npr--2020-10-27--A World Without Legal Abortion: How Activists Envision A 'Post-Roe' Nation

Judge Amy Coney Barrett 's Supreme Court confirmation could open the door to a world that many anti-abortion-rights activists have been envisioning for decades .
`` I hope and pray that we will be in a world post-Roe v. Wade , '' said Carrie Murray Nellis , 41 , an adoption attorney based in Georgia .
Murray Nellis is the founder of Abiding Love Adoptions , which operates in Georgia , Florida and Alabama .
She hopes Barrett 's confirmation will lead to the overturning of the 1973 Supreme Court decision that legalized abortion nationwide , which would thereby allow @ @ @ @ @ @ @ procedure .
Murray Nellis believes organizations like hers , which works primarily with birth mothers who are choosing adoption for their babies , need to be ready to help more women facing unplanned pregnancies .
`` We as a pro-life community have got to get ready and get our ducks in a row , '' she said .
`` Because this could likely be happening , and I do n't think we 're ready . ''
A majority of Americans favor some restrictions on abortion but support Roe v. Wade , according to @ @ @ @ @ @ @ the goal of ending abortion in the U.S. have been organizing for decades at every level of government .
They often say their goal is to make abortion both `` illegal and unthinkable . ''
`` There 's always a reason why a woman is choosing abortion , '' said Heather Lawless , co-founder of the Reliance Center in Idaho , which counsels women against abortion and offers free pregnancy tests and screenings for sexually transmitted infections .
`` And I believe that if we work together , we can provide them with @ @ @ @ @ @ @ need to not make that choice . ''
Lawless said that this can mean helping a pregnant woman find housing or get treatment for addiction .
But ultimately , she said , abortion should not be a choice .
`` I do n't think abortion should be legal , period .
Because abortion at any stage is willfully taking a human life , and I do n't think that should be legal — at all , '' Lawless said .
That includes , Lawless said , pregnancies resulting from rape or incest .
@ @ @ @ @ @ @ penalties for those who are convicted of violating those laws .
In the post-Roe world Lawless envisions , doctors could be prosecuted for providing the procedure , though Lawless said she would not support penalties for pregnant patients .
Murray Nellis , the adoption attorney from Georgia , said she supports early-abortion bans like one passed in 2019 in her state , which critics said was less than clear about how it would be enforced and against whom .
That law , as well as several other so-called `` heartbeat laws '' in @ @ @ @ @ @ @ federal court .
But advocates hope the Supreme Court might use such a law as an opportunity to reconsider Roe and related precedent .
Murray Nellis said she would not want to see patients punished if abortion were banned .
`` I just think that that is cruel , '' she said .
`` I just think the responsibility and liability should be at the hands of the individual she [ would be ] literally paying to do something illegal . ''
That 's the position of many of the major national anti-abortion-rights @ @ @ @ @ @ @ a universal one .
Catherine Davis is the founder of the Restoration Project , a group based in Georgia that promotes an anti-abortion message primarily among African American pastors .
She hopes to see abortion banned nationwide .
Davis said the focus of prosecution should be on doctors , though she would n't rule out one day punishing women who induce their own abortions .
`` If she decides to self-abort herself , then she 's subjected to the same penalty as the doctor , '' Davis said .
Davis said she believes @ @ @ @ @ @ @ — up to and including capital punishment .
`` If a doctor makes the decision in a jurisdiction that he or she knows the penalty for taking the life of another human being is the death penalty , and they decide to do it anyway , then they 've subjected themselves to the death penalty , '' Davis said .
Mary Ziegler , the Stearns Weaver Miller professor at Florida State University College of Law , said that while many groups opposed to abortion rights have historically said they would n't support laws @ @ @ @ @ @ @ , the growing availability of medication to self-induce abortion at home could complicate that position .
`` I do n't see how you do that without punishing women , because we 're going to be in an environment where women can end pregnancies without a third-party being present , '' she said .
Leslie Reagan is a history professor at the University of Illinois and author of the book When Abortion Was a Crime .
If Roe falls , Reagan said , women will still seek out illegal and sometimes unsafe abortions , @ @ @ @ @ @ @ said activists who 've been organizing with that thought in mind for decades are likely to insist on enforcing state abortion bans .
`` We have a movement — a religiously based movement that 's led by the churches and can organize out of the church — that wants these laws changed and will want these laws enforced , '' Reagan said .
It 's impossible to know how any justice might rule in a given case .
But in a written exchange with Senate Judiciary Committee members , Barrett was asked if @ @ @ @ @ @ @ felony or a capital crime punishable by death .
Barrett responded that as a judge and Supreme Court nominee , `` It would not be appropriate for me to offer an opinion on abstract legal issues or hypotheticals . ''

A World Without Legal Abortion: How Activists Envision A 'Post-Roe' Nation
Enlarge this image toggle caption Susan Walsh/AP Susan Walsh/AP
Judge Amy Coney Barrett's Supreme Court confirmation could open the door to a world that many anti-abortion-rights activists have been envisioning for decades.
"I hope and pray that we will be in a world post-Roe v. Wade," said Carrie Murray Nellis, 41, an adoption attorney based in Georgia.
Murray Nellis is the founder of Abiding Love Adoptions, which operates in Georgia, Florida and Alabama. She hopes Barrett's confirmation will lead to the overturning of the 1973 Supreme Court decision that legalized abortion nationwide, which would thereby allow states to further restrict or ban the procedure.
Preparing for a post-Roe society
Murray Nellis believes organizations like hers, which works primarily with birth mothers who are choosing adoption for their babies, need to be ready to help more women facing unplanned pregnancies.
"We as a pro-life community have got to get ready and get our ducks in a row," she said. "Because this could likely be happening, and I don't think we're ready."
Enlarge this image toggle caption Stellar Styles Photography, Lewiston, Idaho Stellar Styles Photography, Lewiston, Idaho
Persuasion and the law
A majority of Americans favor some restrictions on abortion but support Roe v. Wade, according to national polls. But activists dedicated to the goal of ending abortion in the U.S. have been organizing for decades at every level of government. They often say their goal is to make abortion both "illegal and unthinkable."
"There's always a reason why a woman is choosing abortion," said Heather Lawless, co-founder of the Reliance Center in Idaho, which counsels women against abortion and offers free pregnancy tests and screenings for sexually transmitted infections. "And I believe that if we work together, we can provide them with the resources and the tools that they need to not make that choice."
Lawless said that this can mean helping a pregnant woman find housing or get treatment for addiction. But ultimately, she said, abortion should not be a choice.
"I don't think abortion should be legal, period. Because abortion at any stage is willfully taking a human life, and I don't think that should be legal — at all," Lawless said.
That includes, Lawless said, pregnancies resulting from rape or incest.
Questions of enforcement
Banning abortion would mean civil or criminal penalties for those who are convicted of violating those laws. In the post-Roe world Lawless envisions, doctors could be prosecuted for providing the procedure, though Lawless said she would not support penalties for pregnant patients.
Murray Nellis, the adoption attorney from Georgia, said she supports early-abortion bans like one passed in 2019 in her state, which critics said was less than clear about how it would be enforced and against whom. That law, as well as several other so-called "heartbeat laws" in other states, has been blocked in federal court. But advocates hope the Supreme Court might use such a law as an opportunity to reconsider Roe and related precedent.
Murray Nellis said she would not want to see patients punished if abortion were banned.
"I just think that that is cruel," she said. "I just think the responsibility and liability should be at the hands of the individual she [would be] literally paying to do something illegal."
That's the position of many of the major national anti-abortion-rights activist groups. But it's not a universal one.
Catherine Davis is the founder of the Restoration Project, a group based in Georgia that promotes an anti-abortion message primarily among African American pastors. She hopes to see abortion banned nationwide. Davis said the focus of prosecution should be on doctors, though she wouldn't rule out one day punishing women who induce their own abortions.
toggle caption Charles Joseph/Courtesy Catherine Davis
"If she decides to self-abort herself, then she's subjected to the same penalty as the doctor," Davis said.
Davis said she believes abortion should be treated exactly like murder — up to and including capital punishment.
"If a doctor makes the decision in a jurisdiction that he or she knows the penalty for taking the life of another human being is the death penalty, and they decide to do it anyway, then they've subjected themselves to the death penalty," Davis said.
Punishing women?
Mary Ziegler, the Stearns Weaver Miller professor at Florida State University College of Law, said that while many groups opposed to abortion rights have historically said they wouldn't support laws that punish pregnant women who get abortions, the growing availability of medication to self-induce abortion at home could complicate that position.
"I don't see how you do that without punishing women, because we're going to be in an environment where women can end pregnancies without a third-party being present," she said.
Leslie Reagan is a history professor at the University of Illinois and author of the book When Abortion Was a Crime. If Roe falls, Reagan said, women will still seek out illegal and sometimes unsafe abortions, as they did before Roe.
Reagan said activists who've been organizing with that thought in mind for decades are likely to insist on enforcing state abortion bans.
"We have a movement — a religiously based movement that's led by the churches and can organize out of the church — that wants these laws changed and will want these laws enforced," Reagan said.
It's impossible to know how any justice might rule in a given case. But in a written exchange with Senate Judiciary Committee members, Barrett was asked if states could make getting an abortion a felony or a capital crime punishable by death.
Barrett responded that as a judge and Supreme Court nominee, "It would not be appropriate for me to offer an opinion on abstract legal issues or hypotheticals."


npr--2020-10-27--Despite Trump-Modi Friendship, Survey Says Indian Americans Back Biden

Indian Americans — a small but possibly pivotal voting bloc — are overwhelmingly voting for Joe Biden this election , according to a new survey .
Both Joe Biden and President Trump 's campaigns have been courting Indian American voters this year .
Indian Americans are about 1 % of the U.S. population and make up .82 % of all eligible voters in the U.S. — but are large enough in numbers to make a decisive difference in certain swing states .
Indian Americans historically lean Democratic .
In 2016 , 77 % voted for Hillary Clinton and 16 % @ @ @ @ @ @ @ of Indian Prime Minister Narendra Modi fueled speculation that it could drive many Indian American voters to the Republican Party .
But researchers from the Carnegie Endowment for International Peace , Johns Hopkins School of Advanced International Studies and the University of Pennsylvania say there 's `` little indication of a shift toward the Republican Party '' among Indian Americans , who view U.S.-India ties as a low-priority issue .
`` The survey is pretty unambiguous , '' says Milan Vaishnav , one of the study 's authors who directs the South Asia @ @ @ @ @ @ @ the 936 Indian American citizens surveyed in September , 72 % planned to vote for Biden and 22 % for Trump .
`` And that is actually in keeping with past trends of the pro-Democratic orientation of Indian Americans in this country in terms of their voter turnout , '' Vaishnav tells NPR 's Noel King on Morning Edition .
Vaishnav talked about the issues important to Indian American voters and how campaigns are reaching out .
Here are excerpts from the interview : What are the issues that draw Indian Americans to @ @ @ @ @ @ @ issues across the board were the state of the economy , health care and racism and racial discrimination .
And in some ways , this is n't all that surprising , given that these are precisely the issues that all Americans are really worried about in the face of an economic crisis , a pandemic , and the kind of national conversation we 're having around race and social justice .
What surprised us was the extent to which foreign policy really did n't rate very much .
We asked Indian Americans , @ @ @ @ @ @ @ be an important determining factor for you ? ''
And there 's been a lot of talk about this because of the close partnership between President Donald Trump and Indian Prime Minister Narendra Modi .
And just 3 % of Indian Americans said that this was going to be their No .
1 election issue this fall .
A person might look broadly and say , OK , 1 % of the electorate spread throughout the country .
The Indian American vote does n't really matter .
It 's not a swing vote @ @ @ @ @ @ @ that ?
There is certainly truth in the absolute numbers .
In fact , Indian Americans are less than 1 % of the eligible electorate .
However , there are two caveats to that .
The first is that their numbers are growing rapidly .
Indians in America have grown by more than 150 % since the year 2000 .
Secondly , they are now sizable enough in certain swing states , places like New Hampshire , Pennsylvania and Michigan , that their numbers are actually larger than the margin of victory in @ @ @ @ @ @ @ in aggregate they are not huge , they can be pivotal in certain swing states .
How have Republicans and Democrats reached out to Indian Americans ?
We 're seeing it in an unprecedented way this election .
I mean , both the Trump and the Biden campaigns have cut television and online ads just for this demographic .
What the Republicans have tried to do is really emphasize again the partnership between Donald Trump and Narendra Modi to say , `` We have formed a unique personal bond .
And for this @ @ @ @ @ @ @ U.S.-India relations succeed in the future as Indian Americans , you should really come to our side . ''
What Joe Biden , the Democrats have really done is to say , `` Indian Americans have really been the poster children for America 's legacy of relatively open immigration .
And if you want an America that is more inclusive , that is more tolerant , that is more welcoming to you and your family members and those who may wish to come from India after you , then there 's really only @ @ @ @ @ @ @ is the Democratic Party . ''
And so we are seeing both sides really court this vote , I think , in new and interesting ways , which is a recognition that their , sort of , time in the political spotlight has really arrived .
Jeevika Verma and Reena Advani produced and edited the audio interview .

Despite Trump-Modi Friendship, Survey Says Indian Americans Back Biden
Enlarge this image toggle caption Saul Loeb/AFP via Getty Images Saul Loeb/AFP via Getty Images
Indian Americans — a small but possibly pivotal voting bloc — are overwhelmingly voting for Joe Biden this election, according to a new survey.
Both Joe Biden and President Trump's campaigns have been courting Indian American voters this year. Indian Americans are about 1% of the U.S. population and make up .82% of all eligible voters in the U.S. — but are large enough in numbers to make a decisive difference in certain swing states.
Indian Americans historically lean Democratic. In 2016, 77% voted for Hillary Clinton and 16% for Trump.
Asia What Might Happen To U.S.-India Relations Under A President Biden What Might Happen To U.S.-India Relations Under A President Biden Listen · 3:51 3:51
President Trump's embrace of Indian Prime Minister Narendra Modi fueled speculation that it could drive many Indian American voters to the Republican Party.
But researchers from the Carnegie Endowment for International Peace, Johns Hopkins School of Advanced International Studies and the University of Pennsylvania say there's "little indication of a shift toward the Republican Party" among Indian Americans, who view U.S.-India ties as a low-priority issue.
"The survey is pretty unambiguous," says Milan Vaishnav, one of the study's authors who directs the South Asia Program at the Carnegie Endowment. Of the 936 Indian American citizens surveyed in September, 72% planned to vote for Biden and 22% for Trump.
"And that is actually in keeping with past trends of the pro-Democratic orientation of Indian Americans in this country in terms of their voter turnout," Vaishnav tells NPR's Noel King on Morning Edition.
Vaishnav talked about the issues important to Indian American voters and how campaigns are reaching out. Here are excerpts from the interview:
What are the issues that draw Indian Americans to the Democratic Party?
The top three issues across the board were the state of the economy, health care and racism and racial discrimination. And in some ways, this isn't all that surprising, given that these are precisely the issues that all Americans are really worried about in the face of an economic crisis, a pandemic, and the kind of national conversation we're having around race and social justice.
What surprised us was the extent to which foreign policy really didn't rate very much. We asked Indian Americans, you know, "Will U.S.-India relations be an important determining factor for you?" And there's been a lot of talk about this because of the close partnership between President Donald Trump and Indian Prime Minister Narendra Modi. And just 3% of Indian Americans said that this was going to be their No. 1 election issue this fall.
A person might look broadly and say, OK, 1% of the electorate spread throughout the country. The Indian American vote doesn't really matter. It's not a swing vote, for example. Any truth to that?
There is certainly truth in the absolute numbers. In fact, Indian Americans are less than 1% of the eligible electorate. However, there are two caveats to that. The first is that their numbers are growing rapidly. Indians in America have grown by more than 150% since the year 2000. Secondly, they are now sizable enough in certain swing states, places like New Hampshire, Pennsylvania and Michigan, that their numbers are actually larger than the margin of victory in the 2016 presidential election. So while in aggregate they are not huge, they can be pivotal in certain swing states.
How have Republicans and Democrats reached out to Indian Americans?
We're seeing it in an unprecedented way this election. I mean, both the Trump and the Biden campaigns have cut television and online ads just for this demographic.
What the Republicans have tried to do is really emphasize again the partnership between Donald Trump and Narendra Modi to say, "We have formed a unique personal bond. And for this reason, if you want to see U.S.-India relations succeed in the future as Indian Americans, you should really come to our side."
What Joe Biden, the Democrats have really done is to say, "Indian Americans have really been the poster children for America's legacy of relatively open immigration. And if you want an America that is more inclusive, that is more tolerant, that is more welcoming to you and your family members and those who may wish to come from India after you, then there's really only one choice in this election: that is the Democratic Party."
And so we are seeing both sides really court this vote, I think, in new and interesting ways, which is a recognition that their, sort of, time in the political spotlight has really arrived.
Jeevika Verma and Reena Advani produced and edited the audio interview.


npr--2020-10-27--Hit With An Unexpectedly High Medical Bill, Here's How A Savvy Patient Fought Back

Hit With An Unexpectedly High Medical Bill , Here 's How A Savvy Patient Fought Back When Tiffany Qiu heard how much her surgery was going to cost her , she was sure the hospital 's financial department had made a mistake .
Qiu already knew from a breast cancer scare earlier that year that her plan required a 30 % coinsurance payment on operations , so she pressed the person on the phone several times to make sure she had heard correctly : Her coinsurance payment would be only 20 % if she had the procedure at Palomar Medical @ @ @ @ @ @ @ 38 miles south of where Qiu lives .
`` I was kind of in doubt , so I called them a second time , '' said Qiu .
`` They gave me the exact same amount . ''
Qiu had been diagnosed with uterine polyps , a benign condition that was making her periods heavier and more unpredictable .
Her OB-GYN proposed removing them but said it was safe to wait .
Qiu said that she asked about the possibility of doing it in the doctor 's office under local anesthesia to make @ @ @ @ @ @ @ doctor rebuffed her suggestion .
Because Qiu thought she was getting a deal on her usual 30 % share of the bill , she decided to go ahead with the polyp removal on Nov. 5 , 2019 .
As she sat in the waiting room filling out forms , staffers let her know she needed to pay in full before the surgery .
Unease set in .
The hospital asked for the 20 % coinsurance — $ 1,656.10 — that she had been quoted over the phone , but Qiu had n't been @ @ @ @ @ @ @ day of the procedure .
As she handed over her credit card , she confirmed one more time that this would be her total patient responsibility , barring complications .
The surgery was over in less than 30 minutes , and she walked out of the hospital with her husband , feeling perfectly fine .
Then the bill came .
Patient : Tiffany Qiu is a 49-year-old real estate agent and mother of two who lives in Temecula , California .
Her family of four is covered by a Blue Shield of California @ @ @ @ @ @ @ on the marketplace .
Last year , they paid a $ 1,455 monthly premium , with an individual annual $ 1,850 deductible and an individual out-of-pocket maximum of $ 7,550 .
Total Bill : Palomar Health billed Blue Shield $ 22,219.64 for the polyp removal , which the insurer negotiated down to $ 8,576.79 .
Blue Shield paid $ 5,769.72 and stated in an explanation of benefits document that Qiu was responsible for a $ 334.32 deductible and $ 2,472.75 coinsurance .
Because Qiu had already paid $ 1,873.20 on the day of @ @ @ @ @ @ @ additional $ 933.87 , which meant Qiu was on the hook for the remainder of her 30 % coinsurance .
These figures do n't include the fees Qiu paid for anesthesia or her doctor 's services .
Care Provider : Palomar Medical Center in Poway is one of three hospitals in the Palomar Health system .
Palomar Health is a San Diego County public health care district , which means the health care facilities are nonprofit and receive property taxes as a portion of their revenue stream .
The system is governed by @ @ @ @ @ @ @ the district 's boundaries .
What Gives : Hospitals and surgery centers sometimes offer discounts if patients are uninsured and able to pay with cash or a credit card .
Physicians may even offer discounts on a patient 's share of the costs if they know the patient is unemployed or has fallen on hard times .
But regularly offering discounts to attract patients is not common , and could even be fraudulent if the patients are insured through Medicare , said Paul Ginsburg , director of the USC-Brookings Schaeffer Initiative for Health @ @ @ @ @ @ @ the hospital seemed to be offering a discount on the insurer 's normally required coinsurance .
`` The hospital would be in breach of their contract with the insurance if they did not bill her for that amount , '' said Martine Brousse , a California-based patient advocate and medical billing consultant for AdvimedPRO .
`` She owes what the insurance has calculated , and the facility has every right to demand payment . ''
Copayments and coinsurance exist , in theory , so patients have `` skin in the game . ''
@ @ @ @ @ @ @ portion of the cost of their care , according to their policy , so they will shop around and use medical care judiciously ( though many health experts say coinsurance amounts have gotten so high that many can not afford them ) .
Another thing to note is how much the hospital billed Qiu for a simple outpatient procedure : $ 22,219.64 .
That amount is `` totally laughable , '' said Dr. Merrit Quarum , founder of WellRithms , a company that works with self-funded employers and other clients to make sense @ @ @ @ @ @ @ is the charge far out of line with what that procedure typically costs in that region ( around $ 5,500 ) , but Qiu is now stuck paying a larger amount as her share under the terms of her insurance .
This is how those `` sticker prices '' that few people pay still drive up costs for individuals .
Resolution : If she had n't been quoted 20 % , Qiu said , she would have shopped for a better deal .
She flies to China often to visit her mother and @ @ @ @ @ @ @ there .
Qiu called the hospital to ask why she was being billed a second time , despite the lack of complications during the surgery .
She remembers the back-and-forth over the remaining bill was exhausting , especially because it happened over the holidays .
`` I got tired and said , ' I do n't want to play this game anymore , ' '' Qiu recalled .
`` 'If you want to send it to collections , you can do it , but I 'm not going to pay for it .
@ @ @ @ @ @ @ collection agency called IC System .
In a May 23 phone call , Qiu said , a representative offered to slash the remaining bill by 25 % if she would just pay that day .
But Qiu refused , though she could easily afford to pay .
She 's undaunted by the risk the unpaid bill poses to her credit score , preferring instead to fight the hospital on behalf of other patients who may not have the time or luxury to persist .
The experience left her feeling as if the hospital @ @ @ @ @ @ @ in her business .
`` I double-checked and tripled-checked with them , '' Qiu said .
`` They have financial departments that should be verifying this with my insurance company . ''
After a reporter 's call , Palomar Health looked back at phone records , confirmed Qiu 's version of events and said a hospital staffer had made a mistake by quoting her a 20 % cost-sharing obligation .
That percentage then got automatically put into her patient notes and was on the bill of estimated costs she signed and paid on @ @ @ @ @ @ @ it was incorrect .
They apologized for giving the mistaken impression that Qiu was getting a discount .
Staff members are not authorized to offer discounts when providing estimates , said Derryl Acosta , a spokesman for Palomar Health .
Acosta also pointed out other communication breakdowns , like dropping the complaint Qiu phoned in after she received the second bill in late November .
Her issue did not get put into the standard customer complaint process , which would have elevated the problem and triggered an investigation into the phone records .
@ @ @ @ @ @ @ sent to the collection agency .
`` We definitely admit that the call should have been handled differently , '' Acosta said .
`` We now have a new call center that we believe will handle this type of call better . ''
Because Palomar Health was able to see in their phone records that a staffer had confirmed the erroneous 20 % coinsurance amount to Qiu , the health system will change her bill to reflect what she was promised .
Qiu will get a statement in the mail saying she has @ @ @ @ @ @ @ The Takeaway : Multiple medical billing advocates who reviewed Qiu 's case praised her for her tenacity in calling the hospital financial department twice before the procedure .
But as she herself acknowledged , most people do n't have the time or spine to fight .
To avoid such situations , experts advised , patients should check in with their insurer about the discounts offered , as hospital staffers may be poorly trained or ill informed .
If a patient hears conflicting information about charges before a procedure , they need to approach @ @ @ @ @ @ @ their own policy , said Brousse , the patient advocate .
The simple fact that a hospital staffer misinformed a patient is n't a legal reason to force a hospital to lower a bill , Brousse said .
Also , get promises in writing — before the day of surgery .
Make sure the offer is explicit about which services are included and what might count as a complication .
Ask whether you 'll have to pay upfront .
Initial estimated bills can be full of asterisks and `` weasel words , '' @ @ @ @ @ @ @ , a medical bill review and patient advocacy company .
`` Even though she tried to be diligent , obviously she still did n't know that she would need to get something that was legally enforceable , '' said Gupta .
Dan Weissmann , host of the podcast `` An Arm and a Leg , '' reported the radio interview of this story .
Joe Neel of NPR produced the interview with KHN Editor-in-Chief Elisabeth Rosenthal on `` Morning Edition . ''
Bill of the Month is a crowdsourced investigation by KHN and @ @ @ @ @ @ @ .
Do you have an interesting medical bill you want to share with us ?
Tell us about it !

Hit With An Unexpectedly High Medical Bill, Here's How A Savvy Patient Fought Back
Enlarge this image toggle caption Shelby Knowles for KHN Shelby Knowles for KHN
When Tiffany Qiu heard how much her surgery was going to cost her, she was sure the hospital's financial department had made a mistake. Qiu already knew from a breast cancer scare earlier that year that her plan required a 30% coinsurance payment on operations, so she pressed the person on the phone several times to make sure she had heard correctly: Her coinsurance payment would be only 20% if she had the procedure at Palomar Medical Center in Poway, Calif., about 38 miles south of where Qiu lives.
"I was kind of in doubt, so I called them a second time," said Qiu. "They gave me the exact same amount."
Qiu had been diagnosed with uterine polyps, a benign condition that was making her periods heavier and more unpredictable. Her OB-GYN proposed removing them but said it was safe to wait. Qiu said that she asked about the possibility of doing it in the doctor's office under local anesthesia to make the procedure cheaper, but that her doctor rebuffed her suggestion.
Because Qiu thought she was getting a deal on her usual 30% share of the bill, she decided to go ahead with the polyp removal on Nov. 5, 2019. As she sat in the waiting room filling out forms, staffers let her know she needed to pay in full before the surgery.
Unease set in. The hospital asked for the 20% coinsurance — $1,656.10 — that she had been quoted over the phone, but Qiu hadn't been told she needed to pay on the day of the procedure. As she handed over her credit card, she confirmed one more time that this would be her total patient responsibility, barring complications.
The surgery was over in less than 30 minutes, and she walked out of the hospital with her husband feeling perfectly fine.
Then the bill came.
Patient: Tiffany Qiu is a 49-year-old real estate agent and mother of two who lives in Temecula, Calif. Her family of four is covered by a Blue Shield of California policy that she and her husband purchased on the marketplace. Last year, they paid a $1,455 monthly premium, with an individual annual $1,850 deductible and an individual out-of-pocket maximum of $7,550.
Total bill: Palomar Health billed Blue Shield $22,219.64 for the polyp removal, which the insurer negotiated down to $8,576.79. Blue Shield paid $5,769.72 and stated in an explanation of benefits document that Qiu was responsible for a $334.32 deductible and $2,472.75 coinsurance.
Because Qiu had already paid $1,873.20 on the day of surgery, the hospital billed her an additional $933.87, which meant Qiu was on the hook for the remainder of her 30% coinsurance.
These figures don't include the fees Qiu paid for anesthesia or her doctor's services.
Care provider: Palomar Medical Center in Poway is one of three hospitals in the Palomar Health system. Palomar Health is a San Diego County public health care district, which means the health care facilities are nonprofit and receive property taxes as a portion of their revenue stream. The system is governed by a board of directors elected from within the district's boundaries.
What gives: Hospitals and surgery centers sometimes offer discounts if patients are uninsured and able to pay with cash or a credit card. Physicians may even offer discounts on a patient's share of the costs if they know the patient is unemployed or has fallen on hard times. But regularly offering discounts to attract patients is not common and could even be fraudulent if the patients are insured through Medicare, said Paul Ginsburg, director of the USC-Brookings Schaeffer Initiative for Health Policy.
In Qiu's case, the hospital seemed to be offering a discount on the insurer's normally required coinsurance.
"The hospital would be in breach of their contract with the insurance if they did not bill her for that amount," said Martine Brousse, a California-based patient advocate and medical billing consultant for AdvimedPRO. "She owes what the insurance has calculated, and the facility has every right to demand payment."
Copayments and coinsurance exist, in theory, so patients have "skin in the game." They have to pay a clearly defined portion of the cost of their care, according to their policy, so they will shop around and use medical care judiciously (though many health experts say coinsurance amounts have gotten so high that many cannot afford them).
Another thing to note is how much the hospital billed Qiu for a simple outpatient procedure: $22,219.64. That amount is "totally laughable," said Dr. Merrit Quarum, founder of WellRithms, a company that works with self-funded employers and other clients to make sense of complex medical claims.
Not only is the charge far out of line with what that procedure typically costs in that region (about $5,500), but Qiu is now stuck paying a larger amount as her share under the terms of her insurance. This is how those "sticker prices" that few people pay still drive up costs for individuals.
Resolution: If she hadn't been quoted 20%, Qiu said, she would have shopped for a better deal. She flies to China often to visit her mother and was open to getting the surgery done there.
Qiu called the hospital to ask why she was being billed a second time, despite the lack of complications during the surgery. She remembers the back-and-forth over the remaining bill was exhausting, especially because it happened over the holidays.
"I got tired and said, 'I don't want to play this game anymore,'" Qiu recalled. "'If you want to send it to collections, you can do it, but I'm not going to pay for it.'"
The bill landed at a collection agency called IC System. In a May 23 phone call, Qiu said, a representative offered to slash the remaining bill by 25% if she would just pay that day.
But Qiu refused, though she could afford to pay. She's undaunted by the risk the unpaid bill poses to her credit score, preferring instead to fight the hospital on behalf of other patients who may not have the time or luxury to persist.
The experience left her feeling as if the hospital offered her a fake discount to reel in her business. "I double-checked and tripled-checked with them," Qiu said. "They have financial departments that should be verifying this with my insurance company."
After a reporter's call, Palomar Health looked back at phone records, confirmed Qiu's version of events and said a hospital staffer had made a mistake by quoting her a 20% cost-sharing obligation. That percentage then got automatically put into her patient notes and was on the bill of estimated costs she signed and paid on the day of surgery, even though it was incorrect.
They apologized for giving the mistaken impression that Qiu was getting a discount. Staff members are not authorized to offer discounts when providing estimates, said Derryl Acosta, a spokesman for Palomar Health.
Acosta also pointed out other communication breakdowns, like dropping the complaint Qiu phoned in after she received the second bill in late November. Her issue did not get put into the standard customer complaint process, which would have elevated the problem and triggered an investigation into the phone records. That's why Qiu's bill was sent to the collection agency.
"We definitely admit that the call should have been handled differently," Acosta said. "We now have a new call center that we believe will handle this type of call better."
Because Palomar Health was able to see in its phone records that a staffer had confirmed the erroneous 20% coinsurance amount to Qiu, the health system will change her bill to reflect what she was promised. Qiu will get a statement in the mail saying she has a zero balance, Acosta said.
The takeaway: Multiple medical billing advocates who reviewed Qiu's case praised her for her tenacity in calling the hospital financial department twice before the procedure. But as she acknowledged, most people don't have the time or spine to fight.
To avoid such situations, experts advised, patients should check in with their insurer about the discounts offered, as hospital staffers may be poorly trained or ill informed.
If a patient hears conflicting information about charges before a procedure, they need to approach their insurer to confirm the details of their own policy, said Brousse, the patient advocate.
The simple fact that a hospital staffer misinformed a patient isn't a legal reason to force a hospital to lower a bill, Brousse said.
Also, get promises in writing — before the day of surgery. Make sure the offer is explicit about which services are included and what might count as a complication. Ask whether you'll have to pay upfront.
Initial estimated bills can be full of asterisks and "weasel words," said Akshay Gupta, co-founder of CoPatient, a medical bill review and patient advocacy company.
"Even though she tried to be diligent, obviously she still didn't know that she would need to get something that was legally enforceable," said Gupta.
Dan Weissmann, host of the podcast "An Arm and a Leg," reported the radio interview of this story. Joe Neel of NPR produced the interview with KHN Editor-in-Chief Elisabeth Rosenthal on "Morning Edition."
Bill of the Month is a crowdsourced investigation by KHN and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!


npr--2020-10-27--Voters' Guide To Election Security In The 2020 Presidential Campaign

Voters ' Guide To Election Security In The 2020 Presidential Campaign Foreign interference is a very old problem , but most Americans did n't used to worry much about it and the security of elections .
Now , lessons learned about the Russian attack on the 2016 presidential election have brought the most intense focus ever on the U.S. information environment , elections practices , voter databases and other parts of the infrastructure of democracy .
With seven days to run until the end of voting in this year 's election , here 's what you need to know .
@ @ @ @ @ @ @ — but it 's important to understand exactly what that means : Foreign nations probably can not affect the casting and counting of ballots , U.S. officials say , meaning that voters can feel confident about submitting their choices and the practices involved with tallying them .
What foreign nations , especially Russia and Iran , are trying to do is chip away at Americans ' confidence about that process .
They 're also trying to create an environment in which citizens do n't feel they can believe what they see or accept @ @ @ @ @ @ @ legitimate .
Complicating matters is the help given to those efforts — knowingly or not — by real Americans who say publicly that the race is `` rigged '' or likely to be plagued by `` fraud . ''
How are foreign nations trying to interfere ?
There are two big strategies : changing votes and changing minds .
Actually affecting ballots is difficult , and U.S. officials say it 's unlikely that any foreign nation could tamper with , for example , a state 's correct tally of ballots .
Changing minds @ @ @ @ @ @ @ much of the energy is focused by governments hostile to the United States .
There are two big sub-themes within this category : sowing doubt about the conduct of the election and spreading false or misleading information to influence voters .
U.S. national security officials have issued a series of bulletins warning about the prospect that foreign influence-mongers could try to attack systems adjacent to ballot infrastructure to cause doubts , even if the collection and counting of votes was proceeding honestly .
A cyberattack might try to shut down or deface a @ @ @ @ @ @ @ for example , without actually affecting the true result .
Other strategies include making it appear that information about voters has been stolen and is being used to reveal for whom they voted or make more claims about deeper security compromises .
Iranian hackers , for example , sent a number of emails to voters in Alaska and Florida and said , in so many words : We know you 're a registered Democrat but you better vote for President Trump `` or else . ''
The messages purported to come from the @ @ @ @ @ @ @ get more messages like that before the election is over , national security officials acknowledge , and according to one cybersecurity report , many domains remain vulnerable to being spoofed in this way — including permitting attackers to pretend they 're sending a message from an organization the sender knows .
Security firm Cloudflare has built a public dashboard that shows some cyberattack activity targeting political and elections Web domains .
CEO Matthew Prince said the intensity of attacks has been lower so far than in 2016 — `` but that does n't @ @ @ @ @ @ @ . ''
The other big sub-strategy involved with changing minds is using the vast , popular and largely unregulated world of social media to try to make Americans believe things that are n't true , amplify disagreement and , in some cases , persuade people not to vote .
This was a big part of Russia 's attack on the 2016 election and has never stopped , although researchers say the accounts involved have become somewhat more difficult to detect and other aspects of this work also have evolved since then .
One @ @ @ @ @ @ @ some once-clandestine messaging into the open , making their statements with accounts linked to official spokesmen or state-controlled operations .
Another way is that foreign governments have moved the core of some information attacks off social media .
In one scheme , for example , Facebook was being used only to recruit contributors who then posted on other websites controlled by the attacking nation .
National security officials say they 're taking new approaches too , including knocking down these schemes as quickly as they can to deny time during which they might @ @ @ @ @ @ @ talking more openly than ever before about their work safeguarding the election .
What about freedom of speech ?
The Big Tech platforms , especially Facebook , Google and Twitter , have struggled to strike a balance between permitting Americans to use their services within the bounds of Western values about expression — and identifying bad actors seeking to exploit those same freedoms .
Normal users and some American political operatives also are borrowing from the `` active measures '' playbook .
The chain reaction of misleading or false information on social media @ @ @ @ @ @ @ and appears self-sustaining on its own even without foreign government efforts .
Security-watchers fretted in an earlier stage of this election cycle about the prospect that Americans could be fooled by high-quality fake videos that depict political figures doing things or saying things that never really happened .
There are also less sophisticated `` cheapfakes '' in which videos are edited with cruder tools to make someone appear to be slurring her words , for example — as though the target were suffering from some kind of health affliction .
Many technology experts @ @ @ @ @ @ @ awareness about this fake media means they could n't convince as many unsuspecting people as once contemplated in the nightmare scenarios .
And specialists have said they 're confident the techniques for detecting fakes have moved faster than the software used to create them , suggesting that authorities could catch them before they fooled too many Americans and caused major disruptions .
How are we supposed to tell what 's real and what 's not ?
Voters are the last line of defense , argues Chris Krebs , director of the Cybersecurity and @ @ @ @ @ @ @ something outrageous on Facebook or a story that does n't seem right , be skeptical .
Read more here about how to assess whether something you 've seen might not be legit .
This is important when it comes to news or news-like items that spread on social media , and it 's especially true about stories involving the actual operations of voting .
If you have questions about your ability to find a polling place or cast a ballot , check with your local officials such as a secretary of state 's @ @ @ @ @ @ @ Krebs ' agency also has set up a dedicated national homepage : Rumor Control .
Even before this era of `` active measures , '' chicanery often intensified in the final few days before the end of voting .
Be cautious about messages that say , for example , `` Democrats ' day to vote is Nov. 3 ; Republicans ' turn will be on Nov. 4 '' — that 's not true and never has been .
Election Day for everyone is Nov. 3 , though early and mail-in voting options vary @ @ @ @ @ @ @ election ?
This year may feature the most turnout ever , according to some projections , and combined with an expected surge in mailed ballots could mean that Americans do n't get a definitive result on election night .
That in and of itself does n't mean there was an attack or `` fraud '' or a problem .
However , the more uncertainty and controversy associated with the results following the morning of Nov. 4 , the more appealing for foreign adversaries , as Laura Rosenberger , director of the Alliance for @ @ @ @ @ @ @ Day .
That includes deception about deception , as Cloudflare 's Prince observed .
`` I continue to worry that the day after the election , Vladimir Putin shows up on TV and says , 'Well that worked out the way we hoped , ' with a wry wink — even if there was no actual hacking , '' Prince said .
`` That 's a really tough thing to overcome . ''
The task — and the challenge — for Americans is both to remain engaged and confident in their system as @ @ @ @ @ @ @ while also preserving some skepticism , common sense and patience .

Voters' Guide To Election Security In The 2020 Presidential Campaign
Enlarge this image toggle caption Caroline Amenabar/NPR Caroline Amenabar/NPR
Foreign interference is a very old problem, but most Americans didn't used to worry much about it and the security of elections.
Now, lessons learned about the Russian attack on the 2016 presidential election have brought the most intense focus ever on the U.S. information environment, elections practices, voter databases and other parts of the infrastructure of democracy.
With seven days to run until the end of voting in this year's election, here's what you need to know.
Is the election under attack?
Yes — but it's important to understand exactly what that means: Foreign nations probably cannot affect the casting and counting of ballots, U.S. officials say, meaning that voters can feel confident about submitting their choices and the practices involved with tallying them.
What foreign nations, especially Russia and Iran, are trying to do is chip away at Americans' confidence about that process. They're also trying to create an environment in which citizens don't feel they can believe what they see or accept that the results of the race are legitimate.
Complicating matters is the help given to those efforts — knowingly or not — by real Americans who say publicly that the race is "rigged" or likely to be plagued by "fraud."
How are foreign nations trying to interfere?
There are two big strategies: changing votes and changing minds.
Actually affecting ballots is difficult, and U.S. officials say it's unlikely that any foreign nation could tamper with, for example, a state's correct tally of ballots.
Changing minds is simpler, and that is where much of the energy is focused by governments hostile to the United States. There are two big sub-themes within this category: sowing doubt about the conduct of the election and spreading false or misleading information to influence voters.
Sowing doubt and confusion
U.S. national security officials have issued a series of bulletins warning about the prospect that foreign influence-mongers could try to attack systems adjacent to ballot infrastructure to cause doubts, even if the collection and counting of votes was proceeding honestly.
A cyberattack might try to shut down or deface a county website that showed vote tallies, for example, without actually affecting the true result.
Other strategies include making it appear that information about voters has been stolen and is being used to reveal for whom they voted or make more claims about deeper security compromises.
Iranian hackers, for example, sent a number of emails to voters in Alaska and Florida and said, in so many words: We know you're a registered Democrat but you better vote for President Trump "or else." The messages purported to come from the white supremacist Proud Boys.
Americans may get more messages like that before the election is over, national security officials acknowledge, and according to one cybersecurity report, many domains remain vulnerable to being spoofed in this way — including permitting attackers to pretend they're sending a message from an organization the sender knows.
Security firm Cloudflare has built a public dashboard that shows some cyberattack activity targeting political and elections Web domains. CEO Matthew Prince said the intensity of attacks has been lower so far than in 2016 — "but that doesn't mean we can let our guard down."
Social media misinformation and agitation
The other big sub-strategy involved with changing minds is using the vast, popular and largely unregulated world of social media to try to make Americans believe things that aren't true, amplify disagreement and, in some cases, persuade people not to vote.
This was a big part of Russia's attack on the 2016 election and has never stopped, although researchers say the accounts involved have become somewhat more difficult to detect and other aspects of this work also have evolved since then.
One way is that foreign governments have moved some once-clandestine messaging into the open, making their statements with accounts linked to official spokesmen or state-controlled operations.
Another way is that foreign governments have moved the core of some information attacks off social media. In one scheme, for example, Facebook was being used only to recruit contributors who then posted on other websites controlled by the attacking nation.
National security officials say they're taking new approaches too, including knocking down these schemes as quickly as they can to deny time during which they might gain credibility. U.S. officials also are talking more openly than ever before about their work safeguarding the election.
What about freedom of speech?
The Big Tech platforms, especially Facebook, Google and Twitter, have struggled to strike a balance between permitting Americans to use their services within the bounds of Western values about expression — and identifying bad actors seeking to exploit those same freedoms.
Normal users and some American political operatives also are borrowing from the "active measures" playbook. The chain reaction of misleading or false information on social media now has ample fuel from domestic users and appears self-sustaining on its own even without foreign government efforts.
What about "deepfakes"?
Security-watchers fretted in an earlier stage of this election cycle about the prospect that Americans could be fooled by high-quality fake videos that depict political figures doing things or saying things that never really happened.
There are also less sophisticated "cheapfakes" in which videos are edited with cruder tools to make someone appear to be slurring her words, for example — as though the target were suffering from some kind of health affliction.
Many technology experts, however, think that the heightened awareness about this fake media means they couldn't convince as many unsuspecting people as once contemplated in the nightmare scenarios. And specialists have said they're confident the techniques for detecting fakes have moved faster than the software used to create them, suggesting that authorities could catch them before they fooled too many Americans and caused major disruptions.
How are we supposed to tell what's real and what's not?
Voters are the last line of defense, argues Chris Krebs, director of the Cybersecurity and Infrastructure Security Administration.
If you see something outrageous on Facebook or a story that doesn't seem right, be skeptical. Read more here about how to assess whether something you've seen might not be legit.
This is important when it comes to news or news-like items that spread on social media, and it's especially true about stories involving the actual operations of voting. If you have questions about your ability to find a polling place or cast a ballot, check with your local officials such as a secretary of state's office or a county elections official.
Krebs' agency also has set up a dedicated national homepage: Rumor Control.
Even before this era of "active measures," chicanery often intensified in the final few days before the end of voting. Be cautious about messages that say, for example, "Democrats' day to vote is Nov. 3; Republicans' turn will be on Nov. 4" — that's not true and never has been.
Election Day for everyone is Nov. 3, though early and mail-in voting options vary by state.
What about after the election?
NPR YouTube
This year may feature the most turnout ever, according to some projections, and combined with an expected surge in mailed ballots could mean that Americans don't get a definitive result on election night.
That in and of itself doesn't mean there was an attack or "fraud" or a problem.
However, the more uncertainty and controversy associated with the results following the morning of Nov. 4, the more appealing for foreign adversaries, as Laura Rosenberger, director of the Alliance for Securing Democracy, warned ahead of Election Day.
That includes deception about deception, as Cloudflare's Prince observed.
"I continue to worry that the day after the election, Vladimir Putin shows up on TV and says, 'Well that worked out the way we hoped,' with a wry wink — even if there was no actual hacking," Prince said. "That's a really tough thing to overcome."
The task — and the challenge — for Americans is both to remain engaged and confident in their system as national security officials say is appropriate, while also preserving some skepticism, common sense and patience.


npr--2020-10-27--'Something Has To Give': Latinas Leaving Workforce At Faster Rate Than Other Groups

'Something Has To Give ' : Latinas Leaving Workforce At Faster Rate Than Other Groups Throughout her years as a working mother climbing the corporate ladder , Farida Mercedes tried to be home for dinner with her kids .
But until recently , she never imagined staying home full time .
`` I respect stay-at-home moms .
But it was n't part of my DNA , '' said Mercedes , who spent almost two decades working for the cosmetics company , L'Oreal .
`` I love the hustle .
I love being hungry and passionate .
And I love my @ @ @ @ @ @ @ see myself out of that . ''
That changed with the pandemic .
Work became more stressful when L'Oreal 's sales dropped .
Mercedes — an assistant vice president of human relations — had to lay people off .
Family life was even tougher .
Mercedes ' husband is a guard at New York 's Rikers Island jail .
He stayed away from home for a month out of fear of passing the virus on to his family .
It 's a story common to working mothers during the pandemic , but Latinas @ @ @ @ @ @ @ hundreds of thousands of women dropped out of the workforce in September , Latinas led the way , leaving at nearly three times the rate of white women and more than four times the rate of African Americans .
That could have lasting consequences for both household budgets and the broader U.S. economy .
Mercedes was one of the women who had to make the difficult choice to leave the workforce .
As her sons struggled with home schooling , she found herself crying almost every day .
So in late August , @ @ @ @ @ @ @ `` My family needs me , '' Mercedes said , in a voice breaking with emotion .
`` So I made the really hard decision to be home with them .
And it 's exactly where I need to be . ''
Analysts offer a variety of explanations for the widespread Latina exodus .
Hispanic women are more likely to maintain a traditional view of mothers as primary caregivers .
`` My mom , for all of my life , worked two jobs , '' Mercedes said .
`` But there 's something @ @ @ @ @ @ @ the matriarch , the mother that needs to be home . ''
Even as some 324,000 Latinas left the job market last month , 87,000 Latino men joined the workforce .
Many Latinas also work in industries that have been hammered by the pandemic .
While the overall unemployment rate fell last month , the jobless rate among Latinas rose to 11 % .
Before the pandemic , Sabrina Castillo felt like she had a good balance between her job with the Campaign Finance Board in New York and her two children .
@ @ @ @ @ @ @ , trying to manage a workplace team while also coaching her five-year-old through online lessons .
`` I 'm embarrassed to say this , but I 'm a week behind on kindergarten homework , '' Castillo said .
`` I ca n't give my kids the attention they need , continue to give my team the energy and focus and fulfill myself with things that really bring joy to me , '' she said .
`` I 'm also married , so there 's a lot of roles there .
Something has to @ @ @ @ @ @ @ job she 's held for eight years , right after the November election .
As someone who came to the United States as an infant from El Salvador , it was n't an easy decision .
`` In our culture , in my culture , like leaving a really good nine-to-five is not something you do , '' Castillo said .
Not everyone has a choice .
Maria Silva is a single mom who was furloughed from her job as a teaching assistant in Vancouver , Wash. She applied for food stamps and @ @ @ @ @ @ @ Even if her job re-opens , Silva does n't expect to go back to work , so long as her 13-year-old daughter and 10-year-old autistic son are schooling at home .
`` I 'm a full-time mom and I 'm a part-time employee , '' Silva said .
`` But when there 's a pandemic or situation like this , it 's impossible to do — either way . ''
Before the pandemic , Latinas had been joining the workforce in large numbers for decades — an influx that helped fuel economic growth @ @ @ @ @ @ @ drag on prospects for future growth .
`` It is n't just a concern with what 's happening for Latinas or Hispanic communities , '' said Marie Mora , an economist at the University of Missouri , St. Louis .
`` It does have effects for the national labor force . ''
If the pandemic is controlled quickly , Mora said , Latina women may soon go back to work .
But the longer it drags on , the greater the danger that Latinas — along with other women — will lose skills @ @ @ @ @ @ @ good .
`` If not soon reversed , the decline in the participation rate for prime-age women could have longer-term implications for household incomes and potential growth , '' Federal Reserve governor Lael Brainard warned last week .
Mercedes , who left her job at L'Oreal , said she can imagine going back to the corporate world at some point , but not back to 50- or 60-hour workweeks .
`` It 's no longer the V.P .
title , '' she said .
`` It 's how do I build a life @ @ @ @ @ @ @ doing the things that I love , being with the people I love ?
How can I create that for myself ? ''
Castillo also found , oddly enough , that the pandemic had given her space to imagine a new kind of work-life balance .
`` Latinas are very resourceful , '' she said .
`` A lot of women that I 've personally been talking to are taking this time to reflect , 'OK , how can I provide for my family and still not feel completely stretched out ? ''
@ @ @ @ @ @ @ their own businesses or finding other ways to be productive , outside the regular workforce .
`` I do n't feel like I 'm giving up my career , '' Castillo said .
`` But I am giving up the traditional nine-to-five . ''
Mercedes realized just how much her outlook had changed this fall , when she got a recruiting call from Google , which had always been her dream job .
After a month as a stay-at-home mom , she turned it down .

'My Family Needs Me': Latinas Drop Out Of Workforce At Alarming Rates
Enlarge this image toggle caption Erica Seryhm Lee for NPR Erica Seryhm Lee for NPR
Throughout her years as a working mother climbing the corporate ladder, Farida Mercedes tried to be home for dinner with her kids. But until recently, she never imagined staying home full time.
"I respect stay-at-home moms. But it wasn't part of my DNA," said Mercedes, who spent almost two decades working for the cosmetics company, L'Oreal. "I love the hustle. I love being hungry and passionate. And I love my children. But I just couldn't see myself out of that."
That changed with the pandemic. Work became more stressful when L'Oreal's sales dropped. Mercedes — an assistant vice president of human relations — had to lay people off.
Family life was even tougher. Mercedes' husband is a guard at New York's Rikers Island jail. He stayed away from home for a month out of fear of passing the virus on to his family.
It's a story common to working mothers during the pandemic, but Latinas appear to have suffered most.
As hundreds of thousands of women dropped out of the workforce in September, Latinas led the way, leaving at nearly three times the rate of white women and more than four times the rate of African Americans. That could have lasting consequences for both household budgets and the broader U.S. economy.
Enlarge this image toggle caption Erica Seryhm Lee for NPR Erica Seryhm Lee for NPR
Mercedes was one of the women who had to make the difficult choice to leave the workforce. As her sons struggled with home schooling, she found herself crying almost every day. So in late August, she gave up her corporate job.
"My family needs me," Mercedes said, in a voice breaking with emotion. "So I made the really hard decision to be home with them. And it's exactly where I need to be."
Loading...
Analysts offer a variety of explanations for the widespread Latina exodus. Hispanic women are more likely to maintain a traditional view of mothers as primary caregivers.
"My mom, for all of my life, worked two jobs," Mercedes said. "But there's something about — in a Latino home — the matriarch, the mother that needs to be home."
Even as some 324,000 Latinas left the job market last month, 87,000 Latino men joined the workforce.
Many Latinas also work in industries that have been hammered by the pandemic. While the overall unemployment rate fell last month, the jobless rate among Latinas rose to 11%.
Before the pandemic, Sabrina Castillo felt like she had a good balance between her job with the Campaign Finance Board in New York and her two children. Now, it feels like a tug-of-war, trying to manage a workplace team while also coaching her five-year-old through online lessons.
"I'm embarrassed to say this, but I'm a week behind on kindergarten homework," Castillo said.
Enlarge this image toggle caption Erica Seryhm Lee for NPR Erica Seryhm Lee for NPR
"I can't give my kids the attention they need, continue to give my team the energy and focus and fulfill myself with things that really bring joy to me," she said. "I'm also married, so there's a lot of roles there. Something has to give."
Castillo is leaving the job she's held for eight years, right after the November election. As someone who came to the United States as an infant from El Salvador, it wasn't an easy decision.
"In our culture, in my culture, like leaving a really good nine-to-five is not something you do," Castillo said.
Enlarge this image toggle caption Erica Seryhm Lee for NPR Erica Seryhm Lee for NPR
Not everyone has a choice. Maria Silva is a single mom who was furloughed from her job as a teaching assistant in Vancouver, Wash. She applied for food stamps and sold her car to pay bills. Even if her job re-opens, Silva doesn't expect to go back to work, so long as her 13-year-old daughter and 10-year-old autistic son are schooling at home.
"I'm a full-time mom and I'm a part-time employee," Silva said. "But when there's a pandemic or situation like this, it's impossible to do — either way."
Before the pandemic, Latinas had been joining the workforce in large numbers for decades — an influx that helped fuel economic growth. The pandemic-driven exodus could be a drag on prospects for future growth.
"It isn't just a concern with what's happening for Latinas or Hispanic communities," said Marie Mora, an economist at the University of Missouri, St. Louis. "It does have effects for the national labor force."
Enlarge this image toggle caption Erica Seryhm Lee Erica Seryhm Lee
If the pandemic is controlled quickly, Mora said, Latina women may soon go back to work. But the longer it drags on, the greater the danger that Latinas — along with other women — will lose skills and experience and possibly drop out for good.
"If not soon reversed, the decline in the participation rate for prime-age women could have longer-term implications for household incomes and potential growth," Federal Reserve governor Lael Brainard warned last week.
Mercedes, who left her job at L'Oreal, said she can imagine going back to the corporate world at some point, but not back to 50- or 60-hour workweeks.
"It's no longer the V.P. title," she said. "It's how do I build a life that allows me to spend more time doing the things that I love, being with the people I love? How can I create that for myself?"
Castillo also found, oddly enough, that the pandemic had given her space to imagine a new kind of work-life balance.
"Latinas are very resourceful," she said. "A lot of women that I've personally been talking to are taking this time to reflect, 'OK, how can I provide for my family and still not feel completely stretched out?"
She noted that some Latinas are starting their own businesses or finding other ways to be productive, outside the regular workforce.
"I don't feel like I'm giving up my career," Castillo said. "But I am giving up the traditional nine-to-five."
Enlarge this image toggle caption Erica Seryhm Lee for NPR Erica Seryhm Lee for NPR
Mercedes realized just how much her outlook had changed this fall, when she got a recruiting call from Google, which had always been her dream job. After a month as a stay-at-home mom, she turned it down.


npr--2020-10-27--Experts To Western States: Time To Finally Fight Wildfires With More Fire

Experts To Western States : Time To Finally Fight Wildfires With More Fire Earlier this month California Gov .
Gavin Newsom , looking uncharacteristically wan and frustrated , stood in the burnt ruins of an elementary school in Napa County obliterated by yet another catastrophic blaze .
It 's a scene the governor acknowledged has become painfully familiar across the Golden State .
`` Regions that have been torn asunder by wildfires seemingly every single year , this drum beat where people are exhausted , concerned , anxious about their fate and their future not just their safety , '' @ @ @ @ @ @ @ of exhaustion , `` so clearly we have our work cut out for us to deal with not only suppression , but prevention strategies . ''
Top of the prevention strategy list for fire ecologists is more fire .
This historically destructive wildfire season across much of the Western U.S. has wildfire experts calling for a dramatic increase in the numbers of acres intentionally burned .
( That 's when trained staff deliberately set fires as a form of control . )
They also want significant new investment in workforce training and infrastructure @ @ @ @ @ @ @ and private lands .
Vastly increasing the number of these low-intensity , carefully managed fires is key .
Experts say it reduces dangerous levels of highly combustible fuel and underbrush built up over more than a century of trying to snuff out most every forest fire .
The conditions set by that longstanding federal and state policy are now worsened by climate change , with fires growing larger , more frequent and more destructive .
`` Some people might say that they 're scared of doing prescribed fire .
But you know , @ @ @ @ @ @ @ the next 10 years if we do n't get prescribed fire , '' says fire ecologist and professor Kate Wilkin with the Wildfire Interdisciplinary Research Center at San Jose State University .
'Use more fire to fix region 's wildfire problem' In Colorado , three of the state 's five largest wildfires have burned this year , including the still-burning East Troublesome and Cameron Peak blazes .
In California , five of biggest on record have occurred just since August .
Wilkin recognizes how awful it 's been for many in recent years @ @ @ @ @ @ @ , homes , businesses and entire communities damaged or destroyed .
There 's the fear , stress and the smoke-filled air drifting hundreds of miles .
So she knows most people in the West right now might not want to hear it , but the West needs to strategically use more fire to fix the region 's wildfire problem .
In terms of forest health , Wilkin says , California is supposed to burn .
So when the state topped 4 million acres burned earlier this month , setting a record , Wilkin @ @ @ @ @ @ @ actually getting into the ballpark of how many acres used to burn in California every year .
Historically , somewhere between 4.4 million and 12 million acres used to burn every year . ''
By contrast , in the past few years California intentionally burned roughly 50 thousand acres on public lands .
In fact , a study published in the journal Fire showed that prescribed burns on federal lands in the West over the past 20 years stayed flat or fell despite ongoing calls to do much more .
Bureau of Indian @ @ @ @ @ @ @ federal agency to substantially increase prescribed fire use , the study said , likely due to tribal self-governance and a historic embrace of intentional fire .
Federal and California officials recently signed an agreement to try boost that significantly : the new goal is to treat about 1 million acres a year with combined thinning and controlled burns .
But experts warn that states continue to set ambitions prescribed fire goals they never reach .
And critics say that new goal is nowhere near enough to meet this moment .
`` It 's @ @ @ @ @ @ @ decisions are going to solve the problem , '' says Malcolm North , an outspoken research scientist with the U.S. Forest Service who has long advocated for more controlled burns .
`` We have some of the best firefighting forces in the in the world .
And yet we 're obviously losing this battle every year , both in terms of cost , acreage and damages . ''
North says the public has to realize that they 're going to get fire one way or another .
`` But you can have much @ @ @ @ @ @ @ the fire on the landscape rather than reactively trying to suppress it and then dealing with the inevitable escapes , '' he says He and others say a major obstacle to expanding controlled burns is institutional inertia in these large , risk-averse state and federal agencies .
Critics say both Cal Fire and the U.S. Forest Service largely continue to embrace an antiquated 'fight every fire ' ethos .
Leaders in federal land management positions , North says , need to be much more supportive and bold in their use of targeted use @ @ @ @ @ @ @ be a cultural shift in the public 's understanding about both the inevitability of fire , he says , and a shift within the leadership of these agencies .
`` The people who end up getting promoted and often end up in the leadership positions are very good at being cautious , '' North says of his own employer the U.S. Forest Service .
`` You really need a pretty fundamental and aggressive change to what we 're doing .
And that 's not inherently the behavior that you often get in leadership @ @ @ @ @ @ @ Still , North recognizes the enormous challenge for managers : it 's not popular or easy to intentionally light fires to clear out built-up fuel when states are being ravaged and citizens reeling from annual catastrophic wildfires .
If historically flawed forest management is half the problem here – battling most every fire - the other half is the world 's warming climate with hotter , drier conditions igniting a Century of built-up fuel .
`` It 's a great example of climate change as a kind of an accelerant , '' says @ @ @ @ @ @ @ for the Environment .
`` This is a problem that 's been building gradually for decades .
But what is happening this decade is the problem has kind of turned from this thing that we can manage to a monster . ''
'Problem too big for states to solve on their own' And taming that monster through intentional fire , Wara says , is vital yet costly : It 's estimated that thinning and prescribed burns can cost somewhere between $ 1,500 and $ 2,000 per acre .
The problem is simply too @ @ @ @ @ @ @ own , especially since the federal government owns the vast majority of public lands in the West , not the states .
`` Coming up with the money to do this at scale has always been a major obstacle , '' Wara says .
`` We need sustained federal and state financial support if we 're going to have any hope of moving the needle and bring good fire back into the landscape in a way that will be big enough to actually make a difference . ''
Another challenge too big to @ @ @ @ @ @ @ trained workforce to prep and conduct more controlled fires .
Fire suppression crews remain stretched incredibly thin across much of the West .
And putting out fires and setting controlled blazes `` really are two different skill sets , '' says University of California , Berkeley Fire Science professor Scott Stephens who has long documented the positive impact of fire on the forest eco-system .
`` So it really does require us to develop that workforce . ''
Stephens and other experts in fire ecology want the region to train up an entirely @ @ @ @ @ @ @ southern U.S. already has .
`` There are so many people in the South that are certified prescribed fire burn bosses and practitioners , and they do n't work in fire suppression at all , '' he says adding , `` we just do n't have that out here . ''
Despite the long , bitter fights in Washington , D.C. , over how to manage the nation 's forests there are currently several bills in the U.S. Senate that would significantly boost federal funding for intentional fires .
One of them even @ @ @ @ @ @ @ two of the bills call for the creation of a Western U.S. prescribed fire training center to build that much-needed workforce to learn to prep and set fires , not just put them out .
Other big barriers to doing more intentional burns include tough environmental rules and strong liability laws that can slow the pace and scale of set blazes .
For example , some intentional burns have taken years to plan and implement .
Then there 's safety .
The vast majority of these fires are done without harm to people @ @ @ @ @ @ @ A 2012 prescribed fire in Colorado killed three people and damaged or destroyed more than two dozen homes .
Another example is a notorious U.S. National Park Service controlled burn 20 years ago near Los Alamos , New Mexico got out of control when high winds picked up .
Some 400 family homes were burned .
The federal nuclear lab there was threatened , with a few of its buildings damaged .
Withering criticism and congressional hearings followed .
`` The plan was flawed , the higher ups rubber stamped it , the @ @ @ @ @ @ @ a fire this big , '' then-Congresswoman Heather Wilson , a Republican , told a house hearing on the burn shortly after the fire .
That Los Alamos fire kind of became the Enron or Solyndra of controlled burns : a rare but spectacularly botched event that ends up having out-sized influence and ripple effects .
Twenty years on , the Los Alamos debacle is still felt today across federal land agencies .
It 's a ghost that needs to be exorcised , ecologists say , because controlled burns are largely safe .
@ @ @ @ @ @ @ different than the reality , which is that the fires generally have been able to be controlled , '' says the Forest Service 's Malcolm North .
For fire-ravaged communities the hard truth is that these shifts to increase controlled blazes and reduce catastrophic fire risk will take years , if not decades , of sustained effort .
`` So that 's the real problem because , you know , it is n't something that you can invest in wholeheartedly , say , in three years and guarantee yourself a result , '' @ @ @ @ @ @ @ It would take a 10-year effort , but probably even closer to 20 to really start to change kind of the fundamentals '' of wildfire risk .

Experts To Western States: Time To Finally Fight Wildfires With More Fire
Enlarge this image toggle caption Noah Berger/AP Noah Berger/AP
Earlier this month California Gov. Gavin Newsom, looking uncharacteristically wan and frustrated, stood in the burnt ruins of an elementary school in Napa County obliterated by yet another catastrophic blaze.
It's a scene the governor acknowledged has become painfully familiar across the Golden State.
"Regions that have been torn asunder by wildfires seemingly every single year, this drum beat where people are exhausted, concerned, anxious about their fate and their future not just their safety," Newsom said, adding with a hint of exhaustion, "so clearly we have our work cut out for us to deal with not only suppression, but prevention strategies."
Top of the prevention strategy list for fire ecologists is more fire. This historically destructive wildfire season across much of the Western U.S. has wildfire experts calling for a dramatic increase in the numbers of acres intentionally burned. (That's when trained staff deliberately set fires as a form of control.) They also want significant new investment in workforce training and infrastructure to scale up prescribed burns on public and private lands.
Vastly increasing the number of these low-intensity, carefully managed fires is key. Experts say it reduces dangerous levels of highly combustible fuel and underbrush built up over more than a century of trying to snuff out most every forest fire. The conditions set by that longstanding federal and state policy are now worsened by climate change, with fires growing larger, more frequent and more destructive.
"Some people might say that they're scared of doing prescribed fire. But you know, I'm scared what will happen in the next 10 years if we don't get prescribed fire," says fire ecologist and professor Kate Wilkin with the Wildfire Interdisciplinary Research Center at San Jose State University.
'Use more fire to fix region's wildfire problem'
In Colorado, three of the state's five largest wildfires have burned this year, including the still-burning East Troublesome and Cameron Peak blazes. In California, five of biggest on record have occurred just since August.
Wilkin recognizes how awful it's been for many in recent years: people who've lost loved ones, homes, businesses and entire communities damaged or destroyed. There's the fear, stress and the smoke-filled air drifting hundreds of miles. So she knows most people in the West right now might not want to hear it, but the West needs to strategically use more fire to fix the region's wildfire problem.
In terms of forest health, Wilkin says, California is supposed to burn. So when the state topped 4 million acres burned earlier this month, setting a record, Wilkin thought, "Wow, we're actually getting into the ballpark of how many acres used to burn in California every year. Historically, somewhere between 4.4 million and 12 million acres used to burn every year."
By contrast, in the past few years California intentionally burned roughly 50 thousand acres on public lands. In fact, a study published in the journal Fire showed that prescribed burns on federal lands in the West over the past 20 years stayed flat or fell despite ongoing calls to do much more.
Enlarge this image toggle caption Jessy Ellenberger/AP Jessy Ellenberger/AP
'Losing this battle every year'
Bureau of Indian Affairs (BIA) was the only federal agency to substantially increase prescribed fire use, the study said, likely due to tribal self-governance and a historic embrace of intentional fire.
Federal and California officials recently signed an agreement to try boost that significantly: the new goal is to treat about 1 million acres a year with combined thinning and controlled burns.
But experts warn that states continue to set ambitious prescribed fire goals they never reach. And critics say that new goal is nowhere near enough to meet this moment.
"It's not something in which incremental, cautious decisions are going to solve the problem," says Malcolm North, an outspoken research scientist with the U.S. Forest Service who has long advocated for more controlled burns. "We have some of the best firefighting forces in the in the world. And yet we're obviously losing this battle every year, both in terms of cost, acreage and damages."
North says the public has to realize that they're going to get fire one way or another. "But you can have much better outcomes when you're proactively putting the fire on the landscape rather than reactively trying to suppress it and then dealing with the inevitable escapes," he says
He and others say a major obstacle to expanding controlled burns is institutional inertia in these large, risk-averse state and federal agencies. Critics say both Cal Fire and the U.S. Forest Service largely continue to embrace an antiquated 'fight every fire' ethos.
Leaders in federal land management positions, North says, need to be much more supportive and bold in their use of targeted use of prescribed fire. There needs to be a cultural shift in the public's understanding about both the inevitability of fire, he says, and a shift within the leadership of these agencies.
"The people who end up getting promoted and often end up in the leadership positions are very good at being cautious," North says of his own employer the U.S. Forest Service. "You really need a pretty fundamental and aggressive change to what we're doing. And that's not inherently the behavior that you often get in leadership in these in these positions."
Still, North recognizes the enormous challenge for managers: it's not popular or easy to intentionally light fires to clear out built-up fuel when states are being ravaged and citizens reeling from annual catastrophic wildfires.
If historically flawed forest management is half the problem here – battling most every fire - the other half is the world's warming climate with hotter, drier conditions igniting a Century of built-up fuel.
"It's a great example of climate change as a kind of an accelerant," says Michael Wara with Stanford's Woods Institute for the Environment. "This is a problem that's been building gradually for decades. But what is happening this decade is the problem has kind of turned from this thing that we can manage to a monster."
'Problem too big for states to solve on their own'
And taming that monster through intentional fire, Wara says, is vital yet costly: It's estimated that thinning and prescribed burns can cost somewhere between $1,500 and $2,000 per acre.
The problem is simply too big for states to solve on their own, especially since the federal government owns the vast majority of public lands in the West, not the states.
"Coming up with the money to do this at scale has always been a major obstacle," Wara says. "We need sustained federal and state financial support if we're going to have any hope of moving the needle and bring good fire back into the landscape in a way that will be big enough to actually make a difference."
Another challenge too big to solve alone is the lack of a trained workforce to prep and conduct more controlled fires. Fire suppression crews remain stretched incredibly thin across much of the West. And putting out fires and setting controlled blazes "really are two different skill sets," says University of California, Berkeley Fire Science professor Scott Stephens who has long documented the positive impact of fire on the forest eco-system. "So it really does require us to develop that workforce."
Stephens and other experts in fire ecology want the region to train up an entirely new force, like the one the southern U.S. already has.
"There are so many people in the South that are certified prescribed fire burn bosses and practitioners, and they don't work in fire suppression at all," he says adding, "we just don't have that out here."
Despite the long, bitter fights in Washington, D.C., over how to manage the nation's forests there are currently several bills in the U.S. Senate that would significantly boost federal funding for intentional fires. One of them even has a little bipartisan support. And two of the bills call for the creation of a Western U.S. prescribed fire training center to build that much-needed workforce to learn to prep and set fires, not just put them out.
Other big barriers to doing more intentional burns include tough environmental rules and strong liability laws that can slow the pace and scale of set blazes. For example, some intentional burns have taken years to plan and implement.
Then there's safety. The vast majority of these fires are done without harm to people or property. But not all. A 2012 prescribed fire in Colorado killed three people and damaged or destroyed more than two dozen homes.
Another example is a notorious U.S. National Park Service controlled burn 20 years ago near Los Alamos, New Mexico that got out of control when high winds picked up.
Some 400 family homes were burned. The federal nuclear lab there was threatened, with a few of its buildings damaged. Withering criticism and congressional hearings followed.
"The plan was flawed, the higher ups rubber stamped it, the burn boss was not qualified to do a fire this big," then-Congresswoman Heather Wilson, a Republican, told a house hearing on the burn shortly after the fire.
That Los Alamos fire kind of became the Enron or Solyndra of controlled burns: a rare but spectacularly botched event that ends up having out-sized influence and ripple effects. Twenty years on, the Los Alamos debacle is still felt today across federal land agencies.
It's a ghost that needs to be exorcised, ecologists say, because controlled burns are largely safe.
"The perception there is definitely far different than the reality, which is that the fires generally have been able to be controlled," says the Forest Service's Malcolm North.
For fire-ravaged communities the hard truth is that these shifts to increase controlled blazes and reduce catastrophic fire risk will take years, if not decades, of sustained effort.
"So that's the real problem because, you know, it isn't something that you can invest in wholeheartedly, say, in three years and guarantee yourself a result," says UC Berkeley's Stephens. "It would take a 10-year effort, but probably even closer to 20 to really start to change kind of the fundamentals" of wildfire risk.