What Happens If Kentucky Dismantles Its Health Insurance Exchange?

Kentucky Gov.-elect Matt Bevin has vowed to do away with Kynect, the successful state-run insurance exchange.

Kentucky Gov.-elect Matt Bevin has vowed to do away with Kynect, the successful state-run insurance exchange. Timothy D. Easley/AP hide caption

toggle caption Timothy D. Easley/AP

Kentucky Gov.-elect Matt Bevin, who takes office Dec. 8, plans to dismantle the state’s successful health insurance exchange and shift consumers to the federal one. It’s a campaign promise that has sparked controversy in the state.

Supporters of Kentucky’s exchange, called Kynect, have asked Bevin to reconsider. They say the exchange created under Obamacare and an expansion of Medicaid have improved public health by dramatically increasing the number of Kentuckians with health coverage.

But health analysts say Bevin’s plan to move Kentucky to HealthCare.gov would have little immediate effect on consumers. “The federal exchange is a perfectly viable alternative,” says Jon Kingsdale, a health care consultant who formerly led the Massachusetts agency that started the state’s exchange in 2006, providing the model for the federal health law. On a federal exchange, consumers would still be able to shop and enroll in private plans and apply for federal subsidies to lower their costs.

And even if Kynect goes away, other states with exchanges will likely decide individually what’s best for them rather than rush to follow Kentucky’s example.

State-run exchanges do have some advantages, Kingsdale says. For instance, they make it easier for people to enroll in Medicaid because the exchanges connect directly to the state-federal program health insurance program for the poor in each state. State exchanges also generally have lower premium taxes than the federal exchange, fees that insurers pass on to consumers. And states that run their own exchanges have more say about insurance options for consumers than those states that use the federal marketplace.

Bevin’s plan to end Kynect has brought a strong rebuke from Obamacare advocates and outgoing Kentucky Gov. Steve Beshear, but it’s also revived questions about whether the states or the federal government are best positioned to run the marketplaces. Bevin is a Republican and Beshear is a Democrat.

The exchanges are a linchpin in the federal law that has brought health coverage to 16 million people since 2010. The law’s drafters initially thought all but the smallest states would run their own exchanges. Most Republican governors blocked them in their states, citing opposition to the Affordable Care Act.

Thirteen states run their own insurance exchanges. The rest are run fully or in part by the federal government. If Bevin follows through on his plan, Kentucky would be the first state to close its exchange and push most responsibilities to the federal government.

Nevada, Oregon and Hawaii ran into technological problems with their enrollment systems and have shifted in the past year to using the federal HealthCare.gov site. But the states still handle other marketplace functions, including marketing and offering consumer assistance. Nevada and Oregon both posted solid enrollment gains in the second annual enrollment period ended in March 2015 after switching to HealthCare.gov.

Overall, state-run exchanges have enrolled higher percentages of their uninsured citizens than states using the federal exchange. That’s partly because all but one state with its own exchange also has expanded Medicaid, making millions more people eligible. Idaho is the only state that has its own exchange and has not broadened Medicaid. Twenty states have not expanded Medicaid.

Kentucky’s exchange is considered one of the best-run state exchanges because of its innovative, extensive marketing to uninsured consumers and its ease of use. About 500,000 Kentucky consumers have enrolled on Kynect since 2013, most of them for Medicaid. The state’s uninsured rate has dropped from 20 percent to 9 percent over the past two years, according to the latest Gallup poll.

Bevin’s says he is concerned that the state could end up being on the hook financially if its revenues from premium taxes don’t keep up with Kynect’s operating expenses. That wasn’t a problem in the exchange’s startup years when the federal government paid all the costs for state exchanges. But the federal money has run out, and Kynect, like other state exchanges, must rely mainly on premium taxes to fund operations.

Several states including Vermont and Minnesota are struggling to raise enough revenue through premium taxes. With less money, some state exchanges including Rhode Island have greatly curtailed marketing to attract more enrollees.

States that run their own exchanges retain more control over their individual insurance markets and the consumer sign-up experience, says Dan Schuyler, at health care consulting firm Leavitt Partners. California’s exchange, for instance, limits which insurers can participate to help it negotiate better rates. Connecticut’s exchange requires all insurers to offer standardized plans so it’s easier to compare rates and benefits.

Even so, a shift by Kentucky to the federal exchange wouldn’t change their insurance choices right away. “If you take consumers out of Kynect and put them into the federal marketplace from a product perspective nothing changes as consumers have access to same plans,” Schuyler says.

But the move would cost Kentucky control over which nonprofit groups provide consumer assistance and the state’s call center would likely move out. State exchanges could lower their costs by using HealthCare.gov for enrollment while retaining other functions such as consumer assistance and marketing. Starting next year, the federal government will charge state exchanges to use its enrollment system.

Kynect has an annual budget of about $28 million, funded by its 1 percent assessment on health premiums. The assessment would increase to 3.5 percent in a federal exchange, and dismantling Kynect would cost the state an estimated $23 million in one-time expenses, said Audrey Tayse Haynes, head of Kentucky’s Cabinet for Health and Family Services.

Bevin takes office Dec. 8. The earliest that he could shut down Kynect would be in 2017, because the health law requires a 12-month notice to the federal government.

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These Are The Faces Of People Facing HIV/AIDS: #WorldAidsDay

Eduardo Gonzalez is HIV positive. His mother died of AIDS; his father, who's HIV positive, is in jail. The boy lives at Eunime, a Tijuana facility for children whose parents have faced AIDS in their family and who may themselves be infected.

Eduardo Gonzalez is HIV positive. His mother died of AIDS; his father, who’s HIV positive, is in jail. The boy lives at Eunime, a Tijuana facility for children whose parents have faced AIDS in their family and who may themselves be infected. Courtesy of Malcolm Linton hide caption

toggle caption Courtesy of Malcolm Linton

There’s a place in the city of Tijuana, Mexico, called El Bordo, which has always been somewhat reminiscent of a post-apocalyptic movie scene. The name comes from “the border,” which is where it’s located: right by the fence that separates the U.S. from Mexico, among the enormous paved canals that run through Southern California like concrete veins. Hundreds of people live in those canals, often in makeshift tents, the smell of sewage made ripe by the hot Tijuana sun. It’s a place where many deportees try to get by. It’s also a site of heavy drug use.

El Bordo is one of the main locations for Tijuana’s HIV/AIDS epidemic, which is concentrated among drug users and sex workers. According to a 2006 study, the number of men and women age 15 to 49 who are infected with HIV in Tijuana may be as high as one in 125.

Jon Cohen, who covers HIV/AIDS for Science magazine, and photographer Malcolm Linton have been documenting the lives of HIV-infected people in Tijuana for two years. In their new book, Tomorrow Is A Long Time, they tell stories of the people in El Bordo as well as the Zona Norte (the red light district) and La Mesa prison.

Reyna Cortiz once dreamed of being a policewoman. Outside her makeshift shelter, she holds a syringe in her mouth before injecting heroin. She has tested negative for HIV but lives in fear of contracting the virus.

Reyna Cortiz once dreamed of being a policewoman. Outside her makeshift shelter, she holds a syringe in her mouth before injecting heroin. She has tested negative for HIV but lives in fear of contracting the virus. Courtesy of Malcolm Linton hide caption

toggle caption Courtesy of Malcolm Linton

Both a nurse and a photographer, Linton was uniquely positioned to approach this project. A few years ago, frustrated with how little work he was getting as a photographer, he studied nursing at Hunter College. He figured his degree would allow him to continue working with communities that are often marginalized. As he finished his studies, the opportunity to do the book in Tijuana came about. Linton moved there and worked as a nurse for a research project that tested IV drug users to monitor the rate of HIV.

Linton was able to zoom into the community — slowly. “It took several weeks before I even took my camera out,” he says. “I didn’t want people to feel like I’d come in, taken a few pictures and ripped them off. I wanted to build trust slowly. I wanted to make sure they knew me and liked me, and also that I could safely go out after dark.”

Linton says he couldn’t have done the work without a woman named Susi Leal, whose photograph and story is featured in the book. Many years ago she’d begun receiving assistance from AFABI (Binational Family Agency), a nonprofit in Tijuana that allowed her to receive antiretroviral drugs. She has been off heroin since 2001, and her HIV levels have been undetectable since 2005. Leal now works in outreach for at risk communities in the area and was key to helping Linton gain access.

The book documents the impact the epidemic has had on entire families. Juanita Ortiz moved from the state of Michoacán to Tijuana with her father when she was 12. Three years later, in 1995, she learned that her mother back in Michoacán had died of AIDS. Eight of her siblings were living there. Eunice and Noemí were infected. Juanita, who was not, co-founded an orphanage for children affected by HIV/AIDS and named it after them: Eunime

Dr. Patricia Gonzalez examines a patient's neck at a first-aid clinic that she started in 2014 in the Tijuana River Canal, where hundreds of drug users live. Some of them inject in the neck; wounds can result.

Dr. Patricia Gonzalez examines a patient’s neck at a first-aid clinic that she started in 2014 in the Tijuana River Canal, where hundreds of drug users live. Some of them inject in the neck; wounds can result. Courtesy of Malcolm Linton hide caption

toggle caption Courtesy of Malcolm Linton

Linton says one of the biggest challenges faced by people living with HIV/AIDS is stigma, which he feels weighs more heavily in Mexico than in the U.S. “There is a sense that they are second-class citizens and that they don’t necessarily deserve a lot of money spent on them,” he says.

Mexico has made advances. In 2003, antiretroviral therapy became covered by universal healthcare, although shortages have been reported. And in 2006 the government began setting up care facilities for people living with HIV. But activists have complained about a scarcity of essential goods, such as condoms and breast milk for babies whose mothers are infected. “I think the government is not devoting as much money as is necessary, because they regard the people who are infected as marginalized and dispensable,” says Linton. “It’s a mistake, because the epidemic will continue as long as you fail to treat the people who are the reservoir of the infection.”

Another common complaint is that government facilities are too far from the epicenters of infection. Many of those who need help the most simply cannot spend the day traveling. “The government clinic is an hour away from town,” Linton points out. “And people who are surviving day to day can’t afford to lose the day. They need to be earning money to get food.

Oscar Villareal, 28, lived in Wisconsin as a boy, married and had a son, returned to his native Tijuana, became a sex worker (above, he makes himself up as his female alter ego, Ale), binged on meth, has tested positive for HIV.

Oscar Villareal, 28, lived in Wisconsin as a boy, married and had a son, returned to his native Tijuana, became a sex worker (above, he makes himself up as his female alter ego, Ale), binged on meth, has tested positive for HIV. Courtesy of Malcolm Linton hide caption

toggle caption Courtesy of Malcolm Linton

Of all the inhabitants of Tijuana’s underworld, transgender people suffer the most stigma. As in the rest of Latin America, being trans in Tijuana makes it extremely difficult to have a mainstream job. The usual options are prostitution or hairdressing. For Linton, this was the most insular community, and it took around a year to find a way in. “They are a group that has been abused and mistreated so much,” he explains. “They suspect foreigners. They suspect anyone who wants to be friendly and isn’t a client.”

The book also looks at Mexicans caught between two countries — their birthplace and neighboring America.

That’s the case for Reyna Ortiz, born in Michoacán in 1968. When she was a year old, her parents took her to live in the suburbs of Los Angeles. She dreamed of joining the police force but dropped out of high school to work and help her mother raise five children. Around that time she started using heroin and at 23 was sent to jail for robbery. She was deported twice to Mexico, a country she could not even remember. “I didn’t know nothing about TJ [Tijuana]. Even though I’m not originally from the USA, I felt like I was from the USA,” she says in the book. “My whole life was robbed.”

After 9/11, as the border closed down, she didn’t even consider crossing back a third time. Instead she settled in El Bordo.

Martha Patricia Ruiz ran away from home in fifth grade to escape her abusive father, married a trapeze artist, left him, cleaned houses, became a sex worker (“I really didn’t want to, but I told myself I had to”), became addicted to heroin, tested positive for HIV in 2012. Courtesy of Malcolm Linton hide caption

toggle caption Courtesy of Malcolm Linton

The tales of life in the underbelly of Tijuana are unsurprising. After all, the city does have a reputation as a place where poverty, addiction, sexual exploitation and the desperation of those caught on the border come together. But Linton says the goal of the book went beyond showing that anguish. “There’s a lot of exuberance,” Linton says. “I enjoyed the people. I liked hanging out with the people of the canal. I found them in many ways very pleasant. In some sense they have little contact with reality, because they are high a lot of the time. But in other senses they have a high degree of self-knowledge. They are realistic, they don’t have a lot of inhibitions, there’s not a lot of attitude.”

El Bordo has changed in the time since Cohen and Linton did their work. In March of this year, the mayor of Tijuana began an aggressive campaign to “clean” the canal. More than 500 residents were moved into rehab centers. Others were shipped to their home states. But many others began sleeping on the streets. Police set up round the clock patrols to make sure no one returned.

Sergio Gonzalez (top bunk, left) lies on his bunk in Tijuana's La Mesa prison, where he was jailed the previous February for holding more crystal meth than legally allowed. He is HIV positive as is his young son, Eduardo, who now lives in an orphanage.

Sergio Gonzalez (top bunk, left) lies on his bunk in Tijuana’s La Mesa prison, where he was jailed the previous February for holding more crystal meth than legally allowed. He is HIV positive as is his young son, Eduardo, who now lives in an orphanage. Courtesy of Malcolm Linton hide caption

toggle caption Courtesy of Malcolm Linton

Dr. Patricia Gonzalez, who works in the area clinics, says, “They swept the people away like cockroaches.”

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Expanded Medicaid Coverage Means More Women Get Mammograms

Access to cancer screening can be difficult for minorities and people with low incomes.

Access to cancer screening can be difficult for minorities and people with low incomes. Wavebreak Media Ltd./Corbis hide caption

toggle caption Wavebreak Media Ltd./Corbis

If you’re a low-income woman, you’re more likely to get screened for breast cancer if you live in a state that expanded Medicaid under the Affordable Care Act than in a state that didn’t.

According to new research, low-income women who lived in a handful of early-adopter states that implemented Medicaid expansion by 2011 were 25 percent more likely to be screened for breast cancer in 2012 than women in non-expansion states. That’s a big change from 2008, when low-income women in both sets of states had similar odds of being screened. The study was presented Monday at the annual meeting of the Radiological Society of North America.

The researchers had hoped to see an effect from the Medicaid expansion, says lead author Soudabeh Fazeli Dehkordy. “We would expect to see actually greater differences if we redo the analysis today with 2015 [data],” says Fazeli Dehkordy, a resident at St. John Providence Hospital in Southfield, Mich.

Under the Affordable Care Act, states had the option of expanding Medicaid to cover low-income people living at or below 138 percent of the federal poverty level. Thirty states and the District of Columbia have expanded the health insurance program for low-income people, while 20 states are not adopting the expansion at this time.

Fazeli Dehkordy and her colleagues used data from the 2008 and 2012 Behavioral Risk Factor Surveillance System to look at roughly 31,000 American women ages 40 to 70 who self-reported how often they got mammograms. When the researchers adjusted for age, race, education and income, they found that low-income women in the early-expansion states in 2012 – which included California, Connecticut, Minnesota, New Jersey, Washington and the District of Columbia – were 25 percent more likely to get screened than women in non-expansion states.

Several studies have indicated a general decline in mammography rates following updated recommendations from the U.S. Preventive Services Task Force in 2009, Fazeli Dehkordy says. Those recommendations suggested that women could wait until age 50 before beginning regular mammograms and, at that point, begin getting them every other year. “There has been a lot of controversy regarding the importance of screening mammography, especially regarding the best age,” Fazeli Dehkordy says.

Indeed, the guidelines can still be confusing to women: the American Cancer Society updated its guidelines in October, pushing back the age at which it recommends women begin annual screenings from 40 to 45.

Yet despite the overall decline in screening rates, screening rates among low-income women stayed steady from 2008 to 2012 in states that expanded Medicaid early on, the researchers found.

The next step for research, Fazeli Dehkordy says, is to explore whether expanded coverage and more mammograms translate to better health outcomes with regard to breast cancer. For this study, the researchers did not look into whether low-income women who are now on Medicaid had difficulty finding providers where they could obtain screenings or specialists to follow up with if a screening finds something abnormal.

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Clinton Emails: 'ROLF,' Plus 'Mittens,' Romney And Newt, 'The Grinch'

The State Department released the largest batch yet of emails from Hillary Clinton's time as secretary.

The State Department released the largest batch yet of emails from Hillary Clinton’s time as secretary. Cheryl Senter/AP hide caption

toggle caption Cheryl Senter/AP

Call it an early Christmas present.

On Monday, the State Department released the largest batch yet of emails from Hillary Clinton’s time as secretary of State that have been culled from the controversial private server she used.

According to a State Department official, Tuesday’s release included 5,109 new emails totally 7,825 pages. It’s the largest release yet, which began in May, and now includes about two-thirds of Clinton’s total emails. Most of the new emails are ones received and sent during 2012 and 2013, shortly before she left office. The full database can be searched here.

Republicans have criticized the Democratic presidential candidate for the use of her server instead of a government email address. While Clinton maintains that she never sent classified email over her account, a number have been retroactively classified. In the latest release, portions of 328 emails were upgraded to “Confidential” status.

As has been the case with previous releases, the emails have largely been routine process email correspondence. A running trend is confusion from Clinton over technology, glowing praise from close friends and employees and some insight into what her days looked like at the State Department.

Here are a few ones that stand out:

Praise following congressional testimony

On January 23, 2013, Clinton appeared before the Senate Foreign Relations Committee and the House Foreign Affairs Committee to answer questions about the September 11, 2012, attacks on the U.S. Consulate in Benghazi, Libya, that killed four Americans, including U.S. Ambassador Christopher Stevens.

She delivered a forceful, and sometimes emotional, defense of the events surrounding the attack and her response to it.

And some of her closest allies and others sent her several emails praising her performance.

Well, if Twitter says it....

Well, if Twitter says it…. State Department hide caption

toggle caption State Department

"Turkey?!?!?"

“Turkey?!?!?” State Department hide caption

toggle caption State Department

Hillary <3's Twitter

After her staff sends her a compilation of tweets after her testimony, she voices something we’ve all wondered — what did we do before Twitter?

It is so addictive.

It is so addictive. State Department hide caption

toggle caption State Department

Glasses are very “in”

Clinton’s relationship and emails from Sidney Blumenthal, a longtime friend and adviser, was a top target when she testified before the House Select Committee on Benghazi in October. In an email about her previous testimony in January 2013, he praises how she answered questions from the “cretins and reptiles.” And he notes, her look with her glasses with fab, according to his wife, Jackie. And as she needs to clear her head once she leaves office, why not walk a dog?!

Were they Warby Parker?

Were they Warby Parker? State Department hide caption

toggle caption State Department

How to work the moving picture box

Another email where Clinton is having trouble with technology. This time, it’s trying to find what channel Showtime’s “Homeland” is on.

Must find out what happened to Carrie Mathison and Nicholas Brody!

Must find out what happened to Carrie Mathison and Nicholas Brody! State Department hide caption

toggle caption State Department

We think she meant “ROFL?”

Clinton doesn’t get this abbreviation exactly right, unless she did mean “Rolling On The Laughing Floor.”

I don't think that's what she meant.....

I don’t think that’s what she meant….. State Department hide caption

toggle caption State Department

‘Mittens’ and the ‘Grinch’

Clinton had some nicknames for Mitt Romney and Newt Gingrich during the 2012 GOP primary race.

Spoiler alert: "Mittens" ended up pulling it out.

Spoiler alert: “Mittens” ended up pulling it out. State Department hide caption

toggle caption State Department

The NFL Knows All About These Things

Who better to reach out to than NFL Commissioner Roger Goodell about head injuries and concussions when Clinton suffered one herself in December 2012.

Having a “cracked head” doesn’t sound like fun. State Department hide caption

toggle caption State Department

Keeping Count

Republicans have criticized Clinton for touting her travel as an accomplishment while at State, and emails from that time show her aides were indeed keeping track of her time abroad, as well as her approval ratings.

Up, up in the air.

Up, up in the air. State Department hide caption

toggle caption State Department

Tracking poll numbers.

Tracking poll numbers. State Department hide caption

toggle caption State Department

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'Unprecedented': What ISIS Looks Like In America

A map shows the numbers of ISIS recruits who are now in the U.S. legal system, by state. At least 56 people were arrested on terrorism charges in 2015 — the most since September of 2011.

A map shows the numbers of ISIS recruits who are now in the U.S. legal system, by state. At least 56 people were arrested on terrorism charges in 2015 — the most since September of 2011. Program on Extremism/ George Washington University hide caption

toggle caption Program on Extremism/ George Washington University

They connect via online services — especially Twitter — and in everyday life. Their ages range from 15 to 47, and their roles range from cheering attacks to plotting violence. And curbing their growth is a dynamic challenge without a simple solution: There are currently 900 active investigations into ISIS sympathizers in every American state.

Those are some of the findings of a new study that glimpses life “inside the bubble of American ISIS sympathizers, a diverse and diffuse scene that the FBI estimates include hundreds, if not thousands, of individuals.”

Titled “ISIS in America: From Retweets to Raqqa,” the report by Lorenzo Vidino and Seamus Hughes focuses on around 300 people who have been identified as American recruits or supporters of ISIS.

While it’s not new for Americans to join jihadist groups, Vidino, who directs the Program on Extremism at George Washington University, says, “the size of the ISIS-related radicalization and mobilization is unprecedented.”

NPR’s Carrie Johnson reports:

“The report reviewed social media accounts and legal cases against Islamic State recruits. The study says the highest number of recruits have been charged in New York and Minnesota, though the FBI has open investigations in all 50 states.

“The report’s authors say the average age of the ISIS sympathizers is 26 — and more than half have traveled or tried to travel abroad.

“About 40 percent of the cases George Washington reviewed involved converts to Islam, and a small fraction, about 1 in 10, are women.”

The group is very diverse — both in their demographics and in what motivates them.

“While some seek to join the self-declared caliphate in ISIS-controlled territory, others plan attacks within the U.S.,” Vidino says in a statement accompanying the report. “It’s a growing and disturbing phenomenon.”

Describing the ISIS sympathizers, he says, “We have seen cases in big cities and rural towns. The individuals involved range from hardened militants to teenage girls, petty criminals and college students.”

As for how to combat ISIS’s reach in the U.S., the report’s authors recommend boosting funding to create dynamic programs; helping non–law enforcement groups take people off the path to radicalization; and encouraging American Muslims to engage with ISIS supporters without fear of becoming a target of a federal inquiry.

Describing how ISIS used technology to reach into U.S. society, the report says:

  • “Several thousand Americans consume ISIS propaganda online creating what has been described as a ‘radicalization echo chamber.'”
  • Twitter is “by far the platform of choice” for American activists to connect. Other routes include Facebook, Google+ and Tumblr, along with messaging services like “Kik, Telegram, surespot, and the dark web.”
  • On Twitter, many of the most popular pro-ISIS accounts are “shout-out accounts,” which the researchers call “a unique innovation and vital to the survival of the ISIS online scene.” The accounts introduce new activists – but even more important, they promote the new accounts of users who’ve been suspended by Twitter.
  • “American accounts, like the larger ISIS echo chamber, tend not to tolerate dissent and silence attempts at nuance. Muslim religious leaders, particularly those living in the West, who condemn ISIS are routinely dismissed as ‘coconuts,’ a derogatory term used to insult those accused of denying their Muslim identity. Many U.S.-based Muslim scholars and activists, even those from conservative backgrounds, are subject to routine death threats.”
An image from the report ISIS in America: From Retweets to Raqqa shows, clockwise from top, a suspended Twitter user announcing their new account, and examples of other Twitter accounts that help spread extremist information online.

An image from the report ISIS in America: From Retweets to Raqqa shows, clockwise from top, a suspended Twitter user announcing their new account, and examples of other Twitter accounts that help spread extremist information online. Program on Extremism/George Washington University hide caption

toggle caption Program on Extremism/George Washington University

The Internet isn’t always the main point of contact, the researchers say. In some cases, people became radicalized by in-person meetings with “preexisting social contacts who already embraced jihadist ideology” – and over time, a cluster of like-minded individuals forms.

Most of the sympathizers who are engaged in an ISIS “counter-culture” will never “make the leap from talk to action,” the report says. But it adds that some will turn to real militancy – whether that means attempting to take violent action overseas or in the U.S.

Citing the wide range of people who’ve been identified as ISIS activists, the report states, “Because there is no standard recruit profile, there is also no silver bullet that will blunt ISIS’s allure. Recognizing this complexity is a vital initial step for policymakers, law enforcement officials, civic leaders, teachers, and parents when crafting effective solutions.”

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LISTEN: 'We Have An Obligation' To Refugees, Says Homeland Security Chief

Department of Homeland Security Secretary Jeh Johnson.

Department of Homeland Security Secretary Jeh Johnson. Yuri Gripas/Reuters /Landov hide caption

toggle caption Yuri Gripas/Reuters /Landov

President Obama’s administration contends that refugees are not the true source of U.S. security concerns. Jeh Johnson, the secretary of Homeland Security, tells NPR that the real concern may be a person traveling as an ordinary tourist from Europe.

Johnson’s department is tightening the visa waiver program, under which visitors from 38 countries, including much of Europe, may travel to the United States without applying for visas.

Administration and congressional leaders in both parties have called attention to the visa waiver program, noting that most suspects identified in the recent attacks in Paris were not Syrian refugees, but legal residents of European countries.

Among other things, the U.S. will now deny visa-free travel to those who have previously visited “terrorist safe havens” such as Syria or Iraq. Johnson says the Obama administration wants to work with Congress on legislation that will further strengthen the routine electronic screening of those who are still able to travel without visas.

But the administration still resists a House-passed measure that would make it more difficult for refugees to enter the United States.

“What we want to do is work with Congress in ways that are effective to improve homeland security,” Johnson said. “The refugee program as it is currently exists is probably the most thorough, multilayered, time-consuming way for anyone to cross our borders, to come into this country.”

Listen to Johnson’s answer when I asked if he’s trying to change the subject from refugees:

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Jeh Johnson on ‘Morning Edition’

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Smoke Fairies Know The True Meaning Of Christmas

December 1, 201510:00 AM ET

by Kate Drozynski

Holiday songs aren’t all jingling sleigh bells and glistening snowflakes. Elvis is having a blue Christmas without you. Bing Crosby won’t make it home for the holiday after all. Grandma met her unfortunate end under the hooves of a reindeer.

British dream pop duo Smoke Fairies gets it. Sometimes Christmas is grey and lonely. “Christmas Without A Kiss” beautifully captures unfulfilled holiday wishes with moody vocals and distorted guitar. The song sounds like a Christmas carol stretched and warped like a half-melted string of lights.

“Christmas can put pressure on a person,” Smoke Fairies’ Jessica Davies told us in an email. “Pressure to be loved; pressure to share the holiday with someone special; pressure to have someone to go present shopping and cook a massive dinner for. When it doesn’t quite work out how you hoped it would, it can make you want to hurl yourself on the ground into a pile of snow in resignation. That’s what we tried to capture in this video.”

Davies and bandmate Katherine Blamire peer through the darkness in the video, their faces covered in glitter like gaudy tree ornaments. They writhe and flail and fight through their gnarled holiday hymn. The very antithesis of a silent night.

Smoke Fairies’ seasonally-themed album, Wild Winter, is out now.

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Iowa Evangelicals Warm to Ted Cruz

Senator Ted Cruz is a guest during a morning service at Christian Life Assembly of God in Des Moines on Nov. 29, 2015.

Senator Ted Cruz is a guest during a morning service at Christian Life Assembly of God in Des Moines on Nov. 29, 2015. Clay Masters/Iowa Public Radio hide caption

toggle caption Clay Masters/Iowa Public Radio

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Republican presidential candidate Ted Cruz is stepping up his game in Iowa.

The first term Texas senator has picked up influential endorsements there and is drawing bigger crowds.

At the stage of the race when many caucus-goers are still deciding who to support in the first in the nation presidential caucus, Cruz is making a big play for Iowa evangelical voters, who helped Mike Huckabee in 2008 and Rick Santorum in 2012 win the Iowa Republican caucuses.

On the first Sunday of Advent at the Christian Life Assembly of God Church in Des Moines, Ted Cruz, a Southern Baptist, appeared to feel right at home.

“It is so wonderful to have a chance to spend Thanksgiving Sunday together. Thank you for welcoming me here,” said Cruz.

At the church, Cruz talked about how he sees the country’s religious liberties under attack but did not mention any of the polls that show him closing in second place in Iowa and gaining ground on front-runner Donald Trump.

In a lighter moment, Cruz recited a scene from his favorite movie: The Princess Bride.

“He’s just an honest, Christian man. That’s what I really appreciate about him,” said Mardell Cory, a massage therapist who waited in line to give Cruz a hug and get a picture signed. She’d had her choice down to Cruz and retired neurosurgeon Ben Carson but now plans to volunteer for the Cruz campaign.

For her part, churchgoer Sarah Foster said she and her husband see many good candidates, including political newcomers Carson, Trump and former Hewlett Packard CEO Carly Fiorina. But after hearing Cruz speak she’s leaning towards him.

“He definitely goes against the grain and we really like that,” said Foster, who said national security has become the key issue for her.

Among those at the church, Cruz was also picking Meanwhile, Keith Leslie said he’s leaning towards supporting Cruz.

Churchgoer Keith Leslie argued that Cruz was earning his support in part because he believed Donald Trump isn’t fit to be president.

“I think he’s an even bigger egomaniac than Barack Obama. With this guy we could see the next Mussolini if Trump gets elected,” said Leslie, who emphasized that he appreciated that Trump has raised important issues for Republicans.

Even as Cruz builds his support among Iowa evangelicals with an eye towards winning the caucus, the state’s track record of selecting eventual GOP nominee is poor. The last Republican nominee to win Iowa was George W. Bush in 2000.

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Viking's Choice: Glassjaw, 'New White Extremity'

“New White Extremity” will appear on Glassjaw’s as-yet-untitled third LP. Courtesy of the artist hide caption

toggle caption Courtesy of the artist

In the early 2000s, Glassjaw was a square peg in a round hole — a dynamic post-hardcore band pitched to a mainstream audience caught somewhere between spiky-haired aggro-metal and swoop-haired screamo. Still, Glassjaw’s New York hardcore bona fides were hard to dispute, Daryl Palumbo’s nerve-wracking voice could shred and salve on a dime, and the band’s melodic subversion and occasional Latin rhythms flew Faith No More’s freak flag while also throwing down some grooves. Oh, and Vincent Gallo gave a very Gallo-esque performance in one of Glassjaw’s music videos.

But there hasn’t been a full-length Glassjaw album since 2002’s Worship And Tribute. There have been other projects and fits of touring since — the sporadic activity due mostly to Palumbo’s ongoing issues with Crohn’s Disease — but the speculation around a new record has circulated as far back as 2006. Well, now we have the promise of a new, as-yet-untitled record, with no release date, no label information and no band lineup other than founding guitarist Justin Beck. But we do have a new song and this explanation from Palumbo: “This is a song about walking out of your front door. Thanks for the [patience] and we hope you enjoy.” Unlike 2011’s musically voracious Coloring Book EP, “New White Extremity” captures Glassjaw at its most feral.

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