” a “love song to yourself” that has become an anthem for young Greeks facing unemployment due to the debt crisis.

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Until last year, few Greeks had heard of Marina Satti.

The architecture student-turned-classically-trained singer had performed in musicals and ancient Greek plays, but her music career was largely under the radar. She played what she calls “blender” music — a combination of jazz, funk and rock — with musician friends at home.

“I grew up influenced by Björk and Moderat and the Berlin electronic scene,” Satti says. “And then, while I was studying at the Berklee College of Music, I looked to my roots.”

Satti’s father, a doctor, is from Sudan. Her mother, a chemical engineer, is from the Greek island of Crete. So she grew up biracial in a largely homogeneous Greece.

“I was afraid that I would stick out, ’cause I’m a little darker in the skin,” she says. “And sometimes, I remember myself being shy, and I remember I didn’t want my dad to come and pick me up from the school.”

At Berklee, she immersed herself in traditional Arabic and Greek music and realized the treasure of her heritage.

“What I loved about the States was that there, you can co-exist with something, someone, who is different than you,” Satti says. “It’s a state of mind I got into there that I carried back with me to Greece.”

When she returned home to Athens, she incorporated Greek and Arabic folk music into her jam sessions with friends.

Then, one night last year, after a pasta dinner at her apartment, they recorded a cover of “Koupes,” an old Greek rembetiko song, and uploaded it to YouTube. It went viral.

“YouTube can be a fair playing field for artists,” she says. “Your music is there, it’s free; whoever wants to listen to it can, and whoever doesn’t, that’s fine, too. I’m happy it was someone’s choice to listen to this song.”

So this summer, Satti offered an original song, “Mantissa” (“Seer”). She wrote the music and a friend wrote the lyrics.

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“The whole song is about a fortune teller, basically, but it has its roots in ancient mythology, like Pythia,” Satti says. (In Greek mythology, Pythia is the high priestess of the Temple of Apollo in Delphi.) “Every verse is like an oracle: vague enough to be open for interpretation, like Pythia’s predictions. So, to me, it is a love song — but I like the fact that it doesn’t focus on the human pain; it’s not about being self-absorbed or self-pitying.”

The chorus is about taking charge, about spreading your wings and flying through winds and storms to find what you need.

“That’s the story of my life,” Satti says. “My dad had to come to Greece from Sudan to study and be who he is. And, me, I had to go to the States and embrace who I really am.”

“So,” she says, “it’s like a love song to yourself.”

Mantissa was released along with a music video featuring Satti and a posse of girlfriends dancing, flash mob-style, down Athinas, a street in Athens that’s seen better days.

“It’s one of my favorite streets,” she says. “There are people from Pakistan and Arabs who live there and work there. There’s a market or a bazaar. You can really see the Eastern influences, and then there’s the graffiti — and, in this video, a bunch of girls in our jeans and our jumpsuits, dancing.”

The video received more than 5 million views on YouTube in just a week. Fans made tribute videos. A male comedian in drag filmed a parody of it.

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It also helped Satti, who describes herself as a D.I.Y. artist, get a deal with a record label in a country where the music industry, which hangs on to its aging stars, is hard to break into. She is signed to 314 Records.

“Mantissa” is the song of the summer in Greece: one of the most downloaded tracks and always on the radio. I hear it everywhere — in cafes, in taxis, on my balcony as my neighbors sing along while putting their washing on clotheslines to dry.

I meet a couple of thirtysomething statisticians dancing to “Mantissa” at a recent Satti concert at the gardens of the Athens Concert Hall. Savvas Giovanni and Giorgos Samaras sing the chorus so loudly they drown out the tweens next to them.

“I’m trying to remember the dance steps from the video,” Samaras says, hopping from side to side. “I’m a really good dancer.”

“I love this song,” Giovanni says. “It puts me in such a good mood. It makes me forget my problems.”

“Mantissa” is a love song, but one that “doesn’t focus on the human pain,” Marina Satti says. “It’s not about being self-absorbed or self-pitying.”

Kosmas Koumianos/Courtesy of the artist

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Kosmas Koumianos/Courtesy of the artist

The song has especially resonated with young Greeks, who face a grim future as the economy has yet to recover from the debt crisis and austerity.

“There are so many miserable people in my age, and that’s so bad,” says Melina Chronopoulou, a 21-year-old university student in French literature. She’s also one of Satti’s backup dancers, and performed in the “Mantissa” video. “It’s hard for many of us to just get out and enjoy being young. Many times, I wish I had been born in a different generation just so I could experience real optimism.”

Chronopoulou says she appreciates “Mantissa” for its optimism.

“Greek songs usually talk about being hurt, and being in love, but in a really negative way,” she says, “like suffering, and there is no hope anywhere. Not this song. It’s full of hope.”

Satti smiles a little when she considers that her runaway hit has lifted the spirits of other young Greeks.

“It’s hard out there,” she says, “but we are good at hope.”

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Often Missing From The Current Health Care Debate: Women's Voices

U.S. Sen. Susan Collins, R-Maine, and other female senators were excluded from the Senate leadership health task force this summer.

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Women have a lot at stake in the fight over the future of health care.

Not only do many depend on insurance coverage for maternity care and contraception, they are struck more often by autoimmune conditions, osteoporosis, breast cancer and depression. They are more likely to be poor and depend on Medicaid, and to live longer and depend on Medicare. And it commonly falls to them to plan health care and coverage for the whole family.

Yet in recent months, as leaders in Washington discussed the future of American health care, women were not always invited. To hammer out the Senate’s initial version of a bill to replace Obamacare, Majority Leader Mitch McConnell appointed 12 colleagues, all male, to closed-door sessions – a fact that was not lost on female Senators. Some members of Congress say they don’t see issues like childbirth as a male concern. Why, two GOP representatives wondered aloud during the House debate this spring, should men pay for maternity or prenatal coverage?

As the debate over health care continues, one of the challenges in addressing women’s health concerns is that they have different priorities, depending on their stage in life. A 20-year-old may care more about how to get free contraception, while a 30-year-old may be more concerned about maternity coverage. Women in their 50s might be worried about access to mammograms, and those in their 60s may fear not being able to afford insurance before Medicare kicks in at 65.

To get a richer sense of women’s varied viewpoints on health care, we asked several women around the country of different ages, backgrounds, and political views to share their thoughts and personal experiences.

Now retired, Patricia Loftman, 68, sits on the board of the American College of Nurse-Midwives and advocates for better care for minority women.

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Patricia Loftman, 68, New York City

Loftman spent 30 years as a certified nurse-midwife at Harlem Hospital Center and remembers treating women coming in after having botched abortions.

Some didn’t survive.

“It was a really bad time,” Loftman says. “Women should not have to die just because they don’t want to have a child.”

When the Supreme Court ruled that women had a constitutional right to an abortion in 1973, Loftman remembers feeling relieved. Now she’s angry and scared about the prospect of stricter controls. “Those of us who lived through it just cannot imagine going back,” she says.

A mother and grandmother, Loftman also recalls clearly when the birth control pill became legal in the 1960s. She was in nursing school in upstate New York and glad to have another, more convenient option for contraception. Already, women were gaining more independence, and the Pill “just added to that sense of increased freedom and choice.”

To her, conservatives’ attack on Planned Parenthood, which has already closed many clinics in several states, is frustrating because the organization also provides primary and reproductive health care to many poor women who wouldn’t be able to get it otherwise.

Now retired, Loftman sits on the board of the American College of Nurse-Midwives and advocates for better care for minority women. “There continues to be a dramatic racial and ethnic disparity in the outcome of pregnancy and health for African-American women and women of color,” she says.

Terrisa Bukovinac, 36, serves as president of Pro-Life Future of San Francisco and participates in anti-abortion demonstrations.

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Terrisa Bukovinac, 36, San Francisco

Bukovinac calls herself a passionate pro-lifer. As president of Pro-Life Future of San Francisco, she participates in marches and protests to demonstrate her opposition to abortion.

“Our preliminary goal is defunding Planned Parenthood,” she says. “That is crucial to our mission.”

As much as the organization touts itself as being a place where people get primary care and contraception, “abortion is their primary business model,” Bukovinac says.

She said the vast majority of abortions are not justifiable and that she supports a woman’s right to an abortion only in cases that threaten her life. “We are opposed to what we consider elective abortions,” she says.

Bukovinac says she also tries to help women in crisis get financial assistance so they don’t end their pregnancies just because they can’t afford to have a baby. She supports women’s access to health insurance and health care, both of which are costly for many. “Certainly, the more people who are covered, the better it is” for both the mother and baby.

Bukovinac herself is uninsured because she says the premiums cost more than she would typically pay for care. Self-employed, Bukovinac has a disorder that causes vertigo and ringing in the ear and spends about $300 per month on medication for that and for anxiety.

She doesn’t know if the Affordable Care Act is to blame, but she said that before the law “I was able to afford health insurance and now I’m not.”

Irma Castaneda, 49, says the bright side of becoming eligible for Medicaid was her family now faces fewer out-of-pocket expenses for health care.

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Irma Castaneda, 49, Huntington Beach, Calif.

Castaneda is a breast cancer survivor. She’s been in remission for several years but still sees her oncologist annually and undergoes mammograms, ultrasounds, and blood tests.

The married mom of three, a teacher’s aide to special education students, is worried that Republicans may make insurance more expensive for people like her with pre-existing conditions. “They could make our premiums go sky high,” she says.

Her family previously purchased a plan on Covered California, the state’s Obamacare exchange. But there was a high deductible, so she had to come up with a lot out-of-pocket money before insurance kicked in. “I was paying medical bills up the yin yang,” she says. “I felt like I was paying so much for this crappy plan.”

Then, about a year ago, Castaneda’s husband got injured at work and the family’s income dropped by half. Now they rely on Medicaid. At least now they have fewer out-of-pocket expenses for health care.

Whatever the coverage, Castaneda says, she needs high-quality health care. “God forbid I get sick again,” she says. And she worries about her daughter, who is transgender and receives specialized physical and mental health care.

“Right now she is pretty lucky because there is coverage for her,” Castaneda says. “With the Trump stuff, what’s going to happen then?”

Celene Wong, 39, Boston

The choice was agonizing for Wong. A few months into her pregnancy, she and her husband learned that her fetus had chromosomal abnormalities. The baby would have had severe special needs, she said.

“We always said we couldn’t handle that,” Wong recalls. “We had to make a tough decision, and it is not a decision that most people ever have to face.”

The couple terminated the pregnancy in January 2016, when she was about 18 weeks pregnant. “At the end of the day, everybody is going to go away except for your husband and you and this little baby,” she says. “We did our research. We knew what we would’ve been getting into.”

Wong, who works to improve the experience for patients at a local hospital, says she is fortunate to have been able to make the choice that was right for her family.

“If the [abortion] law changes, what is going to happen with that next generation?” she wonders.

Lorin Ditzler, 33, says concerns about insurance coverage could play a role as she and her husband decide whether to have a second child.

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Courtesy of Lorin Ditzler

Lorin Ditzler, 33, Des Moines, Iowa

Ditzler is frustrated that her insurance coverage may be a deciding factor in her family planning. She quit her job last year to take care of her 2-year-old son and was able to get on her husband’s plan, which doesn’t cover maternity care.

“To me it seems very obvious that our system isn’t set up in a way to support giving birth and raising very small children,” she says.

While maternity benefits are required under the Affordable Care Act, her husband’s plan is grandfathered under the old rules, which is not uncommon among employers that offer coverage. Skirting maternity coverage might become more common if Republicans in Congress pass legislation allowing states to drop maternity coverage an “essential benefit.”

Ditzler looked into switching to an Obamacare plan that they could buy through the exchange, but the rates were much higher than what she pays now.

If she goes back to work, she could get on a better insurance plan that covers maternity care. But that makes little sense to her. “I would go back to a full-time job so I could have a second child, but if I do that, it will be less appealing and less feasible to have a second child because I’d be working full time.”

Ashley Bennett, 34, says she voted for Trump in the 2016 election because he was the anti-abortion candidate.

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Ashley Bennett, 34, Spartanburg, S.C.

Bennett describes herself as devoutly Christian. She is grateful that she was able to plan her family the way she wanted, with the help of birth control. She had her daughter at 22 and her son two years later.

“I felt free to make that choice, which I think is an awesome thing,” she says. She’s advised her 12-year-old daughter to wait for sex until marriage but has also been open with her about birth control within the context of marriage.

But she draws the line at abortion. “I just feel like we’re playing God. If that conception happens, then I feel like it was meant to be.”

Bennett had apprehensions about Trump but voted for him because he was the anti-abortion candidate. “That was the deciding factor for me, [more than] him yelling about how he’s going to build a wall.”

For her, opposition to abortion must be coupled with support for babies once they are born. She supports adoption and is planning to become a foster parent.

She also is concerned about the mental and physical well-being of young women. Bennett teaches seventh-grade math and coaches the school’s cheerleading and dance teams.

She watches the girls take dozens of photos of themselves to get the perfect shot, then add filters to add makeup or slim them down.

“There’s going to be an aftermath that we haven’t even thought about,” she says. “I worry we’re going to have more and more kids suffering from depression, eating disorders and even suicide because of the effects of the social media.”

Maya Guillén says she worries Republican efforts to defund Planned Parenthood could prevent young girls, especially those in predominantly Hispanic communities like hers, from getting access to contraceptives.

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Courtesy of Maya Guillén

Maya Guillén, 24, El Paso, Texas

When Guillén was growing up, her family spent years without health insurance. They crossed the border into Juárez, Mexico, for dental care, doctor appointments, and optometry visits.

Guillén is now on her parents’ insurance plan under a provision of the Affordable Care Act that allows children to stay on until they turn 26. She’s been disheartened by Republicans’ proposed changes to contraception and abortion coverage, she says.

In high school, Guillén received abstinence-only sex education. She watched her friends get pregnant before they graduated.

When it came time to consider sex, she thought she’d be able to count on Planned Parenthood, but the clinic in El Paso closed, as have 20 other women’s health clinics in Texas. She worries that if Republicans defund Planned Parenthood, more young girls, especially those in predominantly Hispanic communities like hers, will not be able to get contraceptives.

Jaimie Kelton, 39, poses with her wife and their daughter.

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Jaimie Kelton, 39, New York City

When Jaimie Kelton’s wife gave birth to their baby 3½ years ago, she thought the country was finally becoming more open-minded toward gays and lesbians.

“Now I am coming to realize that we are the bubble and they are the majority and that’s really scary,” says Kelton, now pregnant with her second child.

Kelton says it seems as though Republicans have launched a war against women in general, with reproductive rights and maternity care at risk.

“It is crazy to think that most of the people making these laws are men,” she said. “Why do they feel the need to take away health care rights from women?”

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. Gold can be reached @JennyAGold on Twitter and Gorman @AnnaGorman.

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Hippos, Anthrax And Hunger Make A Deadly Mix

A hippo walks through the South Luangwa National Park in eastern Zambia, where an anthrax outbreak occurred in 2011.

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A few years ago in Zambia, hippos were dropping dead by the dozens. Soon after the hippos fell ill, people started getting sick, too.

Between August and September of 2011, at least 85 hippos died in a game management area along the South Luangwa River near the border with Malawi. It turns out the hippos were the victims of anthrax, the same bacteria used in a series of letter attacks that killed five people in the weeks after Sept. 11. The anthrax outbreaks in hippos and humans in Zambia however, weren’t part of some sinister terrorist plot. Instead, they were driven by hunger.

“Anthrax infection in wildlife is actually fairly common,” says epidemiologist Melissa Marx, an assistant professor of international health at the Johns Hopkins Bloomberg School of Public Health who investigated the 2011 anthrax incidents in Zambia.

“There have been recently documented [animal] outbreaks all over the world including Italy, Russia, Spain, Zambia, South Africa, Zimbabwe.”

Marx was working for the Centers for Disease Control and Prevention when the Zambia outbreak occurred. It was the dry season — also known as the lean season, when food is in short supply for both hippos and humans. It’s a time when the hippos will chomp grasslands down to almost bare dirt and rip out clumps of grass, unearthing spores of anthrax.

In 2011, as the hippos succumbed to the anthrax infections, local villagers butchered their carcasses for their meat.

Soon more than 500 human anthrax cases were reported in the area and at least five people died.

This was a major outbreak. Local health officials were even pulling in foreign disease experts including Marx to respond to it. Despite this, Marx and her colleagues found that nearly a quarter of the local residents said that the rash of cases wouldn’t stop them from continuing to butcher dead hippos.

“People said they’d eat the meat again even knowing that it could give them anthrax,” Marx says.

Meat is in short supply in this game management area in Zambia. Because the wildlife is protected, the locals aren’t allowed to hunt for food. But scavenging is different.

“For them finding a dead animal when they’re running low on food reserves at home seems like a good thing. This is why a lot of people took the risk even though they might get anthrax,” she says. “But my feeling is they weren’t thinking about that risk. They were thinking about how nice it would be to feed their family.”

Part of their willingness to take that risk may also have been because anthrax is easily treatable with antibiotics. Those drugs were readily available at the local health clinic. If the hippos had been dying of some other infection, the human fatality rate may have been far higher.

As millions of people in Africa face severe food shortages this summer, the roots of this hippo anthrax outbreak in Zambia are worth pondering. Earlier this year, the United Nations warned that in just four countries — Nigeria, South Sudan, Somalia and Yemen — nearly 20 million people are facing starvation. The U.N. called it the worst humanitarian crisis since World War II, and that’s just four countries.

In many other parts of Africa, including Ethiopia, the Democratic Republic of Congo, Kenya and yes, parts of Zambia, food shortages could also reach crisis levels. The transmission of anthrax from dead hippos to hundreds of people in this 2011 incident underscores that people who are desperate will take incredible risks to acquire food.

And that could have major public health consequences. This studypublished Wednesday by Marx and her colleagues in the CDC journal Emerging Infectious Diseases, shows how a lack of food can lead directly to a human disease outbreak.

In this outbreak, it was anthrax. But somewhere else, hunger could drive people to hunt sick monkeys or dying bats that are harboring some other scary pathogen. Scientists suspect this could be how the Ebola virus pops up occasionally in humans.

Marx’s study concludes that “food insecurities appear to be the primary reason for handling and consuming meat from animals found dead.”

Marx says the 2011 anthrax flare-up in Zambia shows the need for a more collaborative, comprehensive and preemptive approach to preventing new disease outbreaks.

“The thing about anthrax outbreaks is that the animal outbreaks are predictable — and in Zambia they’re seasonal. They happen in the dry season,” Marx says. “The authorities can pinpoint areas that are prone to outbreaks. They can warn people who live there to avoid dead animals.”

And she adds, “There does need to be more focus on food insecurity.”

Adequate food reduces the risk of an outbreak by making it less likely that people will eat dodgy bush meat. Chalk this up as one more reason to feed the hungry.

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Guest DJ Week: Björk

Note: Our week of Guest DJs continues with Björk. The Icelandic singer recently announced she’ll be releasing a new album, possibly before the end of the year. In this 2009conversation with All Songs Considered host Bob Boilen, Björk talked about Voltaïc, her box set of live recordings, her love of Syrian musician Omar Souleyman, fellow Icelandic singer Ólöf Arnalds and more.

Björk

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Santiago Felipe/Getty Images Portrait

Icelandic singer Björk chats with All Songs Considered host Bob Boilen about some of her favorite artists and spins an eclectic mix of music. Hear selections from Syrian musician Omar Souleyman, the post punk duo Eyeless in Gaza, fellow Icelandic singer Olof Arnalds, The Pokrovsky Ensemble and the wildly eccentric, London-based rock group Micachu and the Shapes. Bjork’s latest album is ‘Voltaic,’ a collection of live-to-tape studio performances of songs from some of her past albums, including ‘Medulla,’ ‘Post,’ and ‘Vespertine.’ You can hear the entire album online as part of our Exclusive First Listen series.

Guest DJ Week: Björk

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Lansob Sherek [I Will Make a Trap]

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Omar Souleyman

  • Song: Lansob Sherek [I Will Make a Trap]

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Shift al Mani [I Saw Her]

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Omar Souleyman

  • Song: Shift al Mani [I Saw Her]

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Throw a Shadow

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Eyeless in Gaza

  • Song: Throw a Shadow

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Skjaldborg

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Ólöf Arnalds

  • Song: Skjaldborg

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Earth Intruders

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Björk

  • Song: Earth Intruders

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Birch Tree

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Pokrovsky Ensemble

  • Song: Birch Tree

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Golden Phone

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Micachu & The Shapes

  • Song: Golden Phone

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'Body Brokers' Get Kickbacks To Lure People With Addictions To Bad Rehab

Dillon Katz, at home in Delray Beach, Fla., says recovering drug users in his group counseling meetings frequently used to offer to help him get into a new treatment facility. He suspects now they were recruiters — so-called “body brokers” — who were receiving illegal kickbacks from the corrupt facility.

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Peter Haden/WLRN

About five years ago, Dillon Katz, entered a house in West Palm Beach, Fla.

“I walked in and the guy was sitting at this desk — no shirt on, sweating,” Katz says.

The man asked Katz for a smoke.

“So I gave him a couple cigarettes,” Katz says. “He went around the house and grabbed a mattress from underneath the house — covered in dirt and leaves and bugs. He dragged it upstairs and threw it on the floor and told me, ‘Welcome home.’ “

The house was a sober living house or “sober home” — a kind of privately owned halfway house intended to integrate recovering drug and alcohol users back into community life and help them stay on the right path. It was one of the first sober homes Katz lived in. He’s been in and out of drug treatment ever since.

Some sober homes are good places. But others see a person who has an addiction as a payday.

Amid the nation’s growing opioid crisis, South Florida has become a mecca for drug treatment. And as more people arrive looking for help, there’s more opportunity for corruption and insurance fraud. There are millions to be made in billing patients for unnecessary treatment and tests, according to officials investigating the problem.

The first step for unscrupulous rehab centers: Recruiting clients who have good health insurance. That’s created a whole new industry — something called patient brokering or “body brokering.”

Staci Katz, Dillon’s mom, keeps the bills for his five years of on-and-off drug treatment in three large binders. The total charges now exceed $600,000.

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Peter Haden/WLRN

The corrupt owner of a drug treatment center might pay $500 per week in kickbacks to the operators of sober homes who send them clients with health insurance — clients like Dillon Katz.

At her home in Boynton Beach, Fla., Dillon’s mom, Staci Katz, pulls out three huge binders where she keeps track of his medical bills. She’s tallied up the charges for the five years her 25-year-old son has been in-and-out of treatment: more than $600,000 dollars.

“You could see by the billing — this was very lucrative,” Staci says.

There are charges for all kinds of things — nutrition counseling, acupuncture and chiropractic care among them. But the big expenses were for testing — urine testing.

“When they had charged $9,500 for five urinalyses,” she says, “I was like, ‘Huh! Now I get it.’ “

State and federal officials have been cracking down on fraudulent rehab centers.

The Palm Beach County Sober Home Task Force has has arrested and charged more than 30 operators of addiction treatment centers and sober homes with body brokering in the past 10 months.

In July, U.S. Attorney General Jeff Sessions announced the arrest of Eric Snyder, the 30-year old owner of a Delray Beach rehab center. Prosecutors say he billed insurance companies for more than $58 million in bogus treatment and tests, and recruited addicts with gift cards, drugs and visits to strip clubs.

Dillon Katz was staying at a sober home across the street when Snyder’s place was raided.

Katz alternates between an easy smile and a piercing gaze. He was diagnosed with Tourette’s syndrome and attention deficit hyperactivity disorder at a young age. In high school, he loved acting and music but struggled socially. It was after high school that his drug use escalated — from cocaine to crack to heroin. And his behavior went off the rails.

“I ended up throwing my suitcase out of the window,” Katz says. “I was punching the garage. My hands were bloody. I was flipping out.”

His mom eventually decided she’d had enough of the chaos.

“I said, ‘If you want help, then I will help you,’ ” Staci remembers. “We had no idea what we were up against.”

Delray Beach authorities say body brokers used to target recovering drug users hanging out on the patio of a local Starbucks. The coffee shop restricted access to the patio in 2015, after a meeting with the city officials and the police department.

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Peter Haden/WLRN

That’s when their drug treatment rollercoaster started. For the next five years, her son went from one treatment center, to another, to another.

“The people my group counseling meetings would offer to help get me into a new place,” he says. “But they always asked first, ‘What’s your insurance like?’ “

He’s pretty sure now that they were doing it for the money.

Body brokering is a source of frustration for legitimate providers of drug rehab services.

“Kids are literally being bought and sold.” says Andrew Burki, founder of Life of Purpose — an addiction treatment center on the Florida Atlantic University campus in Boca Raton. “You want $500? Sell a friend! I mean, that’s crazy, right? But that’s literally what’s happening.”

Dillon Katz now lives in Port Saint Lucie in a house he shares two roommates. They hang out on the back patio, smoking Marlboro Menthols and cracking wise.

He’s doing well, he says — he’s been clean for eight months now and he’s a tattoo artist, a job he likes.

After the unsuccessful rehab stays, an arrest and stint in jail ultimately landed him in drug court — that means his incentive for staying off drugs now includes the need to convince a judge that he’s clean. Katz says he’s found that, for him, the best support is through a recovery fellowship.

“Any kind of spiritual program,” Katz says. “That’s the answer.”

And, he adds, there’s no insurance required.

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CBO Predicts Rise In Deficit If Trump Cuts Payments To Insurance Companies

An analysis by the Congressional Budget Office released Tuesday found that ending cost-sharing reduction payments to insurers, a move that President Trump is contemplating, would raise the deficit by $194 billion over 10 years.

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Melina Mara/The Washington Post/Getty Images

If President Trump decides to cut off payments to insurance companies called for under the Affordable Care Act, it’s going to cost him.

Or, more accurately, it’s going to cost taxpayers — about $194 billion over 10 years.

The cost is “eye-poppingly large,” says Nicholas Bagley, a professor of health law at the University of Michigan. “This single policy could effectively end up costing 20 percent of the entire bill of the ACA.”

The deficit figure comes from the Congressional Budget Office, which on Tuesday released an estimate of the budget impact of ending what is known as cost-sharing reduction payments. Those are payments the federal government makes to insurance companies to reimburse them for the discounts on copays and deductibles that they’re required by law to give to low-income customers.

The reports also says premiums for benchmark plans sold on the Affordable Care Act exchanges will rise about 20 percent next year and about 25 percent by 2020. The cost to consumers, however, would stay the same or even decline, because the premium increases would be offset by tax credits, which we explain further below.

Trump threatened repeatedly to cut off the payments, which he has called “bailouts,” during the unsuccessful effort by Senate Republicans to repeal and replace the Affordable Care Act, also known as Obamacare.

If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!

— Donald J. Trump (@realDonaldTrump) July 29, 2017

More recently, the president has remained mute on the topic, and insurers have been left to wonder whether they will receive a check this month for the discounts they paid out in July.

Bagley says there is no good policy reason to cut off the payments. “If you can cover roughly the same number of people for about $200 billion less, why wouldn’t you want to do that?” he asks.

Cutting the cost-sharing payments ends up costing the government more because insurance companies say they will raise rates in response. Under the Affordable Care Act, people with lower incomes who buy insurance on the exchanges get a tax credit, so their costs remain stable as a share of their income. That means that when premiums rise, those government subsidies rise as well.

The CBO says for people with incomes below 200 percent of the federal poverty level, the out-of-pocket cost of insurance would remain about the same because of the bigger tax credits. For those with incomes between 200 percent and 400 percent of the federal poverty level, the cost to buy insurance could actually get cheaper.

Last year, about 85 percent of people who bought Obamacare insurance got a tax credit, according to the Centers for Medicare and Medicaid Services.

“The CBO analysis makes clear that ending cost-sharing subsidies would be a perfect example of cutting off your nose to spite your face,” says Larry Levitt, a vice president at the Kaiser Family Foundation. “Premiums would rise, and the government would end up spending more in the end through tax credits that help people pay their premiums.”

The CBO report confirms earlier analyses, including this one by Kaiser and this one from the consulting firm Oliver Wyman, that suggested eliminating the cost-sharing payments could make policies cheaper for some individuals.

Some insurers may decide to leave the ACA markets altogether if the subsidies were to disappear “because of the substantial uncertainty about the effects of the policy on average health care costs,” the CBO says. The agency estimates about 5 percent of the population would not have access to insurance through the ACA markets next year if Trump ends the payments.

But the agency says insurers would come back over the next two years.

Timothy Jost, a professor emeritus of health care law at Washington and Lee University School of Law, says that picture may be a bit too rosy.

He says the CBO assumes that state insurance commissioners will allow insurance companies to set premiums in ways that would be most advantageous to them, thereby ensuring they continue to sell policies on the Obamacare exchanges. But that may not happen, Jost warns.

“CBO assumes that things will work out rationally, and there will be a smooth landing,” he says. “It could be much more chaotic than that.”

Last Friday, the Department of Health and Human Services extended the deadline for insurance companies to decide which health plans to offer on the Obamacare exchanges and what to charge.

The cost-sharing payments have been at the center of a political battle over the Affordable Care Act since before Trump took office.

House Republicans opposed to the health law sued then-President Barack Obama, saying the payments were illegal because Congress hadn’t appropriated money for them. A judge agreed but allowed the administration to continue making the payments during an appeal.

Now that Trump is in the White House but GOP efforts to repeal and replace the Affordable Care Act have failed, many Republicans are urging the president to continue the payments rather than undermine the health care markets.

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Can My Boss Make Me Pay The Tax On My Great Health Plan? Maybe Yes

People with high-value health plans may not be able to get out of paying the tax bill.

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Gary Waters/Getty Images/Ikon Images

Do I have to pay the health law’s so-called “Cadillac tax” because I have good health insurance?When can I get Trumpcare plans for my kids? And what can I do if my insurance plan choices don’t include a specialist who is the only doctor in the area that can treat my cancer? Here are the answers to some recent questions about health insurance from readers.

Q: My company has asked employees to pay the Cadillac tax rather than putting the burden on the company. They are also telling us not to worry because it will never happen, but want us to agree that if it does, we will take on the cost. Can they do that?

Let’s step back for a minute. The Cadillac tax is a 40 percent surcharge on the annual cost of health plans above $10,200 for single coverage and $27,500 for family plans. While these plans are sometimes considered the health plans for well-to-do professionals, some union plans and other group plans with a pool of older, sicker enrollees may also fall into this category.

A few months ago when it looked as if the Affordable Care Act was going to be replaced, many employers believed, as yours apparently still does, that the Cadillac tax would never become effective: Both the House and Senate bills would have delayed the tax until 2026. But with the collapse of those efforts to repeal the ACA, the tax is on the front burner once again, says J.D. Piro, who leads the health and law group at benefits consultant firm Aon Hewitt. Unless Congress addresses it, the tax will take effect in 2020.

By law, insurers or employers would be responsible for paying the tax, but analysts say the costs would likely be passed through to enrollees, whether or not employees like you explicitly agree to absorb them.

So it may not matter how you respond to your employer in this case.

Also, employers who don’t want to pay the surcharge might sidestep the issue altogether by reducing the value of the plans they offer, says Piro. For example, they could increase employee deductibles and other cost-sharing, make coverage less generous, or they could shrink the provider network.

“That’s simplest way to avoid the tax,” he says.

Q: I have a rare disease, and there is literally only one specialist in my area with the expertise needed to treat me. I am self-employed and have to buy my own insurance. What do I do next year if there are zero insurance plans available that allow me to see my specialist? I cannot “break up” with my sub-specialty oncologist. I must be able to see the doctor that is literally saving my life and keeping me alive.

If the plan you pick covers out-of-network providers, you can continue to see your cancer specialist, although you’ll have to pay a higher percentage of the cost than if you were seeing someone in your plan’s network.

But many plans these days don’t provide any out-of-network coverage. This is certainly true of plans sold on the health insurance exchanges.

The situation you’re concerned about — that a specialist you consider crucial to your care isn’t in a plan’s provider network — isn’t uncommon, says Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms. And, unfortunately, you probably can’t get any coverage assurance before you sign up.

If this happens, you can contact your plan and make the case that this particular provider is the only one who has the expertise to meet your needs.

Then ask your plan to make an exception and treat the out-of-network specialist as if she were in-network for cost-sharing purposes. So, if in your plan, an in-network specialist visit requires a $250 copayment, for example, the plan could agree that’s what you’d be charged to see your out-of-network specialist.

Or not. It’s up to officials who administer the health plan, and they may argue that someone in-network has the expertise you need. If you disagree, you can appeal that decision.

But it may not come to that, says Corlette.

“Plans are prepared for this — the good ones are, anyway,” she says. “My understanding is that it’s pretty routine to grant exceptions for narrow subspecialties.”

Q: I need to purchase affordable health insurance for my two daughters who are 19 and 17. Is Trump insurance available yet? I need something I can afford and everything is so expensive.

President Donald Trump never put forward a proposal to replace the ACA. Instead, he backed the House and Senate replacement versions, which ultimately failed. But those versions might not have addressed your concerns, anyway, and you may have several options through the ACA.

“Coverage wouldn’t necessarily have been cheaper,” says Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities.

Under the Senate bill, for example, the average 2018 premiums for single coverage would have been 20 percent higher than this year’s, according to an analysis by the nonpartisan Congressional Budget Office. In 2020, under the Senate bill, premiums would have been 30 percent lower than under current law, on average. But deductibles and other out-of-pocket costs would have been higher for most people, the CBO predicted

Premiums for young people would generally have declined. The bill would have allowed insurers to vary rates to a greater degree based on age, resulting in lower premiums for young people. In addition, premium tax credits generally would have increased for young people who have incomes above 150 percent of the poverty level.

Your current coverage options under the ACA depend on your family situation. If you have coverage available to you through your employer, you can keep your daughters on your plan until they turn 26. For many parents, this is the most affordable, comprehensive option.

If that’s not a possibility, assuming the three of you live together and you claim them as dependents on your taxes, you may qualify for subsidized coverage on the health insurance marketplace next year. Your household income would need to be no more than 400 percent of the federal poverty level (about $82,000 for a family of three). You can apply for that coverage in the fall.

If you live in one of the 31 states plus the District of Columbia that have expanded Medicaid coverage to adults with incomes below 138 percent of the poverty level (about $28,000 for a family of three), you could qualify for that program. You can sign up for Medicaid anytime.

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Michelle Andrews is on Twitter @mandrews110.

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Trump Administration Extends Deadline For Insurers To Decide On Obamacare Markets

President Trump at a listening session with health insurance executives at the White House earlier this year.

Aude Guerrucci/Bloomberg/Getty Images

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Aude Guerrucci/Bloomberg/Getty Images

The Trump administration is giving insurance companies an extra three weeks to decide whether to offer insurance plans through the Affordable Care Act markets, and how much to charge.

The extension comes as insurance companies wait for President Trump to decide whether he will continue to make payments to insurance companies that are called for under the Affordable Care Act but that some Republicans have opposed.

The payments — known as cost-sharing reduction payments — reimburse insurance companies for discounts on copayments and deductibles that they’re required by law to offer to low-income customers. The Congressional Budget Office estimates the payments this year would be about $7 billion.

Trump has said he may end the reimbursements, which he calls “bailouts,” and has been leaving insurers to wonder month to month about whether they will receive a check.

A White House spokesman says Trump is “working with his staff and his Cabinet to consider the issues raised by the CSR payments.”

The U.S. Department of Health and Human Services says it is offering the extra time so insurance companies can plan ahead in case the government decides to end the payments. In a memo Friday, the agency said many states are now requiring companies to file their rates for 2018 on the assumption that they won’t be reimbursed.

Several companies say that without the cost-sharing payments, their rates will see double-digit increases. For example, Blue Cross Blue Shield of North Carolina says ending the payments would push its rates up 14.1 percent.

And Marc Harrison, CEO of Intermountain Healthcare, which covers 173,000 people on the ACA exchanges in Idaho and Utah, says premium increases could be “astonishing.”

Still, he says, his company will stick with the Obamacare markets. “These are our patients. We’re not going anywhere. We’re going to keep trying to figure this out.”

The HHS memo says “there have been no changes regarding HHS’s ability to make cost-sharing reduction payments to insurers.”

But it then says the agency intends to change the ACA’s risk adjustment program to compensate for the loss of cost-sharing payments.

The changes are technical and complex, but Timothy Jost, professor emeritus at Washington & Lee University’s law school, says in a Health Affairs blog that the memo just deepens the confusion.

“We still do not know if all of this is needed or not — the Trump administration has not made up its mind,” he says.

The cost-sharing payments have been at the center of a political battle over the Affordable Care Act since before President Trump took office.

House Republicans opposed to the health law sued then-President Barack Obama, saying the payments were illegal because Congress hadn’t appropriated money for them. A judge agreed but allowed the administration to continue making the payments during an appeal.

Now that Trump is in the White House, and Republican efforts to repeal and replace the Affordable Care Act have failed, many Republicans are urging the president to continue the payments rather than undermine the health care markets.

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Nurse Wins Prize For Research On Benefits Of Faster Tuberculosis Testing

Researcher Chenai Mathabire, center, takes part in an HIV awareness campaign in Malawi in 2016.

Courtesy of MSF

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Courtesy of MSF

There was a time when Chenai Mathabire read Vogue, watched beauty pageants on TV and fantasized about being a supermodel. Today she helps the sick and injured as a nurse and epidemiologist.

Last month, the 35-year-old Zimbabwean received an International AIDS Society prize for showing thata faster tuberculosis test could be implemented at health centers in southeast Africa. Her work will help save the lives of HIV-positive patients who contract TB.

“Nursing is often looked down upon and people just think you are there to be the maid of the doctor or do the dirty work. But teachers made me realize that nurses have a big role to play,” says Mathabire.

In Zimbabwe’s bustling capital, Harare, Mathabire earned high enough points in her studies to pursue a degree in physiotherapy, occupational therapy or nursing at university. She chose to become a nurse — the first nurse in her family. In 2008, she was between jobs and Zimbabwe was facing economic problems. Mathabire decided to apply for a job at Doctors Without Borders.

The work took her into some of Africa’s grimmest situations. She helped diagnose malnourished children with HIV, tuberculosis, pneumonia and malaria in Zimbabwe. Then she supervised workers who were teaching HIV-positive pregnant women how to protect their children from the virus. After that, she worked in a mobile hospital in South Sudan, treating gunshot wounds during a tribal war.

In 2015, she was recruited for her first research assignment at Doctors Without Borders, work that would eventually earn her an International AIDS Society prize. She knew that TB was the No. 1 killer of HIV-positive patients from her previous work, but she didn’t know about the rapid tuberculosis test until she read the study’s protocol. She was eager to get started on the project.

For two years, Mathabire and a team explored how easilyhealth clinics and hospitals in the Chiradzulu District of Malawi and the Chamanculo District of Mozambique could implement the tuberculosis test for HIV patients, who are more susceptible to the infection.

In Malawi and Mozambique, HIV is the leading cause of death. It is often spread through unprotected sex, and it has wiped out 27 percent of Malawi’s and 24 percent of Mozambique’s populations according to the Centers for Disease Control and Prevention.

Finding out whether an HIV-positive person has tuberculosis is a matter of life and death. Mathabire remembers a Malawi man in his early 30s who left a clinic untreated. The rapid test, which analyzes a molecule in the patient’s urine with a paper strip, had shown that he had TB. A coughing test didn’t. But doctors weren’t referring patients for the rapid test in their assessment of the man. It hadn’t yet been approved by the Ministry of Health which was awaiting the World Health Organization’s policy guidance. The man died before he could go back to get help.

His story wasn’t unique, Mathabire says. “It’s very sad but then you realize why you are doing the study — to prevent this from happening,” she says. “You start to realize the urgency of what you are doing.”

Under normal circumstances, patients are given cough tests or chest X-rays to test for TB. Mathabire’s team found that it takes an average of two to four days for results, but the wait could drag on for months.

Though the government of Malawi pays for certain medical care, including tuberculosis treatment, patients might not have the money to pay for a bus ride to the hospital or clinic for follow-up visits. And more remote clinics don’t always have the resources to transport samples to hospitals.

With the rapid TB test, sick patients could begin treatment the same day. Mathabire’s data showed that the test provided results in less than an hour. Staff in Malawi and Mozambique could be trained to administer the test in just a few hours. And doctors, nurses and clinical officers said it was easy to interpret the bands on the test strips.

Mathabire also found that patients weren’t skeptical of a new method. They really wanted to take the high-tech test. Mainly peasant farmers, they took the words of the health workers seriously. “Everybody basically knew somebody that had died ofHIV [and opportunistic infections] in a terrible way,” she says. It was like that in Zimbabwe too.

The team’s findings, published by Doctors Without Borders this year, has led some of the health centers where the aid group works to embrace rapid TB testing. It could pave the way for more facilities to incorporate the test it into their health systems, meaning faster care for the sickest of HIV patients.

In a statement, International AIDS Society president Linda-Gail Bekker said that Mathabire’s research will “support the next generation of investigators whose work can help to change the course of this epidemic.”

Mathabire still works for Doctors Without Borders and is considering conducting more research on HIV and tuberculosis. But her award-winning research isn’t the only major event of her summer.

She moved to Falun, central Sweden, to marry an infectious disease specialist whom she worked with in Zimbabwe. True to her early love of fashion, she’s sewing her own wedding dress, with glass beads, silk and lace.

Sasha Ingber is a multimedia journalist who has covered science, culture and foreign affairs for such publications as National Geographic, The Washington Post Magazine and Smithsonian. You can contact her @SashaIngber.

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