MR. TOIV: Good afternoon. Welcome to the White House. And to brief today on the President's Medicare proposal are Gene Sperling, the President's Senior Economic Advisor, and Secretary of Health and Human Services Donna Shalala, and Secretary of Labor Alexis Herman.
Today is another announcement in this President's step-by-step commitment to provide more health coverage and address more of the health needs of the American people in a careful, but serious and fiscally responsible manner. The people, Americans in the age group of 55 to 64, and particularly those between 62 and 65, face serious and unique health care needs. They are more than twice as likely to go into the individual markets and face denial or exorbitant prices. They are significantly more likely to have trouble finding new jobs if they are displaced, and they are more than twice as likely to have a serious health need. And what we have tried to do, what the President has put forward today is a significant attempt to address those needs in a fiscally responsible manner.
In the last several days you have heard some suggest that this is not enough. You have heard others say this is somehow going to open the floodgates and be too much. If the accusation is that this is a sensible, serious and fiscally responsible plan to provide access to health care for hundreds of thousands of Americans between 55 and 65, we plead guilty. And if the accusation is that we will continue to look at other possibilities for how we can provide more coverage for Americans who have serious health care needs in a way that is fiscally responsible, we plead guilty again.
This is why we're here, to try to address the needs of the American people in a way that is fiscally responsible. And what we're doing today is not only paid for, but is self-financed within the Medicare system so that it in no way sets back the Medicare trust fund or Medicare solvency. And that should be an encouraging sign for those who care about the long-term fiscal solvency of Medicare. If the new way of doing things is to ensure that everything that is done is self-financing within Medicare and paid for, that is the right way to address future health care needs in a way that is sustainable for this country.
I'm going to introduce Secretary of Health and Human Service Donna Shalala, who is going to go through two of the components here. And then Secretary Herman is going to talk about the provisions we have for displaced workers and those who had their promises broken concerning retiree health insurance.
SECRETARY SHALALA: Thank you very much, Gene. As Gene said, this is a targeted, responsible program for thousands of Americans who do not have access to good health insurance because they have a preexisting condition or they're too old and there simply isn't a private sector market.
Let me talk first about what the President described as a centerpiece -- Americans between 62 and 65 to buy into Medicare. There are a million people in this country between 62 and 65 who have no health insurance. They are often women like Mrs. Cain whose husbands have moved into the Medicare program --husband worked all of his life, she stayed at home, she was covered by his policy when he worked. He now moves into Medicare as an individual; she's without insurance. But, just as important, she said that she had a pre-existing condition. She had a heart condition. There was no insurance company out there that would give her insurance.
We will now have a solution for women like her, women whose husbands have moved into Medicare, they're no longer covered; people with pre-existing conditions, women and men, who will be able to buy an insurance policy, an actuarily sound insurance policy. Alexis Herman and I are both trustees of the Medicare system. We are committed -- of course, the President is -- to not increase costs of the Medicare trust fund. They will be able to buy a policy. That policy will cost about $300 a month. Plus, when they reach 65 and enter the Medicare, they'll have to pay a little bit more, depending on when they entered this new Medicare program -- they'll pay a little more every month to pay back the total cost of the premium that was provided for them earlier than 65.
So for people between 62 and 65, they'll be able to buy a good insurance program through the Medicare system. They'll have a choice. If they can find a policy for themselves in the private sector that's cheaper and better, that's their choice. If they can't, many of these people will be people with pre-existing conditions or they live in a part of the country where they can't find insurance for themselves -- they'll be able to buy a program through the Medicare system. It will be paid for by them, first through their premiums and then by an extra charge on their Medicare premium once they enter the Medicare program. So a million people.
There also will be some people who are in the individual insurance market in which it's very expensive for them to pay for their policy that may drop back and do this. But we expect for this program alone that there will be probably 150,000, 160,000 people that will take advantage of this. It won't be everyone, because of the cost.
Second, displaced workers over 55, we want to give them access to Medicare by offering people who have involuntarily lost their jobs -- their company has closed down, they were let go in a downsizing, their health care coverage will be similar to the current Medicare buy-in option that I just described. Again, they will pay for their premium every month until they reach the Medicare age. For this group their premium will be a little higher because they'll be buying in earlier into the program. But, again, they'll get access to health insurance through Medicare. For many of these people, they do find some health insurance if they're healthy, at a reasonable price, depending on where they live in the country. But some of them may not be able to and they will be allowed to buy into the Medicare program, but they will have had to have lost their jobs involuntarily to be able to enter that program.
I'll turn the third issue over to Alexis and then we'll both answer questions.
Q How many are in the second group?
SECRETARY SHALALA: Alexis will do that.
SECRETARY HERMAN: Thank you very much, Secretary Shalala. I'm very pleased that the initiative that the President has proposed today, in my view, certainly takes us a step closer to helping to manage the change and the anxiety that clearly workers experience when they are going through transitions in the work place today through downsizing, through other kinds of adjustment issues in the work place today. And particularly as the proposal relates to retirees who have had their promises broken by their employers, who have actually lost their coverage after they have left the labor market.
Specifically, as it relates to what we see the benefits being for dislocated workers in particular, we know that there are approximately 700,000 dislocated workers between the ages of 55 and 62 over a two-year period who lose their jobs, who would fall into this category. We also know from our own experiences of job search and job assistance to this population, that the older the displaced worker the more difficult it is for you to get that second job experience, particularly job experiences that have health insurance attached to it. It is more likely that they are going to find jobs in smaller firms and that they will not have, oftentimes, the option to get health insurance.
So this proposal for a dislocated workers in particular I think will help to certainly manage the change and the anxiety that goes along with being downsized, with being dislocated from your job. When we look at the retiree population, those individuals who will be affected by what we call broken promises by employers. While it is a small population, it is a very significant population. You are talking about approximately 1.5 individuals in this category that are retired workers that have health insurance -- 1.5 million that have health insurance that has been promised to them by their employers and they will no longer, because of perhaps promises being broken, be eligible for this insurance should you have the experience, for instance, of what has happened with some companies in this country today of actually cancelling those benefits. We know that the trend is towards declining benefits for this population. We've seen it go more recently from 37 percent now to approximately 27 percent for just this population alone. So we think this will clearly provide greater options in particular to retirees.
I would just say in conclusion, as Secretary Shalala has already indicated and Gene Sperling, this obviously is not a policy that everyone will take advantage of. But clearly it is a policy that puts in place options for individuals to know that it is there as a real safety net. I liken it to a fire hydrant, you know -- not all of us will take advantage, hopefully, of the fire hydrant being there, but we sure feel a heck of a lot better knowing that it's there. And I clearly see this policy as having that kind of impact for dislocated workers and for retirees.
SECRETARY SHALALA: Let me give you one number, Alexis. We expect 300,000 people across all three of these programs to take up this option. So out of the millions that would be eligible, we expect 300,000 people. That is what the actuaries are estimating. And that is because people have to pay for it, obviously.
Q I'm trying to understand the logic of this then, because Secretary Herman just talked about this as a safety net, you said for the retirees or near-retirees, 62 and 64, between 150,000-160,000 would participate. That's about one in five. The people least able to afford it, the ones presumably most needing the help aren't going to get it.
SECRETARY SHALALA: Well, one could not listen to Mrs. Cain and not believe that she also needed help. This administration has addressed different aspects of the health care system -- this massive public-private system we have -- with a variety of different strategies targeted for different populations. Last year we did children's health insurance. In that case, it was a subsidy to make sure that working parents could get access to health insurance for their children.
This year, as one part of the President's overall budget message, we are targeting a group of people who can afford a decent plan if they had access to that plan. This strategy is about access; it is not addressing the financial problems of every individual. It's about access to health insurance, and therefore, it focuses on access and makes itself finance it.
Q But the people who are advocating for this say that Mrs. Cain's example -- I mean, there are a lot of people with preexisting medical conditions, but most of the uninsured are poor and minorities. That's the numbers, and they can't afford this.
SECRETARY SHALALA: There are large numbers of people who don't have health insurance in this country who have preexisting conditions. We address their issue in Kennedy-Kassebaum -- part of their issue -- but we didn't address the issue of ratings, and that is how insurance companies made adjustments so that someone with a preexisting condition simply couldn't get access to health insurance, or got health insurance that eliminated the disease that they needed help on taking care of.
That's why we describe this as targeted and limited, because it addresses a real problem for real people in this country, but it doesn't solve every health insurance problem that's left. Each year we're trying to add more people to the health insurance roles. In these cases, it's displaced workers, it's people that are pushed out of their jobs, and it's people who are 62 that need access to the market.
MR. SPERLING: I just wanted to add one thing. One of the issues that you do face is that when you do go to subsidization, you then do create a lot of other incentives that have to be dealt with, and sometimes we try to carefully deal with them and target them. But this is a plan that would not create those kinds of disincentives. And we were doing this very mindful of the fact that we have a very serious long-term Medicare situation and things we have to do have to be fiscally responsible. And so we said, here is a group of people, hundreds of thousands, who have a very serious problem. We could help them without burdening the Medicare trust fund a penny by essentially allowing them to buy into Medicare to essentially take a loan on the extra premium they have so they could buy a reasonable health care plan and spread that out.
And the question that this needs to be weighed on is, is this a good policy, does this help people and is it fiscally responsible. And if it meets those tests we should support it. And then if there's questions of could we do more, more like we did for the five million children of 24 billion, then we should come back and look at that -- look at what the costs are, look at how we can do subsidies without creating negative disincentives in the market for people that drop coverage, and judge that on its merits. But don't look bad on a program that can help 300,000 people a year with serious problems and fiscally responsible just because there's more to do. We agree there's more to do, we have no argument with that. And we should continue as we're here to find fiscally responsible ways to address more health care needs.
SECRETARY HERMAN: And I don't want to beat a dead horse, but I do want to say -- since you said I used the term "safety net," I used that on purpose, because while the actual numbers we're talking about is approximately 300,000, the reality is you have millions more, hundreds of thousands of more, who just knowing that the possibility of this kind of an initiative is in place, in my view does help to manage the anxiety that many workers feel when they're going through the kinds of transitions and changes that are part of dislocation and downsizing in the work place.
SECRETARY HERMAN: I don't think that there's any indication in the policy that this is an incentive for employers to cut back. Because, first of all, you have to realize that what we're doing is extending the option to continue COBRA payments, and we're doing it at a cost that, quite frankly, is not at a cost to the employer. It simply really puts the option there for that retiree to continue that COBRA benefit that they would have been entitled to anyway as a part of the employer's insurance program.
Also, as I indicated earlier, this is really a small population when you look at the retiree population, of approximately 1.5 million. And, ultimately, I also believe that smart employers today recognize that the whole question of being competitive today in the work place also includes what we're doing more broadly, not just with pay, but also with benefits.
SECRETARY SHALALA: The answer to the question is it's a hundred percent paid for.
SECRETARY SHALALA: A combination of the premiums. And if there's any other costs, we've identified savings in the Medicare program to take care of. But it's all paid for.
SECRETARY HERMAN: And you've got to recognize that right now it's like 102 percent, even for COBRA payments. And because we recognize that this population is an older population and therefore could be viewed at a higher risk, then we're looking at a rate slightly higher than the 102 percent of the existing COBRA payment now.
SECRETARY HERMAN: Somewhere around 120, 125 percent.
Q How do you make sure that this whole program is self-financing? For instance, if the cost is raised -- as they often have been in the past -- would the additional premiums that people after 65, would that be increased? I mean, is there some sort of safety valve here to make sure that this continues to be self-financed?
SECRETARY SHALALA: The answer is yes. And that's what the actuaries do. We've made a commitment to make sure it's self-financing. Congress will want it to be self-financing. And we'll make appropriate adjustments.
Q So you will continually adjust the premium as necessary?
SECRETARY SHALALA: Well, yes. But the point is that we've done these projections with our actuaries, so we have a pretty good -- we do that now in the Medicare system, where we make appropriate adjustments.
SECRETARY SHALALA: We tried that, Helen.
SECRETARY SHALALA: I agree with you.
MR. SPERLING: Boy, of all the criticisms.
Q You didn't have a program that really covered everybody. So now why don't you make the employers accountable and the insurance companies amenable and so forth?
SECRETARY SHALALA: I think that, you know, this is strategy, too. And that is that we are taking deliberate, strategic steps to fill in the gaps of where the health care system -- the public/private system that we have is weak. And this is a clear place where we have identified a problem and developed a strategy that is self-financing for thousands of Americans who are outside the health care system.
It's in all of our interests to bring more people into the health insurance system, whether it's in the private system or in the public system.
Q On the access premium that then gets paid after 65, that continues in perpetuity, even if the person lives until they're 95?
SECRETARY SHALALA: Yes. Yes, it does.
SECRETARY SHALALA: That's what actuaries do.
MR. SPERLING: They're told up front what it will be.
Q So they'll be okay because they will have a cap on the amount that they will pay. But then, if, in fact, you only get the sickest people to enroll in this program, isn't it possible that the cost to the government would somehow rise exorbitantly and Medicare will pay?
SECRETARY SHALALA: We will, in this total package, identify savings to make sure that we are not adding cost to the trust fund. That is the commitment that the President has made as we send these recommendations up to Congress.
Q I have two questions. One about not providing an incentive for employees to continue the trend of dropping current retirees. I mean, if you're extending COBRA at no cost to the employer, why isn't that an incentive for employers to say I'm going to drop all the early retirees on my roles now. I mean, why isn't that an incentive for them to do that? And what will you do if this trend suddenly takes off?
SECRETARY HERMAN: Well, I don't think it's an incentive, as I said earlier, because enlightened employers today are looking at the total package, first of all, of what it takes to keep their own work forces competitive.
SECRETARY HERMAN: Yes, I know. And that's why this policy really speaks to what we call the bad actors, who have made a good-faith promise to their workers and who have chosen to break that promise.
Q It's for bad actors?
Q But the question is, what about marginal bad actors who right now aren't doing it, but under your plan could do it, and so their employee is protected?
SECRETARY HERMAN: But the reality is they are already providing COBRA support anyway.
Q I know, but it doesn't cost them anything. They cancel the health insurance -- the employee turns 55, they say, you're now covered under President Clinton's plan, hence we're canceling and all of our employer costs go away.
MS. BERG: pay for it and pay more. So there already are incentives in the system for people who -- drop it, they've been doing it.
Q But this does not change those incentives.
SECRETARY HERMAN: That's Olena Berg, who is our Assistant Secretary for Pensions at the Department of Labor.
Q I have another question about Kennedy-Kassebaum. Secretary Shalala just said that Kennedy-Kassebaum allowed people with preexisting conditions to get insurance, but not for that preexisting condition. Isn't that an admission that it isn't working?
SECRETARY SHALALA: No. Kennedy-Kassebaum allowed people to get insurance. What it didn't do was deal with the rating issue. And that is, you can get access to insurance, but the insurance company can run up the price and that's been the problem for people. What we do here is we give people, even those that are sick, access to a pool in which they get a price that simply is a better price. What Kennedy-Kassebaum never did was protect us against the ratings -- protect individuals against the ratings issue.
Q They can get, they just have to pay a lot; this makes it more affordable? That's all you're saying?
Q She said she couldn't get it.
SECRETARY SHALALA: Well, she could get insurance. What she couldn't do was get insurance for that particular preexisting condition. She probably actually could now get insurance for that particular condition, but it would be so expensive she wouldn't be able to do it.
The point here is -- particularly for this group between 62 and 65, a lot of women in that group -- a number of people with a preexisting condition, as was described here, who just don't have access to the insurance market. What we're attempting here is to give them access to a reasonable premium that they will pay for, and give them access to a wider pool. So we're putting some order into the market.
Q In terms of the long-term solvency of the Medicare system, there's been a lot of discussion about conforming the Medicare eligibility age to the Social Security eligibility age, which is slated to rise to 67. In conjunction with that discussion, there has been talk about a program like this that allows a Medicare buy-in. Are you -- with the cost of this program you presented so high, are you setting a precedent that if there is this increase in the eligibility age, everyone in this below 67 or 68 age group will have to pay these high premiums every month?
SECRETARY SHALALA: Well, first of all, the Social Security program allows you to begin the program at 62. In many ways we're making the Medicare program consistent with what the Social Security program is. If you want to take early retirement you could take early Social Security at 62. This allows you to take early Medicare at 62, but you pay for it. And again, we are not running up the cost of the trust fund. I think it's extremely important, as the Medicare commission begins to meet that we continue to make improvements in health care in the United States where we see issues. We do not see this as interfering with the commission's decision-making in any way. It doesn't run up cost in the trust fund.
Q One of the concerns that critics express about this plan is that some programs can start out being self-financing or with controlled costs and they tend to grow. For instance, you put this program into place and there may be political pressures to have a government subsidy so it's available to people with low income. Do you have any concerns about that, that over the long haul this may cost the government maybe something substantial?
MR. SPERLING: I think that in the past there have been entitlement commitments that in the past were made where people underestimated what the true cost of those would be, and so, therefore, whatever the pay-for was there didn't meet that and it grew. What's different about this is that if more people come into that, each of them is essentially individually taking essentially a loan from the Medicare system and paying that back. It's not all that inconsistent with early retirement Social Security. If you want to go in and get some of the benefits early, you get less benefits from them on after you turn 65.
This allows -- for those people who feel this option is important to them -- and you saw today that it is for some --it allows them to take this option. So this is very different. I don't see how these costs can explode because each person essentially has a self-financing policy.
So will more people come into this? Certainly the demographics compel that. Today there are 22 million people between the age of 55 and 64. By the year 2010, there will be 35 million. But that means that all of the problems you hear today will go up 66 percent in the number of people that will be affected.
But what's important and why people who care about constraint on the budget should like what we're doing is we're putting in a system that has built-in constraints. And that is different from the type of entitlement explosions that you might have seen over the last 20 or 30 years.
Q But out in the driveway -- said the White House is eager and willing for people like her to push for subsidies, that you -- she's with the Older Women's League, someone who wants subsidies.
MR. SPERLING: Mara, there's two different issues. One issue is, do you put in a commitment by the government to cover a certain group of people and underestimate the cost, and then the cost gets larger. What I've described to you is why this doesn't fit that model.
A second issue is, might we ever want to come back more later and do more on health care for people who are poorer in the way that we affected, helped poorer children. And the question there is, if there are programs that help people that don't have overriding negative incentives in the market and are fiscally responsible and being paid for, who would be against that?
Q About $400 a month? And then people -- these are for individuals, right?
SECRETARY SHALALA: They're not being loaned. They're in a different situation than the 62 to 65.
SECRETARY SHALALA: No, no. We do that up front as part of the monthly payment.
SECRETARY HERMAN: That's the estimate right now. We're still finalizing those numbers.
Q There's no way, I guess, to get a dollar figure.
SECRETARY HERMAN: No, because it depends on what that existing COBRA arrangement would be.
Q So they would really be paying not only their contribution, but the employer's contribution as well.
SECRETARY HERMAN: It's more for the handling. When you do the add-on in terms of the COBRA management, it's more for the handling for that retiree that is now taking advantage of it.
Q I understand, but what I'm saying is if you're a person who is working and you're trying to figure out what would the payment be, you would figure not only the amount that's coming out of your paycheck, but also another amount that you don't see.
SECRETARY SHALALA: Again, this is an issue of access. We're not solving all the financing problems of the health care system.
SECRETARY SHALALA: You know, it's interesting, this is the group, people over 55, that have been losing health insurance at a higher rate. We've actually been looking at this group for some time, because the changing nature of the economy and what's been happening to health care in terms of employer-provided health care, this is the group. Now, some of it also is because they work in places that don't have COBRA and some of it is early retirement in the system as companies restructure.
So what we're trying to do here is to respond to a changing economy and what's happening to workers out there. We're also trying to respond particularly to spouse issues, as people enter Medicare. We've heard a lot about their spouses not being able to get into the Medicare system because they're a couple of years younger.
So we think we're responding to a real issue that both is reflected in the statistics in terms of what's happening to employer coverage, as well as in what people are saying to us about what they can't find out there in terms of health insurance.
SECRETARY HERMAN: Let me also add to that. I want to add to that, because the reality is when you look at the whole question of what we tried to do administration wide for dislocated workers, this is really a part of a broader comprehensive strategy on the part of the President.
You'll find that in the '99 budget that we will have actually tripled the support for dislocated workers. We tried to take serious reform efforts to help workers get reconnected faster to new job experiences. We know from all of the reforms and the efforts that we've been involved in to assist this particular population that the whole question of health care benefits and losing health care as a part of that change that's taking place in the work place is at the top of their radar screens.
And when you break it down age-wise, this is the population that has the most difficulty reconnecting to the labor force with health benefits intact. And so it was very strategic in terms of why we focused in this area.
Q -- larger scale so that people who are on the bottom rung who cannot afford the premium will be able to have access.
SECRETARY HERMAN: And that's a very serious issue, still. I mean, as we said earlier, this is not a panacea in terms of being able to cover all workers. And clearly those with economic need is still very great to be able to afford it.
Q If you left with the impression that faced with a choice between being fiscally responsible and covering the people who most needed it, who you wanted to cover, you chose to be fiscally responsible. I'm asking.
MR. SPERLING: We just did a proposal that we fought for and in fact held the entire balanced budget agreement up for to get, not a compromise between zero and $24 billion, not a compromise between $16 and $24 billion; we fought for every penny of getting $24 billion to cover children, poor children.
Now, what -- there are important issues here. One, we're in a period right now where we are in between a balanced budget agreement where we just implemented significant Medicare savings, and we just had a significant new expansion for the children of working poor families. And we have a Medicare commission about to come back.
What we wanted to do is we saw an opportunity to do something that would help hundreds of thousands of people -- to be a safety net for people maybe who are more working families, but where they have some problems like the woman you saw today -- we saw a way to do that that could be self-financing. Now, the question is should we not do that because we can't solve every single problem with this?
Secondly, there are health care policy issues you have to look at. Whenever you do subsidies, we think that it is worth, at times, subsidizing and helping poor working families or people in need. But there is a health care issue. When you do subsidies you then have the very much more legitimate question of what kind of incentives do you provide. If the same person can now have coverage cheaper by the government than through their employer, then you do have incentives to drop coverage.
Now, sometimes when we look at these programs we think that you can come up with a positive enough program where the benefits in coverage in helping poor people outweigh any of the negative incentives. But those are real issues that you have to look at carefully when you go in, and that's one of the difficulties in doing -- a step-by-step process is one of the challenges, but we've been able to help hundreds of thousands, millions of people. So it's not a choice. We have had a proposal. We have had a plan. We do many things that focus very much on the poorest Americans and working poor Americans. But there's nothing wrong with also trying to address the needs of working families who, as Alexis says, for one reason or another, fall on poor health or hard times.
you can see, as you can see everything that happened, this administration is just getting going and the second term is just getting going, and I think the one thing we've put to bed is any notion that we don't have a lot of new ideas, a lot of new initiatives, a lot of new things to help the American people.
SECRETARY SHALALA: First of all, in some parts of the country people that are healthy that are 62 years old are going to be able to find health insurance perhaps a little cheaper than this. We are filling a need here for a group of people who have not been able to use the private health insurance market. We are not substituting for them, they have not been enthusiastic about 64-year-old women with preexisting conditions. So we are filling that gap with this option for people. So, clearly, we're filling a gap.
What makes us believe that the private sector won't develop some health insurance plan? Nothing makes me believe that. And in fact, if the private sector starts to respond by developing some health care packages, no one would be more enthusiastic than we would. And if we thought there was a private sector package out there for this group of people, it would be there right now. What the market has not done is produced a very good package in every part of the country. We want to make sure everything we do to reduce the number of people that don't have health insurance helps the rest of us -- helps us to keep our costs down in Medicare, helps us to keep our costs down in Medicaid and all the government programs and in the private sector.
What we don't need is a large number of people who are over 55 without access to health insurance who are delaying going to the doctor, going into hospitals when they need to, because in the end we'll pay for it in Medicare later as they put it off. So our strategy from the beginning of this administration has been to do everything we could to fill the gaps, to reduce the number of people without health insurance, whether it's children or the elderly or the middle-aged. That becomes important for everybody in the health insurance system.
Q How many people between the ages of 55 and 64 don't have health insurance today?
SECRETARY SHALALA: Three hundred thousand people will benefit over all and -- we'll get that for you, Susan, in terms of specifics.
Q The total who are eligible?
SECRETARY SHALALA: Well, the people that are eligible are both people who are in the individual market as well as don't have health insurance. We have identified 3 million people without health insurance between 55 through 64. But there are also people in the individual market who are paying very high premiums or about to lose those premiums one way or another. So I think our number of 300,000 ought to stand because that's what our actuaries believe are estimating the number of people that will take up one of these options.
For every single one of those spread across the country, every single one of you is going to hear from one of them because from the time we started talking about this, all of us have run into people in our families or someplace else who can't get health insurance that think this is a wonderful opportunity.
MR. SPERLING: Susan, there's about 1 million uninsured in the 62 to 64 category, and there's about 700,000 in that group who are buying their health insurance through the individual market. So if you're looking at that 62 to 64 you could say a reasonable pool that would be very interested in it would be about that 1.7 million in the 62-65. And the majority, once this is up to speed, would be about 300,000. The overall majority of that group is from the 62 to 65 part of this initiative.
SECRETARY HERMAN: The retirees -- while that population is 1.5 million, we have had cases of about 87,000 that we've worked with.


Kansas was really the WILD WEST!! Wyatt Earp, James Butler "Wild Bill" Hickok and William B. "Bat" Masterson were three of the legendary lawmen who kept the peace in rowdy frontier towns like Abilene, Dodge City, Ellsworth, Hays, and Wichita. Amelia Earhart, first woman granted a pilot's license by the National Aeronautics Associate and first woman to fly solo across the Atlantic Ocean was from Atchison, KS.
Indiana literally means "land of the Indians," as it was once promised to be reserved for Native American use. This was not to be, however, and the area was eventually appropriated by other groups.
Both Ryan and I have family roots in Indiana. My Dad's family is from Fort Wayne and Ryan's Dad's family is from Terre Haute !
When Books Went to War by Molly Guptill Manning (library) this was a wonderful book. It tells the story of how the ASE books of WWII came into being (Armed Services Editions) and really it was the beginning of the popularity of Paperback books. I have a couple of ASE books in my collection.
Concrete Blonde by Michael Connelly (audiobook) liked this one okay, Ryan is getting me to read the Michael Connelly books, so there will be several of his on my lists throughout the rest of the year.
The Life of Objects by Susanna Moore (library) I really liked this one. WWII sort of upstairs/downstairs (Downton Abbey-esque) a young irish girl goes with a countess to be her maid in Germany during the time leading up to WWII and experiences all the changes that the war brings to the social order.
The Last Coyote by Michael Connelly (audiobook) I liked this one better than Concrete Blonde.
The View from Saturday by E. L. Konigsburg (library) YA book about a Quiz Team of kids who come together to form a winning team. I had never read it when I was a kid and it was recommended to me. Very good and I will be picking up more books by Konigsburg.
Over-Dressed The shockingly high cost of cheap fashion by Elizabeth Cline (library) Learned a lot about the over consumption of clothes. And I feel good about buying at consignment and thrift. AND getting things repaired when they break. So glad that I don't fall into the trap of needing the latest trendy thing OR getting a dozen shirts in every color just cause they are $3 at Old Navy.
Black Echo by Michael Connelly moving on through these...this one was good, I think it was the first one and I really ought to be reading these in order, but that has been problematic.
From the Mixed Up Files of Mrs Basil E. Frankweiler by E. L. Konigsburg I told ya I would be reading more of her stuff.
Exploring the Appalachian Trail: Hikes in the Southern Appalachians by Doris Gove I really enjoyed this detailed guide to the AT. Ryan has some "bare bones" hiker guides (light weight, so the detail is not as extensive) and I really liked her descriptions of the areas including natural history and social history.
Just after Sunset by Stephen King (audiobook) short stories on an audiobook that I listened to while driving Ryan to and from the AT. There will be a lot of audiobooks these next few months.
The Camino by Shirley Maclaine just watched The Way again on DVD and saw this book about the camino in a used bookstore.
Jennifer, Hecate, Macbeth, William McKinley, and me, Elizabeth by E. L.Konigsburg (library) I was delighted to figure out that I HAD read this one as a kid. I totally remembered the storyline once I got into it.


Senate Votes AGAINST Protection of Wildlife in national wildlife refuges in Alaska.
The Senate just voted to approve previously approved House legislation to remove protections for wolves and bears in national wildlife refuges—it allows denning wolves and bears to be taken.
The votes by individual senators are listed below—note that it was a straight party-line vote with a split between the two "independent" senators—Vermont's Sanders voted against and Maine's King voted for the resolution.
If protection of wildlife is to have any political currency in the future such as issues over weakening of the Endangered Species Act, there needs to be consequences for the senators and representatives who voted to allow this violation of national wildlife refuges. Both wildlife conservation and animal rights organizations need to publicize the votes, asking their members to contact their representatives and senators either thanking them for Nay votes or expressing strong dissatisfaction with their votes in favor of this resolution. Secondly, it is time for a coalition of these organizations to plan a boycott on wildlife-related tours to Alaska until this policy is changed by the State of Alaska. In the 1990s, there was a successful boycott over the shooting of wolves from airplanes and this policy is just as despicable if not more so than that one.


text:
Cross-Border Commute
By Erika Germer 1 minute Read
Michele Bowman, 32, senior vice president at Global Foresight Associates, a Boston-based futures-research and consulting firm.
"Electronic immigrants, also known as cross-border telecommuters, are nothing new. But as the global economy becomes more integrated and interdependent, the ranks of these workers will grow. Electronic immigrants will soon infiltrate high-end technical fields such as engineering and it."
"Global businesses will have to pay more attention to the issue of intellectual-property rights. Free agents who have a broad range of experiences are highly valuable, but they pose a risk to a company's intellectual capital. And employee ideologies will increasingly reflect industry-based perspectives rather than geographically organized political systems. For example, rice growers in Alabama and Vietnam will collaborate to promote their product but will have little affinity for steel producers in Mobile or Hanoi. Companies will have to foster a corporate culture that transcends national boundaries."
Futurology Decoder Key
"Cybership will vie for importance with citizenship. Companies will need to increase their tolerance for change, and view boundaries — whether national, corporate, or divisional — as more and more nebulous."
Contact Michele Bowman by email (mauka@ix.netcom.com), or visit Global Foresight Associates on the Web (www.globalforesightinc.com).
A version of this article appeared in the September 2000 issue of Fast Company magazine.
Ayn Rand, Leonard Nimoy, and Muhammad Ali told Neil Armstrong what to say as he stepped on the Moon
This historic map of 6 million syllabi reveals how college is changing

redpajama_set_name: RedPajamaCommonCrawl


text:
eden roc
Ludovico Einaudi – Eden Roc (1999)
"Eden Roc" was written in 1999 and established Einaudi as a household name in both Italy and the UK. There are fifteen tracks in all.
Of the album, Einaudi wrote, "Eden Roc is the name of a place on the south coast of France where the writer Francis Scott Fitzgerald lived and where he located the beginning of his novel 'Tender is the Night'. From that book I partially took the inspiration for Eden Roc …. the idea of an ideal place where you can find your inner balance in the world".
'Nefeli' is my favourite solo-piano track on this album and is very beautiful. According to Greek mythology, Nephele was a cloud nymph created by Zeus from a cloud in the image of Hera. Einaudi dedicated this song to the daughter of a couple he would regularly visit. Ludovico was inspired by her vivaciousness. Although 'Nefeli' is Greek for clouds, it reminded Einaudi of sunshine and this is how he viewed the little girl. The music flows so sweetly that it brightens up my day when I hear it. To play it is a magical experience. I recorded it many years ago and I hope you enjoy my rendition.
'Nefeli' composed by Ludovico Einaudi, played by John McGuinness
'Due Tramonti' ('Two Sunsets') is the first piece of Einaudi I ever played. It is a piece for piano and cello although Einaudi later transcribed it for solo piano. The music was inspired by a story told to Ludovico by his father. Apparently, when his father was driving with a friend, they saw the most beautiful sunset in the Italian hills. Blown away by the stunning act of nature they had just witnessed, his father put his foot down on the pedal and they hurried up the next hill in order to have the luxury of a second viewing. This was the night they saw two sunsets. The beauty of the piano and cello combination is breathtaking. I recorded the piano solo version in 2011. I do hope you like it.
'Due Tramonti' composed by Ludovico Einaudi, played by John McGuinness
I love the beautiful lyricism and flow of the track called 'Julia'. It conveys a 'feel' of the rock melodies prevalent in the early sixties and, consequently, I find it touching and refreshing.
'Julia' composed by Ludovico Einaudi, played by John McGuinness
Why not listen to Einaudi's album "Eden Roc" in its entirety? The music covers a range of moods and feelings and there is a deep sense of friendship among the contributing musicians that emerges through the music.
"Eden Roc" was undoubtedly a major landmark in Einaudi's career.
66 April 22 Piano Velouté due tramonti, eden roc, einaudi, F Scott Fitzgerald, julia, nefeli, piano solo, sunset


text:
Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail.
Update: Influenza Activity -- United States and Worldwide, and Composition of the 1992-93 Influenza Vaccine
During the 11 influenza seasons from 1977 through 1988, more than 10,000 excess deaths attributed to pneumonia and influenza (P&I) were reported during each of seven seasons, and approximately 45,000 deaths were reported during each of two seasons (CDC, unpublished data, 1992). The most important strategy for preventing influenza-associated morbidity and mortality is vaccination of persons in high-risk groups with vaccine closely matched to circulating strains. In collaboration with state and local health departments, CDC conducts surveillance to monitor influenza activity and to detect antigenic changes in the circulating strains of influenza virus. This report summarizes surveillance for influenza in the United States and worldwide during the 1991-92 season and describes the composition of the 1992-93 influenza vaccine. United States
During the 1991-92 influenza season, substantial influenza activity began in October and peaked from December 1 through January 18 when 11-20 states reported widespread activity * each week. From January 19 through March 21, activity steadily declined; for the week ending March 21, no states reported widespread activity, and three states reported regional activity.
Before mid-December, outbreaks were reported primarily in schools; subsequently, outbreaks were reported in schools, nursing homes, and other institutional settings. Based on data from death certificates provided by CDC's 121 U.S. Cities Mortality Surveillance System, excess mortality was associated with P&I. The proportion of deaths attributable to P&I exceeded the epidemic threshold for 7 consecutive weeks (from the weeks ending December 28 through February 8) and peaked at 7.9% of all deaths during the week ending January 18.
Of the 5861 influenza virus isolates reported to CDC, more than 99% were influenza A. Of the influenza A virus isolates subtyped, 81% were influenza A(H3N2), and 19% were influenza A(H1N1). As of April 10, 179 (99%) of the 180 influenza A(H3N2) viruses characterized at CDC resembled A/Beijing/353/89, the A(H3N2) component included in the 1991-92 influenza vaccine. Influenza A(H1N1) viruses were isolated most frequently in the mid-Atlantic and South Atlantic regions and accounted for 30% and 52% of influenza A isolates, respectively. Influenza A(H1N1) viruses were characterized by moderate antigenic heterogeneity. Worldwide
Influenza activity worldwide occurred at moderate levels during the 1991-92 influenza season. Although most activity was associated with influenza A(H3N2), influenza A(H1N1) viruses were isolated in 17 countries; influenza B viruses were isolated rarely. Most countries reported that influenza activity began in December and peaked in late January or early February.
In Europe, influenza A(H3N2) virus was the predominant isolate in the Commonwealth of Independent States, Czechoslovakia, Denmark, Finland, France, Greece, Hungary, Italy, the Netherlands, Norway, Portugal, Romania, Spain, Sweden, Switzerland, and the United Kingdom; in some of these countries, it was associated with localized outbreaks. In Asia, outbreaks of influenza A(H3N2) were reported in Japan, Korea, and the People's Republic of China.
Although influenza A(H1N1) viruses were isolated less frequently worldwide, Belgium and Japan reported that A(H1N1) viruses constituted the majority of isolates and were isolated from outbreaks. France, Germany, the Netherlands, and the United Kingdom reported that approximately 20% of the influenza A viruses isolated were A(H1N1). In these countries, the proportion of influenza A(H1N1) viruses isolated increased during the latter part of the season as influenza A(H3N2) activity declined. Bulgaria, Canada, the Commonwealth of Independent States, Croatia, Finland, Norway, Spain, Switzerland, and Yugoslavia reported only sporadic cases of influenza A(H1N1).
Outbreaks caused by influenza B viruses were reported in Greece, Korea, the People's Republic of China, Taiwan, Tunisia, and Yugoslavia. Sporadic cases were reported from Canada, the Commonwealth of Independent States, Finland, France, Norway, Poland, Sweden, the United Kingdom, and the United States. Composition of the 1992-93 Influenza Vaccine
For the 1992-93 influenza season, the Food and Drug Administration (FDA) Vaccines and Related Biologicals Advisory Committee (VRBAC) has recommended that the trivalent influenza vaccine contain A/Texas/36/91-like(H1N1), A/Beijing/353/89-like(H3N2), and B/Panama/45/90-like viruses. This recommendation was based on the antigenic analyses of recent isolates and studies of the antibody response of persons previously vaccinated with the 1991-92 influenza vaccine.
Antigenic analyses of influenza A(H1N1) isolates from North America and Europe indicate that antigenic heterogeneity exists among recent isolates (1,2). Approximately 40% of isolates, represented by the A/Texas/36/91 strain, exhibit drift from the A/Taiwan/1/86 vaccine strain. Antibody induced by the A/Taiwan/1/86 vaccine component reacted at lower titers with the A/Texas/36/91 virus and other representative 1991-92 A(H1N1) viruses than with A/Taiwan/1/86 in several vaccine studies (Table 1). Therefore, the VRBAC recommended changing the influenza A(H1N1) vaccine component to an A/Texas/36/91-like strain for the 1992-93 vaccine.
Although some antigenic heterogeneity exists among influenza A(H3N2) isolates, most viruses isolated throughout the world were antigenically related to the A/Beijing/353/89 vaccine strain (2). Antibody induced by this vaccine component reacted similarly with recent isolates, such as the A/Washington/15/91 virus, in serum from all age groups, and postvaccination geometric mean titers (GMTs) of antibody to the recent isolates were approximately 50%-100% of those to the vaccine virus. Thus, the World Health Organization and the VRBAC recommended retaining the A/Beijing/353/89 vaccine strain.
Two distinct strains of influenza B virus, related to either the B/Victoria/2/87 or the B/Yamagata/16/88 and B/Panama/45/90 reference strains, have cocirculated in the world since 1988. Since October 1991, only two strains related to the B/Victoria/2/87 reference strain have been identified worldwide. Although relatively few influenza B viruses related to the B/Yamagata/16/88 and B/Panama/45/90 reference strains have been isolated, antigenic heterogeneity has been observed among them. Postvaccination serum specimens obtained from vaccinees of all age groups reacted well with the vaccine virus B/Panama/45/90, and except for serum from the youngest children, also reacted well with B/Victoria/2/87. In all age groups, the postvaccination GMTs to recent influenza B isolates were approximately 50%-100% of those for the vaccine virus. Therefore, for the 1992-93 vaccine, the VRBAC recommended retaining the B/Panama/45/90 vaccine strain.
Reported by: K Nerome, PhD, National Institute of Health, Tokyo, Japan. M Chakraverty, PhD, Central Public Health Laboratory; J Skehel, PhD, National Institute for Medical Research, London; G Schild, PhD, J Wood, PhD, National Institute for Biological Standards and Control, Hertfordshire, England. I Gust, MD, Commonwealth Serum Laboratories, Parkville, Australia. J Groothuis, MD, Univ of Colorado School of Medicine and The Children's Hospital; P Graves, G Meiklejohn, MD, Univ of Colorado Medical Center, Denver. A Biache, MSN, Goodwin House, Inc., Alexandria, Virginia. WHO National Influenza Centers, Microbiology and Immunology Support Svcs, World Health Organization, Geneva. Participating state and territorial health department epidemiologists and state public health laboratory directors. Div of Virology, Center for Biologics Evaluation and Research, Food and Drug Administration. Epidemiology Activity and WHO Collaborating Center for Influenza, Div of Viral and Rickettsial Diseases, National Center for Infectious Diseases, CDC.
Editorial Note: Strains to be included in the influenza vaccine for the United States are selected from late January through March each year to meet the production schedule required for the manufacture, quality control, and distribution of more than 30 million doses of vaccine before the next influenza season. Specific recommendations for the use of the newly constituted influenza vaccine will be made by the Immunization Practices Advisory Committee of the Public Health Service and published in the MMWR Recommendations and Reports dated May 15, 1992.
CDC. Update: influenza activity -- United States, 1991-92 season. MMWR 1992;41:63-5.
World Health Organization. Recommended composition of influenza virus vaccines for use in the 1992-1993 season. Wkly Epidemiol Rec 1992;9:57-60.
Levels of activity are: 1) sporadic -- sporadically occurring influenza-like illness (ILI) or culture-confirmed influenza, with no outbreaks detected; 2) regional--outbreaks of ILI or culture-confirmed influenza in counties having a combined population of less than 50% of the state\'s population; 3) widespread -- outbreaks of ILI or culture-confirmed influenza in counties having a combined population of 50% or more of the state's total population.
Disclaimer All MMWR HTML documents published before January 1993 are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.
**Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.
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One of the most important set of questions you can ask about crowdsourcing concerns the intellectual property rights of the work that the community completes for you and how Topcoder ensures those rights.
The formal answer can be found in Topcoder' main legal documents that govern intellectual property, confidentiality, security, and indemnification. Each of these documents is attached to our White Paper entitled How To Drive Open Innovation Without Risking Your Intellectual Property and Security (June 2014) (see pages 11-29).
One of the critical questions asked of Topcoder is the manner in which it ensures ownership and intellectual property of all development. The next section addresses these important questions. Please note that nothing in this document constitutes legal advice. You should always seek the advice of counsel if you have questions.
One of the critical questions asked of Topcoder is the manner in which it ensures ownership and intellectual property of all development. This is important with respect to the transfer of rights and the use of the client's initial body of work. For the purposes of this blog post, the term "Developer" shall refer to data scientists, developers, and designers collectively given the fact that the term is used in our relevant legal documents.
1. All rights, including moral rights, title and interest to work product developed in the course of competitions and delivered to a client under, known as client software, shall become the property of the client, subject to payment in full of all fees.
2. As between Topcoder and community participants, neither party in the contest acquires any intellectual property or any rights that belong to the client. All intellectual property rights belong to the client.
3. To the extent not already owned by Topcoder, the Developer assigns, grants, transfers, and sets over to Topcoder all right, title, and interest throughout the world any and all Intellectual Property Rights, in developments completed during contests. Please note that [topCoder] subsequently transfers that intellectual property to the client for code that is purchased as a solution.
4. Nothing shall be construed as granting a Developer any right or license under any intellectual property right of Topcoder or the client by implication or otherwise.
5. The Developer's submission does not include any content that violates third-party intellectual property rights.
6. The Developer's submissions is free and clear of all liens, claims, encumbrances or demands by any third parties.
7. The Developer's submissions have not been entered in previous contests, or won previous awards.
8. The Developer's submission has not been published or distributed previously in any media.
Your intellectual property rights are governed not only for the protection of your own property, but also for the macro concerns that fuel these very rights. Questions about your intellectual property are never idle. The commonly stated objective of intellectual property is to promote progress. Proponents of IP rights argue that if such rights encourage innovation, then the more, the better. They reason that creators will have insufficient incentive to invest unless they are legally entitled to capture the full value of their innovation.
In 2013, the U.S. Patent & Trademark Office estimated that the worth of IP in the U.S. economy to be more than $5 trillion. You intellectual property rights are much more specific than the economy writ large. With Topcoder, you are able to protect them contractually in a manner that can be enforced with a world-class global innovation partner.
If you haven't already done so, please check out the first three posts of this 5-part series. Enjoy.


text:
e-Exchange
GM venture picks Lansing for third U.S.-based EV battery plant
Leave a Comment	/ Cars / By livingogroup_22v5tq
Downtown Lansing. (Getty Images)
DETROIT — General Motors and a joint venture partner plan to build an electric vehicle battery factory in Lansing, Michigan, which would be their third such factory in the U.S.
The companies' plans were revealed in documents posted on the city's website Friday. They say that the plant will cost up to $2.5 billion and employ as many as 1,700 workers.
The plant would be built on the site of GM's Lansing Delta Township Assembly factory, which has been annexed by the city.
A joint venture between GM and LG Energy Solution called Ultium Cells LLC will build the factory. The plans were revealed in documents detailing a "Renaissance Zone" program.
The selection is a big win for Michigan, which missed out on three Ford Motor Co. battery factories and an electric vehicle assembly plant that were placed in Kentucky and Tennessee.
The documents say the joint venture is obligating itself to investment and job creation. It says the building would be about 2.5 million square feet (230,000 square meters) with two-thirds being a "clean room" environment for battery cell manufacturing.
"The machinery and equipment consists of electrode mixing, coating, assembly and formation areas," the documents say.
The plant's first year of operation would be in 2025. It would start with 750 workers, with 1,700 sometime in 2028.
GM would not comment specifically on the plant's location, but said it was developing business cases "for potential future investments in Michigan." The company said it is discussing incentives with local officials.
"These projects are not approved and securing all available incentives will be critical for any business case to continue moving forward," spokesman Dan Flores said. "I'm not going to speculate on the timing of when GM leadership will make a decision on potential future investments in Michigan."
The step came as Gov. Gretchen Whitmer and the state Legislature worked to quickly enact economic development incentive bills focused on "critical" industries and preparing shovel-ready sites for business expansions. It was not clear what new incentives Michigan could offer GM, though it has billions of dollars in federal discretionary pandemic rescue aid and surplus state tax revenues.
Ford's decision in September to build electric vehicle and battery plants in southern states was a blow to the nation's auto hub, particularly because Ford said Michigan did not have the types of sites it needed.
The Lansing City Council will meet Monday and the following week to approve the tax breaks, said president Peter Spadafore.
"It's my understanding there's a competition for a battery plant and Lansing will do everything we can to make sure we are competitive to bring those jobs and billions of dollars of investment to our community," he said.
GM also has applied for tax breaks in Orion Township, Michigan, where a factory that builds the Chevrolet Bolt electric car and SUV is located. The company wants to build an addition to the plant to assemble battery cells into packs that would go into electric vehicles.
This likely means that GM plans to designate the Orion plant as its third electric vehicle assembly plant, along with factories in Detroit-Hamtramck, Michigan, and Spring Hill, Tennessee. Flores would not comment beyond the company statement.
The company has said it would spend about $2 billion upgrading factories to build EVs, so that would bring the total new investment in Michigan to about $4.5 billion.
GM has said the joint venture will build four North American factories to make EV battery cells.
Two other locations have been announced, in Spring Hill, Tennessee, and Lordstown, Ohio. The fourth location has not been disclosed.
GM has set a goal of selling only electric passenger vehicles by 2035. The company plans to roll out 30 electric vehicles globally by 2025. It also has pledged to invest $35 billion in electric and autonomous vehicles from 2020 through 2025.
LivinGO Group by Nseobong Akrah


text:
System Beat és un col·lectiu de música electrònica format el 2015 a Catalunya. Es constitueix l'octubre de 2015, i inicia una fase de producció i experimentació que s'allarga fins al setembre del 2017, quan presenten el seu primer senzill Una Altra Dimensió. El novembre del mateix any publiquen el seu segon senzill Caminem. El març del 2017 inicien la seva primera gira que els portarà per Catalunya, Euskal Herria i França.

Discografia
 Senzills
 Una Altra Dimensió (feat. Sílvia Farrés), La Atlàntida Studio, 2016
 Caminem, La Atlàntida Studio, 2016

Referències

Enllaços externs
 Pàgina oficial de System Beat
 "System Beat". Viasona.

Grups de música del Maresme
Grups de música catalans

redpajama_set_name: RedPajamaWikipedia


text:
<?php
namespace Whisnet\IrcBotBundle\Tests\IrcCommands;

use Whisnet\IrcBotBundle\IrcCommands\QuitCommand;
use Whisnet\IrcBotBundle\Message\Message;

class QuitCommandTest extends \PHPUnit_Framework_TestCase
{
    public function test__toString_WithoutMessage()
    {
        $this->assertEquals("QUIT\r", (string)new QuitCommand());
    }

    public function test__toString_WithMessage()
    {
        $this->assertEquals("QUIT :fuu\r", (string)new QuitCommand(new Message('fuu')));
    }

    public function test__toString_WithMessageWithTwoWords()
    {
        $this->assertEquals("QUIT :fuu bar\r", (string)new QuitCommand(new Message('fuu bar')));
    }
}

redpajama_set_name: RedPajamaGithub


Labiaplasty Restrictions | Wesley Anne Brady, M.D.
So you're interested in scheduling Labiaplasty surgery, but you've got a summer vacation planned and don't want to miss out? Dr. Brady and the Women's Wellness Institute of Dallas is here to answer any questions you might have about your recovery and/or post surgery restrictions. You should feel confident in not only the surgeon, but the recovery and schedule that you choose for surgery as well. Call our surgery coordinator, Jessica Lusk at 214-442-0055 if you'd still like some more information or have specific questions about recovery. You can also visit our website's FAQ section for some of the best and most up to date information about cosmetic vaginal surgery.
Side note: If you're not a member of RealSelf, it's a great place to research physicians, ask questions about surgeries, see before and after photos and so much more!
Question: After getting a labiaplasty, how long until you can go in water?
I am going away in 5 weeks to Punta Cana and plan to go in the ocean and pool, will I be okay? I also might go on excusrions for horseback riding and zip lining. I need to know if I'll be healed in time.
Healing after a labiaplasty usually takes six weeks so if you're just now getting your labiaplasty, you likely won't be healed in time. Bacteria in the ocean or pool can irritate your labia or cause infection, and horseback riding may cause tearing and bleeding. You should speak with your surgeon about your travel plans. I would hate for you to endanger your final aesthetic results, especially if you are close to having your restrictions lifted. Cheers!


Gordon & Rees's Construction Group consists of more than 80 lawyers covering the nation in our 28 offices. Indeed, last month we launched an office in Philadelphia, Pennsylvania. Our Construction attorneys focus their practice on the comprehensive range of legal service required by all participants in the construction industry -- architects, engineers, design professionals, design joint ventures, owners, developers, property managers, general contractors, subcontractors, material suppliers, product manufacturers, lenders, investors, state agencies, municipalities, and other affiliated consultants and service providers.
On a quarterly basis, we provide important nationwide information about the latest construction industry news and legal developments. Our national construction practice platform allows us to provide insight into developing trends and legal changes throughout the country. This edition of the newsletter is intended to provide information for those concerned about managing construction-related risks and disputes.
If you have questions about this issue of the Construction Quarterly newsletter or our nationwide construction practice, click here to visit our practice group page or contact Mark Russell or George Milionis.
The California Energy Commission (CEC) recently adopted regulations implementing the Nonresidential Building Energy Use Disclosure Program (California Code of Regulations, Title 20, §§1680-1684), which will (i) require the owners of nonresidential buildings to benchmark and disclose the building's energy use prior to any "major financial transaction" — i.e., prior to a sale or refinancing of the building or a lease of the entire building and (ii) require public utilities and other energy service providers to release energy use data to enable building owners to comply with the disclosure requirements. The regulations are intended to further the stated purposes of AB 531 and AB 1103 (codified in §25402.10 of the California Public Resources Code) to promote energy efficiency in the use and operation of commercial buildings throughout the state. The law is similar to a regulation applicable to commercial buildings in New York City — where 80 percent of total carbon dioxide emissions come from the heating and cooling of buildings — that now requires full public disclosure of building energy use data.
1. Not less than 30 days prior to the date on which the applicable disclosure is required, the building owner must establish an ENERGY STAR® account on the EPA website and upload applicable energy consumption and efficiency data — such as operating hours, the number of computers operated within certain premises, occupancy numbers and the percentage of floor areas cooled and/or heated.
2. The building owner will then need to request that the applicable utilities and service providers upload energy use data for the preceding 12-month period directly to the ENERGY STAR® account.
3. After the utilities and service providers provide the usage data, the owner will need to access the CEC website to (a) obtain a Disclosure Summary Sheet and (b) use a link from the site to access the compliance section of the EPA website to prepare an electronic Compliance Verification Report (which is retained by the CEC).
4. The owner will then need to generate a Data Checklist, a Statement of Energy Performance and a Facility Summary (from the ENERGY STAR® account) to be delivered, together with the Disclosure Summary Sheet (from the CEC website), to the prospective purchaser, lender or tenant.
For a step-by-step summary of the disclosure process prepared by the CEC, click here.
In Beacon Residential Community Association v. Skidmore, Owings & Merrill, LLP, the First District of the California Court of Appeals held that architects can be held liable to condominium owners for negligently prepared plans. In doing so, the court enlarged the scope of duty owed by design professionals to third-party purchasers, distinguishing the prior duty limitations for design professionals established in Weseloh Family Ltd. Partnership v. K.L. Wessell Construction Co., Inc. (2004) 125 Cal. App. 4th 152.
In Beacon, plaintiff Beacon Residential Community Association alleged multiple construction defects including "solar heat gain," a condition causing the condominium units to be uninhabitable due to excessively high temperatures. The association alleged the defendant architect should be held liable to the condominium owners for negligence arising from its substitution of less expensive, non-operational windows in conjunction with a design that lacked adequate ventilation. The architect demurred to the association's complaint arguing it owed no duty to the association or the condominium owners. The lower court sustained the architect's demurrer finding that under Weseloh the architect owed no duty of care to the association or its condominium owners. The lower court held that absent such a duty, liability could not be imposed for negligent design. The lower court also held that the owners had the burden to show the architect had control in the construction process beyond providing recommendations to the developer.
The appellate court, in overruling the trial court and finding that the architect owed a duty of care to the condominium owners even though it had no direct connection to the owners, applied the six prong Biakanja factor analysis widely used in California courts for deciding construction defect scope of duty disputes. The six prongs are: (1) the extent to which the transaction was intended to affect the plaintiff; (2) foreseeability of harm to the plaintiff; (3) degree of certainty that the plaintiff suffered injury; (4) the closeness of connection between defendant's conduct and the injury suffered; (5) the moral blame attached to the defendant's conduct, and (6) the policy of preventing future harm.
To read a full, expanded version of this article, please click here.
In a case of first impression, the Nevada Supreme Court recently held that the doctrine of equitable subrogation cannot be used to subordinate mechanic's lien claims to the liens, mortgages or other claims of lenders that attach to the subject property after the commencement of the construction. The court further held that rights of mechanic's lien claimants can only be subrogated in a manner harmonious with Nevada's mechanic's lien statute. As we will see, this is not easily done.
This case provides a compelling reminder that very real differences exist between states with regard to mechanic's liens. Industry stakeholders should seek out advisors, such as Gordon & Rees, which have national reach and experience for advice on state-specific laws and their impact on transactions and potential litigation. Even though this case is one of first impression, the outcome was not surprising to this author and many who practice in this area.
In Neiman v. Daly 2012 DJDAR 15073, the Second District Court of Appeal ruled on a plaintiff's personal-injury action against an architect for sustaining injuries after falling on the stairs at a theater designed by the architect on a community college campus. In its ruling, the court applied the "completed and accepted" doctrine in affirming the lower court's granting of summary judgment.
The completed and accepted doctrine was formally adopted into California law in Sanchez v. Swinerton (1996) 47 Cal. App 1461. In Sanchez, the court defined the defense. The "completed and accepted doctrine" functions so that once an owner accepts a contractor's work, the contractor's liability for injuries resulting from alleged patent defects in the construction ends.
In Neiman, the plaintiff alleged that the architect's plans and specification called for contrast marking stripes to be placed on the stairs. The stripes were not placed per the plans, and the plaintiff alleges that the architect owed a duty of care to the injured plaintiff. She further argued that since the plans and specifications were not strictly complied with, as the stripes were missing, the work was not technically, "completed." The court, unpersuaded by the plaintiff's argument, found that once the owner took control and opened the theater to the public, the architect's services were no longer in question.
In Neiman, it is important to note that not only is the Second District upholding and further establishing the application of the completed and accepted doctrine, but it is extending the doctrine to the work of architects. Traditionally, the completed and accepted doctrine served as a defense to contractors to shift liability to the owners. The owners by acceptance of the contractor's work and subsequent use triggered their assumption of responsibility to third parties. Now, this defense applies to architects for work that owners have inspected and accepted. The only exception is if the defect and the danger are latent.
Effective January 1, 2013, California depositions will be limited to seven (7) hours. The time limit applies to examination by all counsel, other than the witness' counsel of record. The new rule is set forth in Code of Civil Procedure section 2025.290.
Certain types of witnesses are exempt. The time limit does not apply to expert depositions, or to depositions of persons designated most qualified to testify ("Person Most Knowledgeable") under Code of Civil Procedure section 2025.230.
Certain types of cases are exempt. The time limit does not apply to complex civil cases (but if there exists significant doubt a deponent will survive beyond six (6) months, the time limit is extended to two days of no more than seven hours each). The time limit does not apply to cases brought by an employee or applicant for employment against an employer for acts or omissions relating to an employment relationship.
Section 2025.290 provides the court shall allow additional time if needed to fairly examine the deponent, or if the deponent, another person, or any other circumstance impedes or delays the examination. The parties may stipulate the time limit does not apply to any particular deposition, or to the entire proceeding. Any party who appears in an action after a deposition has concluded may notice a deposition of the previously deposed witnesses.
On March 2, 2013, our Phoenix office sponsored the Home Builders Association's Uncorked wine tasting fundraiser to benefit the Home Builders Care Workforce Development, a program to train individuals seeking employment with the necessary skills to fill needs within the home building workforce.
San Francisco partner Ernie Isola presented two full-day seminars on "Fundamentals of Construction Contracts: Understanding the Issues," in San Francisco and San Jose, Calif., on Feb. 5 and 6, through Lorman Education Services. The seminar covered emerging issues in California construction contracts and their impact on all construction participants. If you'd like to speak with Mr. Isola about the presentation or receive materials about the presentation, please email him at eisola@gordonrees.com.
Cecily McLeod and Carl Gebo presented at the U.S. Women's Chamber of Commerce Spring Conference in Orlando, Fla., on Jan. 23 and 24. They spoke on "Drafting Subcontractor Agreements That Protect Your Business." The audience included government construction contracting companies.
On Feb. 1, 2013, Gordon & Rees LLP opened a Philadelphia office with the addition of eight new lateral partners who joined the firm from Cozen O'Connor. William P. Shelley, who previously served on Cozen's board of directors and Management Committee as well as chairman of the firm's Global Insurance Group, now serves as the Philadelphia office Managing Partner for Gordon & Rees.
Contract drafting, review, preparation, counseling and other transactional work forms a large part of the Construction Group practice. As construction is being planned, every project develops distinct specifications and requirements, and ideas and interests to protect. After a comprehensive analysis of each client's business goals and project objectives, we draft the full spectrum of construction-related contracts, such as prime, construction, design-build, teaming, and joint venture. Our lawyers are well versed with standard form agreements produced by the American Institute of Architects, Associated General Contractors, and the Design-Build Institute of America. We also review contract documents prepared by others and, when we sit down at the negotiating table, we are well equipped to achieve the best result possible for our clients.
Construction projects are multidisciplinary collectives. Our Construction Group mirrors that approach, involving lawyers from Gordon & Rees's Employment, Real Estate, Insurance, Intellectual Property, and Business Transactions Groups.
Business Transactions & Real Estate: Choice of corporate entity in construction projects is often a key driver in the profitability of projects. Consequently, we advise clients in forming the most appropriate corporate entity for the specific project, whether it is a corporation, partnership, limited liability company, or joint venture. For efficiency and cost-effectiveness, we use standard form documents whenever possible, turning to custom drafting only when necessary. We will not waste our clients' money, or run up bills.
Insurance: Over the last decade, the construction insurance landscape has changed dramatically due to the increased costs of general liability policies and defending claims under them. Many projects provide for project specific coverage commonly referred to as Owner Controlled Insurance Policies (OCIPs), which are designed to limit defense of claims to one attorney for all insureds. Our lawyers provide counseling and litigation prevention seminars to owners, developers and general contractors regarding insurance planning and the benefits, common pitfalls and management of Owner Controlled Insurance Policies, "wrap ups," stop loss coverage, and risk management throughout the entirety of a project.
Labor & Employment: Employment matters also frequently arise on construction sites. We draft project labor agreements, provide wage and hour advice, and advise on hiring and termination matters.


Safer Internet Day is being celebrated on the February 6th, 2018. Over 90,000 people across Ireland have signed up to do a Safer Internet Day event in their school, youth organisation or club. You can check out the website http://www.saferinternetday.ie to find out more information and also to download useful handbooks for teenagers and children on how to be safe online. The FraudSMART Team wish everyone doing an event the best of luck!!