New Jersey Reverses Ban On Book About Mass Incarceration Under Fire From ACLU

The New Jersey Department of Corrections has lifted a ban on a book that links racial discrimination and mass incarceration after the ACLU called the prohibition unconstitutional and demanded the department reverse its position.

Inmates at the New Jersey State Prison in Trenton and Southern State Correctional Facility in Delmont were barred from reading Michelle Alexander’s 2010 book, The New Jim Crow: Mass Incarceration in the Age of Colorblindness. The ACLU New Jersey chapter made the discovery as a result of a public records request.

In a letter to the state’s Department of Correction on Monday the ACLU demanded the book be immediately removed from any lists of banned publications.

“Keeping a book that examines a national tragedy out of the hands of the people mired within it adds insult to injury,” Amol Sinha, the state ACLU executive director, said in a statement.

A few hours later department officials responded with a statement of their own saying the DOC had reversed the ban in the two facilities and stressed that there had never been a departmentwide ban on the book.

It turns out the book is used in a college enrollment program for inmates called the New Jersey Scholarship and Transformative Education program.

Matthew Schuman, a spokesman for the New Jersey Department of Corrections, told The New York Times the ban was removed because “officials determined that the book should not have been banned, as evidenced by the fact that it is being utilized as a teaching tool for NJ-STEP students.”

In a statement, the corrections department said it is now reviewing its policy on banned materials “for appropriate revisions.”

A spokeswoman, Melanie Weiss, told NBC News that until now, the decision to ban a publication was made on a facility-by-facility basis. She said she expected that to change.

Correctional facilities around the country regularly ban books, magazines and other reading materials for a variety of reasons, including book size, construction and content.

But ACLU staff attorney Tess Borden, who drafted the letter to the New Jersey agency, argued the ban on The New Jim Crow, not only violated the First Amendment, but was especially egregious in the state with the worst black-to-white incarceration rate in the country.

A 2016 report by the Sentencing Project found New Jersey has the biggest gap between black and white incarceration rates of any state in the U.S. black residents are put behind bars at 12 times the rate of white residents. Nationally, that disparity is closer to five to one, the report found.

“For the state burdened with this systemic injustice to prohibit prisoners from reading a book about race and mass incarceration is ironic, misguided, and harmful. It’s also unconstitutional,” said Borden.

And, Sinha added, “Michelle Alexander’s book chronicles how people of color are not just locked in, but locked out of civic life, and New Jersey has exiled them even further by banning this text specifically for them.”

In a 2012 interview on Fresh Air about the book and Alexander’s work as a legal scholar, she told NPR:

“Today there are more African-Americans under correctional control, in prison or jail, on probation or parole, than were enslaved in 1850, a decade before the Civil War began.”

“I think it’s very easy to brush off the notion that the system operates much like a caste system, if in fact you are not trapped within it. I have spent years representing victims of racial profiling and police brutality and investigating patterns of drug law enforcement in poor communities of color, and attempting to help people who have been released from prison attempting to ‘re-enter’ into a society that never seemed to have much use to them in the first place. And in the course of that work, I had my own awakening about our criminal justice system and this system of mass incarceration. … My experience and research has led me to the regrettable conclusion that our system of mass incarceration functions more like a caste system than a system of crime prevention or control.”

Studies about literacy in prison have found reading is both a form of escapism for inmates during their sentences and an opportunity to improve their chances of assimilating back into society after their release.

James LaRue, the director of the Office for Intellectual Freedom of the American Library Association, told the New York Times, banning books “preserves ignorance and imprisonment. All too often, prison censorship, in addition to being an arbitrary abuse of authority, denies the incarcerated the chance to get out of jail and stay out.”

Correctional facilities generally outlaw reading materials based on size (an over-sized hard cover books can be used as a weapon), construction (a pop-up book, for instance, can be a good hiding place for contraband), and content (materials containing certain kinds of sexual encounters, nudity, or even intimidation tactics are often prohibited).

While restrictions vary from state to state, incarcerated inmates across the country are subject to strict guidelines on what they can read.

In November the Dallas Morning News reported more than 10,000 books have been banned by the state, including the 2005 best seller Freakonomics, which includes the theory that the drop in violent crime in the 1990s can be attributed to the legalization of abortion in 1973. The reason: this “racial content” could be construed as being “written solely for the purpose of communicating information designed to achieve the breakdown of prisons through offender disruption.”

But David Duke’s My Awakening, which makes the case for racial segregation, and Adolf Hitler’s autobiographical Mein Kampf, are both permitted.

In 2010 North Carolina changed its inmate publication policy after inmates filed a class-action lawsuit against the state Department of Correction, alleging that their First Amendment rights were violated when prison staff denied them reading material, providing no explanation or appeals process.

Inmates are now allowed to challenge the facility’s decision when a book has been banned. The state also admitted it that “policies and procedures governing inmate publications were not consistently enforced in the past” and enforced mandatory annual staff training,

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Still In Search Of A Deal, Merkel Faces A Crucial Week Of Coalition Talks

German Chancellor Angela Merkel delivers a statement prior to a meeting in Berlin with conservative and Social Democratic party leaders.

Jorg Carstensen/AFP/Getty Images

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Jorg Carstensen/AFP/Getty Images

It has been more than 100 days since Germany headed to the polls — but the next handful of days might matter more than all of them combined.

Since late September — when German voters handed Chancellor Angela Merkel a fourth term, albeit without giving her party an outright majority — the country has teetered without a new formal government. Unable to win the support of another party for a governing coalition yet, Merkel is now staring down the possibility that the monthslong standoff may force a new election entirely.

Enter: the Social Democrats.

On Sunday, Merkel embarked on preliminary coalition talks with the center-left party, also known as the SDP. They were her second choice — after similar negotiations with a separate pro-business party broke down in November — but it appears circumstances have forced her hand: Party leaders, both for the SDP and the center-right alliance fronted by Merkel, have given themselves until Thursday to determine whether a framework agreement is possible.

Now, the two sides are no strangers to one another. Far from it, in fact: They are partners in the caretaker government now steering the country, and their “grand coalition” of centrists has governed for eight of the past 12 years.

Yet the friendship one might expect of such long-connected factions has faltered in recent months. Both groups saw disappointing results at the ballot box in September, losing dozens of votes to smaller minority parties — which many lawmakers took to be a sign of dissatisfaction with the previous arrangement. Martin Schulz, leader of the SDP, even vowed on election night that the party would outright reject a place in any governing coalition and instead act as opposition.

Faced with the prospect of prolonging the political uncertainty of the past three months, Schulz relented on that pledge — at least for the sake of preliminary talks — but that does little to erase the growing policy differences between the two sides.

NPR’s Soraya Sarhaddi Nelson noted on Morning Edition where those wedges rest:

“One is the issue of [European Union] reforms, which is on the table today. In other words: Does the EU or the member states — do they integrate more politically and economically or less so?

“The other issue is whether Germany will actually reach its 2 percent of GDP spending on defense in NATO, which is something that’s being demanded by the Trump administration. The conservatives say yes, and the central Social Democrats say no.

“But the biggest hurdle is probably the refugee policy, because the conservatives are very worried that if they don’t tighten this, that more voters are going to go to the Alternative for Germany party, which is a far-right party that is now in parliament.”

Indeed, the AfG looms as a silent shadow over this week’s talks. The once-marginalized party, which is serving in the German Parliament for the first time, has been denounced by all the other parties as xenophobic — yet it has been gaining in popularity, particularly amid an uncertain political environment.

Now the third-largest faction in Parliament, the AfG would have the opportunity to build on those gains if this week’s talks fall through and circumstances force a new election. Though, as Soraya points out, the party could stand to gain even from successful negotiations, since a coalition between Merkel’s conservatives and the SDP would make the AfG “the main opposition party, which brings with it major posts within parliamentary committees and more money.”

Should this week’s preliminary negotiations emerge with an agreement, it would be far from the final word on the matter. Party leaders would then need to bring the terms back to their own members, many of whom remain opposed to renewing a partnership with the other side. Only with those members’ OK can full-blown coalition talks proceed.

Even in the swiftest possible scenario, Germans have many weeks left before they can arrive at a settled coalition at the helm.

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FACT CHECK: Trump Touts Low Unemployment Rates for African-Americans, Hispanics

Speaking at the American Farm Bureau Federations Annual Convention on Monday, President Donald Trump boasted about the latest job numbers for African-Americans.


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The job market is strong right now, with a 4.1 percent unemployment rate, and President Trump knows it. On Monday, he twice bragged about the latest jobs report, but he focused in on minorities in particular.

In the morning, he did it on Twitter, citing that black unemployment is “the lowest ever recorded in our country.” And he jabbed: “Dems did nothing for you but get your vote!”

African American unemployment is the lowest ever recorded in our country. The Hispanic unemployment rate dropped a full point in the last year and is close to the lowest in recorded history. Dems did nothing for you but get your vote! #NeverForget@foxandfriends

— Donald J. Trump (@realDonaldTrump) January 8, 2018

And then at a speech to the American Farm Bureau Federation, he did it again, saying, “African American unemployment is the lowest it’s ever been in the history of our records.”

This is the third time in as many days that the president has cited black unemployment figures. On Saturday, he also tweeted about the numbers.

Presidents often take credit for a strong economy, and Trump fits that mold, touting jobs and stock market numbers regularly. So we decided to fact check Trump on this claim: is he right, and are these numbers his doing?

The claim: Black and Hispanic unemployment are at or near record lows.

The short answer: Trump’s numbers are right, but it’s generally a stretch for presidents to take credit for job creation.

The long answer:

Trump is right that African-American unemployment hit a record low in December. The unemployment rate for black Americans is currently 6.8 percent, the lowest level recorded since the government started keeping track in January 1972.

And he’s also right that the Hispanic unemployment rate is down a point over the last year — it was at 4.9 percent in December, down from 5.9 percent in December 2016. That is close to record low, though it’s also up 0.1 points from November.

But still: fact check true on Trump’s numbers.

However, that’s not all Trump is doing in this tweet. He is implying that he caused these low African American and Hispanic unemployment rates.

A big problem with that claim, however, is that those rates had been falling for long before Trump took office, and their declines don’t appear to have picked up speed. This implies that there’s nothing specific that Trump did to change this rate.

Indeed, both of these rates have been falling relatively steadily since around 2010, early in President Obama’s tenure in the White House.

So have the unemployment rates for all races and ethnic groups tracked by the Labor Department. In general, these unemployment rates tend to move together. So while Trump called out the African-American and Hispanic unemployment rates, they haven’t changed in any remarkable way, relative to other groups’ unemployment rates.

Separately, the president’s Council of Economic Advisers touted the unemployment rate of other demographic groups on Friday, shortly after the latest jobs report was released.

“The overall unemployment rate, which by October had dropped to 4.1 percent, represented a 17-year low by year’s end,” they wrote. “The benefits of the low rates were felt broadly, resulting in unemployment rates for America’s veterans, African-Americans and Hispanics that reached historic lows in 2017.”

The total unemployment rate is quite low, at 4.1 percent. That’s not a record, but for comparison to that African American rate, it is near its lowest point since 1972.

So Trump here is trying to make a political point — one that he has made before — seeming to tell minorities that they should support him more than they do. But then, the president has a decidedly uneasy relationship with black Americans, as NPR’s Brakkton Booker wrote on Saturday, and his rhetoric on immigration has also upset some Hispanics.

This leads to the bigger question of how much Trump has to do with any of this job growth, regardless of race or ethnicity.

By the jobs numbers themselves, it doesn’t look like he has changed much here. In fact, the average job creation in Trump’s first year is slightly lower than it’s been in prior years. Employers added 171,000 new jobs each month, on average, in 2017. In 2016, that figure was 187,000, and in 2015, it was 226,000.

It is possible that the tax plan that Trump recently signed into law will inspire employers to hire more. It is possible that businesses will plow some of the money they save on their taxes this year into job creation. In a late-November Yahoo poll of more than 1,200 business owners, half said the new tax plan would make them more likely to hire.

Then again, a majority of economists polled by the University of Chicago predict that long term, the tax plan won’t lead to higher economic growth (and almost none said it would lead to higher growth).

And there’s a bigger problem with the idea that Trump has created all these jobs — presidents don’t have much immediate control over the economy, period.

It’s true that they push policies or make hires that can affect economic performance — George W. Bush first appointed former Federal Reserve Chairman Ben Bernanke, who helmed the central bank as it worked to pull the country out of recession; and President Obama signed the 2009 stimulus. It’s also true that at the end of any given president’s tenure, we look at the job market under that president.

But there’s so much about the economy that presidents don’t control — business cycles and other countries’ economic health, for example. The White House also can’t control broader macroeconomic trends, like the U.S. economy’s long-term shift from goods-producing to service-based industries.

Indeed, a 2015 paper from Princeton economists Alan Blinder and Mark Watson found that, while the economy has tended to grow faster under Democratic presidents, policy actions don’t appear to account for that difference.

“Democrats would probably like to attribute a large portion of the D-R growth gap to better fiscal (and perhaps monetary) policies, but the data do not support such a claim,” they wrote.

So could a president — with Congress’ help — target communities with particularly high unemployment? Yes, says one expert — particularly in one policy area Trump already has been championing.

“There needs to be a deliberate attempt to retrain and recruit people into the economy through infrastructure programs,” said Andre Perry, a fellow in the Metropolitan Policy Program at the Brookings Institution.

While the unemployment rate is relatively low — near what economists call “full employment” — it remains true that the black unemployment rate is always much higher than the national rate. He believes that targeted infrastructure policy could reduce that gap, helping disadvantaged Americans get back to work.

“Full employment means nothing to black folk in Baltimore or St. Louis or Pittsburgh,” Perry said. “For far too long, black unemployment has been the sacrificial lamb of full employment, and so again, if there is an infrastructure plan put on the table, it should be targeted at populations in areas that are largely out of work. [And] not only inner-city black America; it’s also rural white men who are being left behind by the economy.”

If that’s true, it seems likely to remain a hypothetical. Democrats and Republicans alike champion the idea of infrastructure, but partisan divides on how to do it remain so wide that passing an infrastructure package this year would likely be a heavy lift.

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Controversial Mississippi Law Limiting LGBT Rights Not Heading To Supreme Court

The Supreme Court declined to take up a case over a Mississippi law that provides specific protection for three “sincerely held” religious beliefs.

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Carolyn Kaster/AP

The Supreme Court says it will not take up a challenge to a Mississippi law that allows businesses and government officials to deny services to LGBT people if doing so would conflict with certain “sincerely held” religious beliefs.

By rejecting the cases, the top court leaves in place a federal appeals court decision that allowed the 2016 law to take effect. It came into force in October.

“We had challenged it before it went into effect … before people were hurt and turned away and left without all the access to health care and government services that everyone else has,” says Beth Littrell, a lawyer for Lambda Legal, a legal organization that advocates for LGBT people.

Some religious conservatives are celebrating the Supreme Court’s decision regarding the law, which was strongly supported by Mississippi Gov. Phil Bryant.

“As I have said from the beginning, this law was democratically enacted and is perfectly constitutional. The people of Mississippi have the right to ensure that all of our citizens are free to peacefully live and work without fear of being punished for their sincerely held religious beliefs,” Bryant said, according to Mississippi Today.

The federal appeals court did not rule last year on the constitutionality of the law, known as HB 1523; it ruled that the plaintiffs did not have standing to challenge the law. The decision was about two similar lawsuits against HB 1523 – Barber v. Bryant and Campaign for Southern Equality v. Bryant – both of which the Supreme Court said Monday that it would not take up.

“This law that targeted LGBT people [and] privileged specific religious beliefs over others — that was a harm in and of itself,” said Littrell. “The stigma itself of targeting LGBT people and saying that if you don’t like them, you don’t have to deal with them, is dangerous and harmful.”

But the Fifth Circuit appeals court did not agree. Before the law had taken effect, the judges did not find the plaintiffs had proved that the law had harmed them enough to have legal standing.

The Supreme Court did not state why it did not take up the case. Lawyers say they will continue to challenge the law by filing new lawsuits as LGBT individuals in Mississippi show how the law has negatively impacted their lives. Littrell says that now that the Supreme Court has declined to take up the case, she believes more LGBT individuals will be tangibly harmed by state officials, religious organizations and service providers.

“We’re ready to sue again when plaintiffs tell us about the harm,” the lawyer adds. “We would have to go back and start over again when we are able to articulate and show the particular ways this law is hurting people.”

The law provides protections to people with three specific “religious beliefs or moral convictions.” Here’s that section of the law:

The sincerely held religious beliefs or moral convictions protected by this act are the belief or conviction that:

(a) Marriage is or should be recognized as the union of one man and one woman;

(b) Sexual relations are properly reserved to such a marriage; and

(c) Male (man) or female (woman) refer to an individual’s immutable biological sex as objectively determined by anatomy and genetics at time of birth.

Opponents argue that the law confers a kind of special status on people with any of these three beliefs. The law lists numerous actions that people with these beliefs can take without facing legal action. For example, religious organizations and state employees declining to officiate same-sex marriages; foster parents raising foster children according to these beliefs; medical professionals declining to provide services to people seeking sex-reassignment surgery; and wedding service providers who deny service to same-sex couples.

It could also impact bathroom policies for transgender people. And as The Associated Press reported, “opponents say it also allows pharmacies to refuse to fill birth control prescriptions for unmarried women.”

Not all of these provisions are a change in Mississippi. As NPR’s Camila Domonoske has reported, “many of these forms of discrimination against gay and trans people are currently legal in Mississippi, and in many other states. For instance, business owners in Mississippi can already refuse to bake a cake for a gay couple without breaking the law.”

Many business owners have also spoken out against the law; according to South Mississippi’s Sun Herald, more business owners in the area have decried it than support it.

It has also recently impacted a local sports team, according to the newspaper:

“The law …was responsible for recent bad news for the Southern Miss baseball team. The Golden Eagles were set to pay three home games in February against Stony Brook university in Long Island, New York, but all non-essential state travel to Mississippi was banned by New York Gov. Andrew Cuomo because of HB 1523.”

One of the most high-profile cases in front of the Supreme Court this term covers similar issues. The Masterpiece Cakeshop case is centered on whether a baker morally opposed to same-sex marriage can decline to make cakes for same-sex weddings. As NPR’s Nina Totenberg has reported, a decision is expected by June.

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New Report Shows Weather Disasters In 2017 Cost More Than $300 Billion

Hurricane Harvey put vast swaths of Texas under water. Elsewhere, fires, tornadoes and extreme weather caused hundreds of billions in damages.

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Emily Kask/AFP/Getty Images

Before it got cold this winter, it was warm. Very warm. In fact, new data out Monday shows 2017 was the third warmest year recorded in the lower 48 states.

And it was also a smackdown year for weather disasters: 16 weather events each broke the billion-dollar barrier.

First, the heat. Last year was 2.6 degrees F warmer than the average year during the 20th century.

That may be hard to remember in the thick of winter. But climate scientist Deke Arndt points out that even in a warm year, we still have frigid weather that invades from the north. “We still have very cold poles and we still have the same weather systems that pull cold air away from those poles into places where we live,” he explains.

Arndt is part of a team at the National Oceanic and Atmospheric Administration that assesses each year’s weather and climate. They note that 2017 is the 21st year in a row in which the average annual temperature was warmer than the average over the 20th century. And the five warmest years for the lower 48 states have all occurred since 2006.

NOAA experts also tally the cost of bad weather. And last year was pricey. NOAA researcher Adam Smith says the cost of these events was unprecedented. “The cumulative impact of these 16 events exceeds $300 billion in damage,” Smith says, “which is a new U.S. annual record.” And having 16 billion-dollar events in one year has only happened once before, in 2011.

This year saw a trinity of horrible hurricanes: Harvey, Irma and Maria. But there was also flooding in California last February, followed by ferocious late-year fires. There were hail storms in Colorado and Minnesota, and three tornado outbreaks. There was drought and fire in the Plains states.

NOAA’s assessment acknowledges that part of the rising disaster toll is due to people building more homes and businesses in vulnerable places. That’s especially true with recent losses from wildfires and hurricanes. But Arndt notes that a warmer world clearly makes some weather worse. “Heat waves, their duration, their intensity, their frequency is going up,” he says, as is the frequency of very heavy rainfalls.

Oceanographer Antonio Busalacchi says climate models predict more of the same. “The trend is there, it is clearly evident,” says Busalacchi, “we are on an upward and warming slope.” And it’s a slope that increasingly worries not only scientists but insurance companies. He says insurance companies have a lot of questions about where the climate is headed. “Where is the risk in the future going to be from regional sea level rise?” he asks. “Where is the risk going to be for the increase in Category 3, 4 and 5 hurricanes? Where is the risk going to be for straight-line winds?”

Busalacchi runs the University Corporation for Atmospheric Research. He says many scientists who work for him are taking on a new task: advising insurance companies on how to lower those risks as the climate keeps warming.

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Large Shareholders Ask Apple To Help Wean Digital-Addicted Youths

Apple is being urged to help protect young users of its smartphones and tablets, with two investors citing problems that have been linked with spending too much time on social media and looking at screens.

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Citing the popularity of Apple’s phones and tablets among children and teenagers, two large investors say the company should do more to help parents protect their kids from the risks of digital addiction and the side effects of social media.

Together, California’s teacher pension fund, or CalSTRS, and the Jana Partners investment group own more than $2 billion in Apple stock. In a letter to the tech giant’s board, they’re calling on Apple to give parents options beyond a “binary” system in which tools and functions are either freely available or closed off.

Warning against handing a child or teenager “the same phone as a 40-year-old,” the investors had these suggestions for Apple:

“For example, the initial setup menu could be expanded so that, just as users choose a language and time zone, parents can enter the age of the user and be given age-appropriate setup options based on the best available research including limiting screen time, restricting use to certain hours, reducing the available number of social media sites, setting up parental monitoring, and many other options.”

Better controls, CalSTRS and Jana said, could help minimize “unintentional negative consequences” of overusing digital devices and spending too much time on social media. They urged Apple to apply its knack for innovation to help protect the physical and mental health of its youngest users.

“The average American teenager who uses a smart phone receives her first phone at age 10 and spends over 4.5 hours a day on it (excluding texting and talking),” the investors wrote, adding that “78 percent of teens check their phones at least hourly and 50 percent report feeling ‘addicted’ to their phones.”

To spread awareness of the issue, CalSTRS and Jana created a website, Think Differently About Kids.

Detailing some of the consequences of heavy smartphone use, the investors cited an inability to focus in class, along with a greater risk of depression and anxiety. Their letter to Apple also said researchers have found that “U.S. teenagers who spend 3 hours a day or more on electronic devices are 35 percent more likely, and those who spend 5 hours or more are 71 percent more likely, to have a risk factor for suicide than those who spend less than 1 hour.”

The letter cited work by Jean Twenge, a psychology professor at San Diego State University who has written a book called iGen, about what she has called troubling trends in teens feeling isolated, depressed and helpless, as she told member station KPBS last year.

“The happiest teens have phones but use them < 2 hrs/day," Twenge said in a tweet welcoming the Apple investors’ letter. She added, “more parents would buy phones if they were easier to set up safely for kids. Win-win both ethically & financially.”

Acknowledging that social media companies try to make their apps and websites “as addictive and time-consuming as possible,” CalSTRS and Jana said Apple could boost both goodwill from parents and demand for its products if it did more to minimize the chances of harm and overuse.

The two investors said Apple should study how technology affects child development and report its findings, much as it would handle environmental and supply chain issues.

As smartphones and social media have become ubiquitous, they’ve also been identified as bringing a new suite of potential problems into play for those who overuse them.

NPR’s Shots blog reported last year:

” ‘Digital addictions,’ whether to social media, video games, texting, shopping or pornography, are not official mental disorders listed in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), and there’s a debate among psychologists about whether that should change.

“…. Some people studying the condition compare the development of an Internet addiction to that of a gambling disorder (sometimes called gambling addiction), which is included in the DSM-V. With gambling, even though most of the time when you’re sitting in front of a slot machine you don’t win, every once in a while you do. And that intermittent reward is what hooks people.”

Overuse of digital devices has prompted a debate over whether tablets and phones are the problem — or if the addiction is best ascribed to either the internet itself, or to social media. With their letter to Apple, CalSTRS and Jana said are suggesting that an approach to all three of those areas could begin by focusing on just one of them.

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What Do We Mean When We Talk About Sexual Harassment?

NPR’s Yuki Noguchi covers business and economic news, and has a special interest in workplace issues — everything from abusive working environments, to the idiosyncratic cubicle culture.

She’s curious to learn what people are talking about when they talk about sexual harassment and whether there are perception differences different groups of people.

Your responses will inform Noguchi’s reporting and may be published online.

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Hospitals In States That Expanded Medicaid Less Likely to Close

Up to one half of rural residents are covered by Medicaid, says Michelle Mills, CEO of Colorado Rural Health Center. And they’re typically older, poorer and sicker than city dwellers.

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John Daley/CPR

The expansion of Medicaid helps rural hospitals stay afloat in states like Colorado, which added 400,000 people to the health insurance program under the Affordable Care Act.

Hospitals in states that expanded Medicaid were about 6 times less likely to close than hospitals in non-expansion states, according to a study by researchers at the University of Colorado Anschutz Medical Campus.

The study was published Monday in the January edition of the journal Health Affairs.

Colorado was one of 32 states to expand Medicaid under the Affordable Care Act. That cut the state’s uninsured rate in half. The biggest group that got coverage was childless adults.

Richard Lindrooth, a professor at the Colorado School of Public Health and lead author of the study, says hospitals saw more people showing up to hospitals with that insurance — so Medicaid payments increased. That helped the hospitals’ bottom line.

“It’s not as though Medicaid is an extremely profitable form of reimbursement, but it is something,” says Lindrooth, a professor the University of Colorado’s School of Public Health. “On the margins, it certainly helps the hospitals’ cash flow.”

Lindrooth says he and his colleagues hypothesized that hospitals in expansion states stood a better chance of remaining financially viable. So they examined national hospital data and local market conditions.

They compared four years before the Affordable Care Act went into effect (2008-2012) with years right after the launch of the ACA (2015-2016). Lindrooth says the results were noteworthy, especially for rural hospitals, which often struggle to stay open.

“Rural hospitals tend to be in more of a financially tenuous position, even prior to the Medicaid expansions,” Lindrooth says. “We found that really about half of the closures that did occur in non-expansion states could have been averted through the expansion.”

With more insured people in expansion states, hospitals made more money and provided less free care. “So overall their margins improved,” he says. Rural hospitals in non-expansion states didn’t have that advantage.

Rural health leaders said the study confirmed what they’ve seen on the ground.

Jason Cleckler, CEO of Delta Memorial Hospital in Delta, Colo., in the rural western part of the state, said the Medicaid expansion helped his hospital’s finances. He compared the numbers in 2011 with 2016, after expansion. The hospital’s Medicaid population grew from 10 percent to 20 percent, and the hospital was left with less uncompensated care. It saved the hospital more than $3 million.

Jason Cleckler, CEO of Delta Memorial Hospital in Delta, Colo., says Medicaid expansion helped the hospital’s bottom line.

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John Daley/CPR

“I think that really speaks to what the researchers found. So Medicaid doubled, our bad debt decreased significantly, and the uninsured rate decreased significantly,” Cleckler says. “It’s pretty remarkable, and I would venture to say that most hospitals, even ones with a lower percentage of Medicaid, have experienced a similar story.”

Cleckler did describe Medicaid coverage as a “mixed bag” for rural providers. Reimbursement rates can be paltry, he says. A hospital that pays $100 for a lab test may only be reimbursed $20. Another problem, he said, is many doctors and providers either won’t accept or limit the number of Medicaid patients due to low reimbursement rates.

An average of 30 percent to 50 percent of rural patients are covered by Medicaid, noted Michelle Mills, CEO of Colorado Rural Health Center, which offers rural health providers education and training. Mills says the population in rural areas is generally “older, sicker and poorer” than in urban communities.

She says the expansion plus a bump in Medicaid reimbursement rates “has helped rural Colorado hospitals from closing.” The jobs generated by those hospitals are key to rural economies, with health care one of the top three rural employers in Colorado.

“The importance of Medicaid expansion in our state cannot be understated,” says Cara Welch, director of communications with the Colorado Hospital Association.

Welch says other factors also provided a boost, including the state’s strong economy and its hospital provider fee. That fee helps reimburse hospitals for uncompensated care from the indigent population and those paying with Medicaid.

Brock Slabach, senior vice president of the National Rural Health Association, says the study correlates with data the group has reviewed. “If state legislatures and Congress want to cure the rural hospital closure problem, expanding Medicaid and not block-granting this important program would be the answer,” he says.

Members of the Republican majority in Congress have suggested changing Medicaid to a block grant. That means that instead of the federal and state governments sharing payment for every enrollee who qualifies, the federal government would provide each state a set amount of money, capping total Medicaid spending. It would let states decide how to spend the money. But health care and hospital advocates worry that the change would likely lead to cuts over time.

This story is part of a reporting partnership with NPR, Colorado Public Radio and Kaiser Health News.

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What To Do About Inequality



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Income inequality is rising. Over the past few decades, the rich have seen huge gains, while incomes for the middle class and the poor have largely stagnated.

Lots of people have ideas for how to get middle-class incomes growing again. On today’s show: Branko Milanovic, one of the most insightful economists we know on this subject, says a lot of those ideas won’t be that helpful in the 21st-century economy. He has some surprising ideas about what will.

Music by Drop Electric. Find us: Twitter/ Facebook.

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