Helen H. Moore's Blog, page 51

A hospital ER charges an “after-hours” fee. Who has to pay it?

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This article originally appeared on Kaiser Health News.

This week, I responded to readers who were unhappy with their health plan’s decision not to pay an emergency department surcharge for after-hours care and concerned about difficulties getting Medicare to cover claims unrelated to a workers’ compensation injury. Another reader asked about a recently announced hardship exemption from the requirement to have health insurance.

Q: I visited a local emergency room one night after I had a severe allergic reaction that caused intense itching, hives, swelling and blistering. Now I received an “explanation of benefits” notice from my insurer that I will be billed by the in-network hospital for “after-hours” service. My insurer does not cover that charge. I am so enraged. Is there anything I can do to get the hospital to remove the charge?

Tacking on an after-hours surcharge to an emergency department bill strikes some consumers as unfair, since the facilities are open 24 hours a day.

The practice is “pretty rare” but defensible, said Dr. Paul Kivela, an emergency physician in Napa, Calif., who is president of the American College of Emergency Physicians. He noted that the cost to staff an emergency department at night is higher than by day. The surcharge is typically modest, often less than $100, experts say.

But that’s neither here nor there. The extra charge should have been built into the overall rate, said Betsy Imholz, special projects director for Consumers Union, an advocacy group. “It’s infuriating,” she said. “I don’t blame [the patient] for being annoyed.”

Just because your health plan is balking now at paying the surcharge, that may not be the final word. Hospitals and insurers frequently sort out these surcharges between themselves, without holding patients responsible, said Richard Gundling, a senior vice president at the Healthcare Financial Management Association, an industry group.

“If it’s an in-network provider, an insurer is generally responsible for addressing the billing of that code under its negotiated contract with the providers,” Gundling said.

Medicare beneficiaries are not responsible for paying the surcharge.

If the hospital pursues the patient to pay the charge, Imholz recommended that consumers file an appeal with their health plan, noting that appeals on many issues are frequently successful.

Q: I fell in 2015 and my injuries are being covered by the workers’ compensation program. It pays only the claims that are related to my back and neck injuries. But Medicare has been refusing all the claims it receives, including a hospital stay for an acute asthma attack as well as routine visits to my primary care physician. The program states that these claims are the responsibility of workers’ comp. What can I do?

Your workers’ compensation insurer is the “primary payer” for medical bills that are related to your work-related injury. Medicare is responsible for your other medical care.

Without more information, it’s impossible to know exactly why Medicare is denying your claims for medical care that’s not related to your work injury.

However, the problem may be rooted in the mandatory data-reporting requirements that the federal Centers for Medicare & Medicaid Services put in place about a decade ago, said Darrell Brown, an executive vice president and chief claims officer at Sedgwick Claims Management Services.

Under the federal rules, insurers and plan administrators have to report claims data about Medicare beneficiaries who are also covered by a group health plan or who receive payments under workers’ compensation, among other things. The aim is to ensure that the Medicare program isn’t acting as a primary payer on some claims when another health plan or program should be doing so.

“My guess is that there’s something that went wrong with that reporting,” Brown said. “There’s so much data that they’re getting, and there’s so much room for error as well.”

Start by contacting the number or person on the notice you received from the Medicare program denying your claim, Brown said. You may also have to contact the workers’ compensation carrier. But your first step should be to find out why the Medicare program mistakenly believes that your asthma hospitalization and other care is related to your workers’ comp injury.

Q: Why is there a new exemption from the penalty for not having health insurance if you live in a bare county with no marketplace insurers? There aren’t any of those and next year there’s no penalty, so what’s the point?

As you note, starting next year, people will no longer owe a penalty for not meeting the Affordable Care Act’s requirement of having health insurance.

People will, however, be able to apply to the marketplace for a hardship exemption if they live somewhere where there are no marketplace insurers. That may give them another option for coverage.

People who qualify for a hardship or affordability exemption can receive an “exemption certificate number,” often referred to as an ECN, which will allow them to buy a catastrophic plan that meets health law standards and is typically available only to people under age 30, said Tara Straw, a senior policy analyst at the Center on Budget and Policy Priorities.

These ACA-compliant plans may be purchased off the exchange, even if no insurers are selling marketplace plans in a particular area.

Catastrophic plans cover the essential health benefits. They often have lower premiums than plans on the health law’s marketplace, but their deductibles are comparatively very high and people can’t receive premium tax credits to pay for them. The high out-of-pocket costs may explain why they haven’t been popular. Fewer than 1 percent of marketplace enrollees picked one in 2018.

Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.

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There’s a scientific reason nerds have bad eyesight

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There may be a scientific reason that nerds wear glasses: All that book learning has made their eyesight worse than their jock counterparts.

New research led by scientists at Cardiff University and the University of Bristol found that people who spend more time in education are more likely to develop short-sightedness — which occurs when distant objects are blurred. Specifically, researchers found that for every year a person spends in education — where they are likely to spend more time reading and typing on computers — there is a rise in myopic refractive error of 0.27 diopters, a diopter being a standard measure of the optical power of a lens. An estimated 68,000 participants were examined using the "Mendelian randomization" (MR), approach which is often used to examine causal effect of a disease in observational studies.

“This study provides new evidence suggesting that education is a causal risk factor for myopia,” said Professor Jez Guggenheim from Cardiff University’s School of Optometry and Vision Sciences, who co-led the research. “With the rapid rise in the global prevalence of myopia and its vision-threatening complications, together with the economic burden of visual loss, the findings of this study have important implications for educational practices.”

Guggenheim added that this research should be taken into consideration regarding children’s health around the world.

“Until the link between education and myopia is better understood, the research team recommend children spend plenty of time outdoors (with appropriate sun protection, including a hat and sunglasses in very sunny conditions),” he added in statement.

The study, entitled “Education and myopia: assessing the direction of causality by mendelian randomisation,” was published in April in the BMJ, a peer-reviewed medical journal.

As Wired reported in 2016, since the 1970s there has been a significant global increase in Myopia, such that some have deemed it the "silent epidemic." A National Eye Institute (NEI) study found that nearsightedness increased 66 percent in the United States between the 1970s and the early 2000s.

Many have speculated the rise in myopia could also be linked to an increase in time in front of our screens. A different study led by researchers from the University of Southern California Eye Institute at Keck Medicine of USC, in collaboration with the National Institutes of Health, found that myopia among American children has more than doubled over the last 50 years.

“While research shows there is a genetic component, the rapid proliferation of myopia in the matter of a few decades among Asians suggests that close-up work and use of mobile devices and screens on a daily basis, combined with a lack of proper lighting or sunlight, may be the real culprit behind these dramatic increases,”  Rohit Varma, MD, MPH and director of the USC Eye Institute, said. “More research is needed to uncover how these environmental or behavioral factors may affect the development or progression of eye disease.”

The FDA doesn’t know if flavored vaping chemicals are safe to breathe

AP/Rich Pedroncelli

Regulation of vapes and e-cigarettes has been in the news this week, after San Franciscans voted yes on a proposition that would prohibit the sale of flavored tobaccos — a category that includes menthol cigarettes, flavored hookah tobacco, infused cigars and flavored vaping liquids.

But while proponents of the ban succeeded by arguing that flavored tobacco products were a way for kids and teens to get hooked on tobacco products, a more looming public health issue lies in the mystery surrounding the safety of the flavoring chemicals inside e-cigarette liquids — many of which are billed by manufacturers as safe because the FDA has approved them for ingestion.

Yet no one knows for sure if you can breathe the same chemicals safely. Moreover, some common vape flavoring chemicals, including diacetyl, have been well-documented as causing chronic lung diseases.

Diacetyl was not originally supposed to be something that you smoke or breathe, but is commonly used to add flavor to food; if you've ever eaten microwave popcorn, you have probably consumed diacetyl.  Also known as 2,3-butanedione, diacetyl is approved by the U.S. Food and Drug Administration for ingestion, but there has not been an agency-approval for it to be inhaled. In fact, there have been multiple reports of people who breathed it contracting bronchiolitis obliterans — also known as “popcorn lung” — a lung disease that affects and inflames the lung’s small airways, or bronchioles. Those with the lung disease can experience shortness of breath, wheezing, and asthma-like symptoms.

The connection between diacetyl and “popcorn lung” came into the public eye in 2000 when an occupational medicine physician alerted the Missouri Department of Health and Senior Services about eight patients who had a fixed obstructive lung disease. The patients were former workers of a microwave popcorn factory; four of them went on lung transplant lists.

The Occupational Safety and Health Administration (OSHA) investigated cases of this popcorn lung and eventually released guidelines to deal with the chemical in factories. However, nothing has been done to regulate its usage in flavored tobacco products, despite evidence that the chemical is being used in flavored tobacco products.

In 2015, researchers at the Harvard T.H. Chan School of Public Health found that diacetyl was in 75 percent of the flavored electronic cigarettes and refill liquids they tested. In total, 51 types of flavored e-cigarettes and liquids sold by leading brands were tested for diacetyl, acetoin, and 2,3-pentanedione. This is a small sample size, considering there are nearly 7,000 varieties of flavored e-cigarettes and e-juice on the market and nearly 400 brands today — but the lack of knowledge of these products' ingredients and the safety of those ingredients could hint at a looming public health crisis. Now, some lung health advocates are alarmed that the FDA has failed to take action on the problem.

“The FDA has significant authority to oversee e-cigarettes and they are failing to use it,” Erika Sward, National Assistant Vice President of Advocacy at the American Lung Association, told Salon. “As a result it is the Wild Wild West, and you have retailers who are mixing liquids in their backrooms.”

“The American Lung Association is very concerned — about not just the chemical of diacetyl, but also the impact of other chemicals such as vegetable glycerin and propylene glycol, which are the base chemicals that are present in every e-liquid,” she added.

Vegetable glycerin and propylene glycol, similar to diacetyl, have been “generally recognized as safe” ("GRAS" in FDA lingo) by the FDA for ingestion — but not for inhalation, for obvious reasons. On popular vaping sites such as Vaping 360, the chemicals are often touted as safe due to its GRAS designation.

The FDA has been urged for the last several years to take immediate action and regulate e-cigarettes and flavored tobacco. Indeed, dozens of state attorney generals sent a letter to the FDA in 2015. The FDA told Salon they could not “accommodate” us with an interview for this story, but provided background information such as the agency’s advance notice of proposed rulemaking (ANPRM), which was issued in March 2018.

The purpose of the ANPRM was to initiate a public discussion around how the FDA should regulate flavored tobacco products, including menthol. As the FDA explained, the ANPRM was issued in order to call "upon all stakeholders to share data, research and information that can inform our process for examining the regulation of flavors in tobacco products." Yet this week the FDA appeared stalled in the regulatory process, and extended its commenting period from June to July 19, 2018.

The delay is disconcerting considering the National Youth Tobacco Survey (NYTS)  by the Centers for Disease Control and Prevention recently noted that e-cigarettes remain the most commonly used tobacco product among youth today. Moreover, a 2016 report from the U.S. surgeon general noted a 900 percent increase in e-cigarette use by high school students from 2011 to 2015.

Some e-cigarettes, including the Juul (pronounced like "jewel"), have gained a foothold among high schoolers, many of whom have reported harrowing stories of addiction. In April, The New York Times reported that the FDA was “cracking down” on Juuls, and noted that the agency had issued warning letters to 40 retailers accusing them of selling the USB drive-shaped vape pen to minors. Yet in the warning letters, there was no mention of concern about the chemicals used.

Tor Hoerman, an attorney who defends victims who have been exposed to diacetyl, says the FDA is capable of regulating these chemicals, but has failed to.

“They have the power to regulate,” Hoerman told Salon, adding that the lack of data can also be contributed to the rise in teens vaping. Sadly, Hoerman believes the repercussions of widespread inhalation of untested chemicals will be obvious when the public health effects are irreversible. “The human data is going to be young human data," he said.

In essence, this leaves any sort of regulation up to city and state policymakers — cities like San Francisco.

“Obviously one of the challenges that we have is right now is that the FDA has not reviewed any e-cigarettes, or the ingredients or chemicals in them,” Sward from the National Lung Association said. “My hope is now with San Francisco’s definitive result from the referendum that we will see more local communities turning to that, and hopefully that will spur the FDA to act across the country.”

 

Fox News’ Jeanine Pirro wants Trump to give her Jeff Sessions’ job: report

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It seems Jeanine Pirro, former prosecutor and judge and now top-rated Fox News host, is ready to leave her day job and has her sights set on being President Donald Trump's Attorney General.

"Pirro has repeatedly told Trump’s aides and advisers over the past 18 months that she’s interested in taking over as the nation’s top law enforcement official, according to four people familiar with the conversations," Politico reported.

Apparently Trump has been somewhat complicit in her ambitions. Politico describes him as "dangling" the job, and even raising the possibility of her appointment during a meeting in the Oval Office in Nov., a former administration official says, while adding that it was likely not genuine.

This unlikelihood was shared by Pirro's Fox News colleagues. Politico reports that one Fox employee says her network colleagues "have laughed at her frequent mentions of the possibility of getting senior-level government work."

And even with Trump's very vocal frustrations with Attorney General Jeff Sessions, White House aides said the president is not seriously considering Pirro to replace Sessions.

Despite the odds, what Pirro seems to be banking on is her long-standing relationship with the president. They've been friends for decades and Pirro has demonstrated her willingness to stand by Trump no matter what — Access Hollywood tape and all. This blind loyalty is a quality Trump favors over nearly anything else, often choosing friends and allies for cabinet and administration positions over people with actual experience.

"People who know the president say he is drawn to those who reinforce his worldview and feed his ego," according to Politico. "From the outset of the administration, she [Pirro] has used her TV platform to hammer the president’s critics and to ding his allies, including Sessions, as insufficiently loyal. She recently described the attorney general as the biggest threat to the Trump agenda, calling him 'the most dangerous man in America.'"

Reportedly, Pirro has been vying for a top government position since late 2016. During the transition, when Sessions was tapped, she then pushed for deputy attorney general. Transition aides tell Politico she was also discussed for the U.S. attorney position for the Eastern District of New York, but senior aides dissuaded Trump from nominating Pirro.

But since then, their relationship has only grown closer. Sources tell Politico Trump and Pirro speak often by phone and that he watches her Saturday evening show, "Justice with Judge Jeanine," religiously. Also, for Pirro's forthcoming book, "Lies, Leakers, and Liberals: The Case Against the Anti-Trump Conspiracy," she recently interviewed the president and his chief of staff John Kelly. Pirro was also in attendance at the American Embassy's relocation to Jerusalem last month per the White House's invitation.

"The cooperation with Pirro further illustrates the inordinate power of the conservative-leaning Fox cable channels on the Trump presidency," the Washington Post reported. "In the White House communications shop, officials rotate going on Pirro’s show because they know Trump will be watching — and partially to prevent him from calling in himself, several officials said, as he did earlier this year."

A top administration official told the Post: "Someone has to be on the show every week," because clearly Trump will be watching.

The Jewish family on Hitler’s street: “We didn’t know he was going to turn the world upside down”

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It all feels too familiar.

There is a crisis in liberal democratic values around the world. In Europe, neo-Nazis and other fascists are marching in the streets and attacking Jews, Muslims, and others who they believe are a type of enemy Other.

There is a deep yearning for a return to the past and "traditional" "conservative" values among many white Christians in Europe and the United States because they feel that globalization, immigration, and changing racial and ethnic demographics are a threat to the "natural" order of things.

The president of the United States Donald Trump, has described neo-Nazis, Ku Klux Klan members, and other right-wing extremists and domestic terrorists as "very fine people". Individuals who are sympathetic to and even outright support neo-Nazis and other far-right wing ideologies are writing America's foreign and domestic policies from within the Trump White House and other parts of the United States government.

These are terrible echoes of how the Nazis and Adolf Hitler came to power in Germany during the 1930s. The past is indeed prologue. Edgar Feuchtwanger was a history professor at the University of Southampton for three decades until he retired in 1989. He is the author of numerous books, most notably "From Weimer to Hitler," Disraeli" and "Imperial Germany 1850-1918." Feuchtwanger also received the Order of Merit from Germany in 2003. His latest book, released last fall, is "Hitler, My Neighbor: Memories of a Jewish Childhood, 1929-1938."

As a Jewish child Feuchtwanger survived the rise of the Nazis when he and several of his family members were eventually able to escape abroad.  He is a firsthand witness to the evil power of Nazism and Adolf Hitler.

In this conversation, Feuchtwanger shares how he as a child made sense of the rise of the Nazis, what it was like to live so close to Hitler, reflects on the Nazi reign of terror and surviving events such as Kristallnacht, and what it was like to return to Germany as an adult.

This conversation has been edited for clarity and length.

In Europe there are now Nazis and others of that type marching in the streets. In the United States there are neo-Nazis and white supremacists running amok and killing people. Did you ever think you would see such a thing again in your lifetime?

No. I don’t know whether it’s just bad as it was then, but it isn’t good, let’s put it that way.

It is almost unbelievable. You were an eight-year-old Jewish child living across the street from Hitler. 

We knew of course that Hitler was a bad thing for us, we knew that, but we didn’t know that he was going to turn the world upside down and kill people by the millions.  We just didn’t know how quickly. One can’t anticipate a thing like that.

Many Germans thought that Hitler and the Nazis were a joke, a hot flash of sorts who would eventually go away. They thought nothing would come of it all because the Germans are a "good people". 

This is the sort of mistake that people like my father made. He couldn’t really believe that it would go like this so he didn’t do the right thing. He should have got out much sooner.

Was your father--who was a newspaper editor--just in denial about what was really happening with Hitler?

Yes I think they thought it would be a passing phase, something that would go away. It’s something that would happen and go again, something like that I think they thought. What is also most remarkable is that my uncle Lion was very much in Hitler’s sights because, of course, he had satirized him as the character Rupert Kutzner in the famous novel "Success". This angered Hitler enormously. But Hitler never realized that we ‑ my father, me, the closest relations to my uncle - were living right under his nose.

You are a distinguished historian. I was wondering, as with Trump in America right now, evil takes place a little bit at a time. But when you’re in the middle of it you can’t make sense of it sometimes. Was it like that for the Germans?

I think so. That somebody like Hitler could turn everything upside down seemed almost impossible to imagine.

Some historians and some of Hitler's contemporaries described him as a very forgettable and not very impressive man. Are they correct? Was that your impression?

No. I knew he was a dangerous man. He wasn’t good for us. Nothing good could come from him to us. We knew that too well I think. But we didn't realize that it could come as fast as it did.

What was it like when Hitler moved in across the street?

I felt it was odd. I didn’t think all that much of it. I had a nanny called Rosie who used to take me for a walk every day. Fresh air was good for me. We passed Hitler’s front door just when he came out, and that’s as close I saw him, and of course he didn’t know who we were, and he looked at me quite benevolently and that was it. But we were right in the middle of the whole thing.

You lived across the street from Hitler for almost ten years. What was his presence like?

I remember that he wore an ordinary hat, a trilby hat. The people in the street immediately shouted, “Heil Hitler,” but he just lifted his hat a little bit, got into his car --and it was one closed car--and of course later on, it was all quite different. There were always at least three cars which were filled up with his bodyguards. Eventually the SS bodyguards took over the flat at the bottom of his block and you could no longer walk on the pavement in front of his house. You had to stay on the opposite side of the road.  But it wasn’t so initially.

One of the ways that the Nazis transformed Germany society was through the schools.

My elementary school teacher was immediately a fanatical Nazi. One of my friends used to be very friendly with me and then he wasn’t anymore.

Did your friends turn on you and become violent?

No, they didn’t become violent. I was told in secondary school that I had to go and listen to all the Nazi speeches. I also had to do the Nazi salute, stretch out my arm and such. I learned that. You get tired of holding up your arm and you can gently let it down on the shoulder of the boy in front of you, that I did learn.

Did the children want to do the Nazi salutes and say the slogans because it made them feel like grownups?

Yes, I think they wanted to do it. The whole thing generated more and more enthusiasm, no doubt about it. People were impressed by Hitler, no doubt about that, especially after he took over Austria.

Do you remember anything on the radio or from the films? The Nazis were masters of propaganda.

The cinema was one of the main ways of entertainment. There were no computers, no computer screens, and in the cinema, there was always massive Nazi stuff. Goebbels of course was the great Nazi propagandist.

Did your parents not listen to the radio because it was propaganda? Maybe to insulate themselves and you from it? 

You had to listen to the radio. What else could you listen to? The radio was also for propaganda. They knew it was propaganda, but what else could they do? You can’t shut yourself off from everything.

You’re Jewish, you’re a "gypsy", you’re someone who is not "Aryan" and you’re hearing these things on the radio and in the cinema.  You know that doom is coming, but you still have to pay attention to survive.

The problem was that people like my father, who was a very cultivated man, and has lived all his life amongst the books and was himself very much part of German civilization, couldn’t imagine it would go like that. He failed to see it.

What was your father like?

He was a very nice and very gentle sort of man. He was much more, I would call it, emollient than my uncle. My father wasn’t a man to fight things tooth and nail.

There are so many different ways to be brave and to stand up to power in difficult circumstances.

Of course. I remember the Night of the Broken Glass, November 1938 when my father was taken away to Dachau, to the concentration camp. We didn’t know were we ever going to see him again and he wasn’t a really well man. My father had a stomach ulcer and he had a big operation in 1937 where part of his was stomach taken away. He was made to stand out in the cold for hours on end and if you fell over, the guards would just finish you off. I remember very clearly how he came back, he was in very bad shape.

Why did they release him? How did he get out of Dachau?

The whole purpose of this incarceration was to frighten certain people to get them to leave Germany. Their aim was to make Germany clean of Jews and this was the part of the game, the main object of the exercise.

Your family survived Night of the Broken Glass. Did your family sense it was coming? What did they do? Hide?

Well, they couldn’t hide. They were still in the flat and the Nazis came around. They took my father away. Then of course they took his whole library away. They came with large boxes and put the most valuable part of his library because he was a book collector and had many old books. The Nazis called it, “Making secure.”  I remember my mother had the courage to basically tell them they were stealing.

Germany was one if not the most educated country on Earth at the time. How could such intelligent and cosmopolitan people become so easily seduced by the Nazis and their hatred? 

Let’s say from a German point-of-view the country was defeated in the first world war. The Germans felt they were humiliated by the Treaty of Versailles and suddenly there was Hitler who reversed it all and made them top dogs again. That’s what convinced them.

What was it like to get the Order of Merit from the Federal Republic of Germany? I know it’s a new Germany, and supposedly a different Germany, but what was it like to get that medal? What were you thinking?

When I was given that medal it was on the 30th of January 2003 and that was exactly 70 years after the day on which Hitler came to power, and then I was back in the German embassy and being given that medal. I found that quite satisfactory in a way.

You got the last laugh in a way. History comes full circle.

It does all come around, doesn’t it? It all comes my way in the end.

Did you go back to your old neighborhood? I know so much of Germany was destroyed, but did you even think about going back to your old home or the neighborhood?

Always. Yes, I went back there. I went back to the room which was my father’s library and from which you could see Hitler’s house. Out of the window you could see how it had been turned into an office full of secretaries, and typists, and so on, and I said to them, “You know who lived down there, at that house down there?” They didn’t know.

When you told them who lived there, what did they say?

Amazed.

When you went back as an adult to that room how did it feel?

I think I would say I was quiet. The whole thing has completely changed.

Some memories are just crystal clear like seeing Hitler as a kid, you never forget that. What were some things that came back in your memory while writing the book that perhaps you didn’t want to talk about? Did you have any moments where you said to yourself, “Oh, my God. Now I remember!”

I remember the family who lived in the flat above us and who I knew really well. One of them was almost like a mother to me and I was sitting on her lap all the time, and her sister married a big industrialist in North Germany. He used people from the Bergen-Belsen concentration camp. I don’t know how it came about, but I went back to him and suddenly he unleashed himself. He said things to me that he couldn’t say to other people  He was sort of excusing himself for why he was involved with all those horrible events. He said things like, “But Hitler seemed a very energetic man,” and that sort of thing. I didn’t ask him anything. I was quite taken aback at him. I wanted to hear it all, but he obviously felt that he must unburden himself to me.

Looking at the world today what worries or frightens you?

What scares me is that there’s so many people around who think they can contract out. It’s like they don’t care, they don’t mind, and those are the people who elect people like Hitler and Trump for that matter. I think people who think they can just forget about it, who think they can contract out of the fate of the world as it were, scare me.

Democratic candidate kisses his husband in “Fox & Friends” ad to “piss off Trump”

YouTube/Richard Madaleno

Maryland gubernatorial candidate Richard S. Madaleno Jr., a Democrat, launched an ad on President Donald Trump's favorite network touting the several ways he's spoken out against the president – and ending with a history-making kiss.

According to Victory Fund, a political action committee dedicated to increasing the number of LGBTQ officials in the U.S., the ad "is the first political ad in American history to feature a kiss between a candidate and a same-sex spouse." The history-making smooch between Madaleno and his husband Mark Hodge ran on the Fox News show "Fox & Friends," which the president spends a lot of time watching, in the Washington, D.C. area this morning.

"I'm running for governor to deliver progressive results and to stand up to Donald Trump," Madaleno says in the intro. "Here are a few of the things that I've done that already infuriate him."

The 30-second ad points to Madaleno's tenure as a state senator and highlights legislation he sponsored last year that would provide money to Planned Parenthood clinics if Congress cut funding, while a young woman chimes in, "Take that, Trump."

The gubernatorial candidate also points to 2013 legislation he co-sponsored that banned assault weapons in Maryland, and a boy holding a "Stop Gun Violence Now" sign says, "Take that, NRA."

Madaleno also voices his support for public schools over vouchers alongside kids on a playground. A girl says, "Take that, Trump," and a boy adds, "and Betsy DeVos," referring to Trump's education secretary.

"And what's the No. 1 way I piss off Donald Trump and the Republicans?" Madaleno asks, as he, his husband and their two children smile into the camera. Then Madaleno, who led Maryland's landmark measure to legalize same-sex marriage, gives his husband a lip-smacking kiss.

"Take that, Trump," Madaleno says.

If elected, Madaleno would be the state's first openly gay governor.

"At a time when the White House and other anti-LGBTQ politicians are attempting to erase our visibility and rollback our rights, Rich Madaleno is boldly stating he’s proud of his family and will fight for all Marylanders if elected," said Mayor Annise Parker, President & CEO of LGBTQ Victory Fund, and Houston's first gay mayor, in a statement.

"Not long ago, out LGBTQ people were unable to run for statewide offices such as governor, but voters now recognize there is an authenticity to LGBTQ leaders rarely found in today's politicians," added Parker. "Rich is on-track to win the Democratic primary because of that authenticity, his deep roots in the state, and his 15 years of legislative experience. And it is great to see him share his love for Mark and the kids with voters too – especially in a political ad airing during the president’s favorite television show."

Madaleno blasted the Trump agenda in statement.

"At a time when political attacks by Trump and other Republicans are fueling so much hatred and division, we need to stand up for the people we love and to continue to confront harassment and discrimination against women, African Americans, immigrants, LGBT couples and so many more," he said.

"Having led the charge for marriage equality, achieving true equality and justice for all Marylanders will be my priority as Governor," Madaleno continued. "June is LGBT Pride Month and I couldn't think of a better time to release this ad. I am proud of my family, proud of my record of standing up for our progressive values and proud to be unflinching in standing up against hate."

"Love does truly trump hate," concluded Madaleno.

Are we teaching our girls too much empathy?

Courtesy of The Mosaic Project

Like many girls, Emily Abad was raised to place others’ needs before her own and struggled with finding the perfect balance between empathy and assertiveness.

“I think a lot of young girls are often taught to sort of stay quiet or to put other people's needs before ourselves,” she told me in our conversation for "Inflection Point." “We're the caretakers. And if we are to speak up or to stand up for ourselves, it could be taken as being bossy or the other b-word.”

When it was time to go to work in a busy restaurant kitchen as an aspiring chef, her head chef told her she was “too nice.”

“He told me, ‘I don't know how you're going to do in this business because I think you're too sweet and you're too nice.’” Emily said. “And at the time I was like, ‘I'm gonna prove you wrong! I can be totally mean!’ And I hate to say that he was right, but I don't think it was because I was too nice or too sweet. It was just that I didn't want to be a part of that environment because I didn't want to feed into that treatment of women or people who didn't meet the stereotype of what a successful chef looks like or sounds like.”

Meanwhile, her father was anything but nice when she came out to him as gay.

“He talked with a lot of people in his Bible study community and they all started giving him the advice that he needs to get me out of that situation very quickly,” Emily told me. “And he took it as like his duty, his responsibility to convert me.”

When she asked him if she got married would he come to the wedding, she told me, this was his response:

“‘My daughter marrying another woman? I can afford to miss that.’”

Ouch.

If Emily had stuck with her tendency to be “too nice,” she probably would have continued to let her father’s disapproval shadow her coming out process and her relationship with her partner.

But luckily, she had recently started working with The Mosaic Project, an outreach program that helps kids and adults develop better conflict resolution skills. One of the very first lessons she learned was a skill many women struggle with: how to say "no" like you mean it.

“There are just so many times in my life where I wish I could have said ‘no’ in a strong voice, in a voice that meant something to me,” Emily said. “Because I think there's plenty of times when I said no, but I was sort of like, you know — laughing as I say it because I felt uncomfortable. And sometimes we laugh when we're uncomfortable, which can come across as being passive, right? So as I continue to watch the kids learn, I continue to learn. And then when I became an instructor myself I still was learning from them.”

With her new-found ability, she put her foot down and said “no” to her father’s intolerance.

“There was a lot of unlearning I had to do, and it is in that situation with my dad where I really felt it come out for the first time,” Emily told me. “Where I felt my voice get strong in a way that meant something to me. And to him it was the first time where I used my voice where he actually knew that I was being serious and he knew that this was important to me.”

She also absorbed an important lesson in how to offer empathy to her father while still creating safe boundaries.

“That was that first moment where it really came together for me, really trying to imagine where he's coming from.” Emily said. “Because from his point of view, it's just what he believes so strongly that it's not right for me to be gay. . . . And we just have completely different views on it. And so I had to just understand he's coming from a place of love. And so am I.”

Hear how teaching kids about the power of empathy and assertiveness has helped Emily Abad speak her truth, and how it’s possible for anyone to stand up for what you believe in with love and respect -- even in the face of intolerance.

And when you’re done, come on over to The Inflection Point Society, our Facebook group of everyday activists who seek to make extraordinary change through small, daily actions.

Subscribe to "Inflection Point" to get more stories of how women rise up right in your feed on Apple Podcasts, RadioPublic, Stitcher and NPROne.

Colin Kaepernick seeks to subpoena Trump in collusion case

Getty/Spencer Platt/AP/Marcio Jose Sanchez

In his collusion case against the NFL and its team owners, former San Francisco 49ers quarterback Colin Kaepernick is seeking testimony by President Donald Trump and Vice President Mike Pence.

According to multiple reports, Kaepernick's lawyers have already made informal attempts to coordinate and schedule depositions and will likely seek to subpoena Trump. Several owners, as well as NFL Commissioner Roger Goodell, have already been deposed in the case. As Yahoo! Sports, which first reported the news, explained on Thursday:

The aim will be a dive into the administration’s political involvement with the NFL during Kaepernick’s free agency and the league’s handling of player protests, sources said. This after recent disclosures that multiple owners had direct talks with Trump about players kneeling during the national anthem. The content of those conversations between Trump and owners – as well as any forms of pressure directed at the league by the administration – are expected to shape the requests to force the testimony of Trump, Pence and other affiliated officials, sources said.

"It was reported that NFL owners don't want to pick him up because they don't want to get a nasty tweet from Donald Trump," the president said at a rally last year. "Do you believe that?"

Pence then left an October 49ers game after some players knelt during the National Anthem. He later said on Twitter that he would not "dignify any event that disrespects our soldiers, our Flag, or our National Anthem."

Then late last month, NFL team owners announced a new policy requiring that players to stand during the National Anthem, or stay in the locker room.

Brian McCarthy, a spokesman for the NFL, said the league had no comment on Kaepernick's suit.

A new poll by Quinnipiac University brought good news for both President Trump and the NFL players who have protested racial injustice by kneeling during the national anthem on Wednesday.

The good news for the players is right at the top of the survey: 58 percent of American voters do not consider the protesters to be unpatriotic, compared to only 35 percent of American voters who do think it's unpatriotic. In addition, 53 percent of American voters believe that professional athletes should have the right to protest on either the playing field or court, with only 43 percent disagreeing.

While this would seem to augur poorly for Trump, it is worth noting that the president often does best when he is able to rile up his base. In that regard, the poll actually has good news for the Republican Party leader as well.

Seventy percent of Republican voters do regard the NFL player protesters as unpatriotic, with only 23 percent saying that this wasn't the case. Similarly, 81 percent of Republican voters said that professional athletes do not have the right to protest, while 53 percent of white voters regardless of party said that they do not have the right to protest. Only 16 percent of Republicans and 43 percent of white voters disagreed with these positions. By contrast, 82 percent of Democratic voters, 85 percent of African American voters and 67 percent of Hispanic voters said that players should have the right to protest (only 16 percent, 11 percent and 28 percent disagreed, respectively).

While Republican voters were the only group polled who said that kneeling during the national anthem was unpatriotic — every other partisan, gender, education, age and racial group said that it was patriotic except for non-college educated white voters, who were evenly split — this doesn't mean that the NFL's controversial new policy to deal with the players protests has backfired.

The Quinnipiac survey found that American voters support the NFL's new policy requiring players on the field to stand for the National Anthem, with players who wish to protest being allowed to do so by staying in their locker rooms. Fifty-one percent of American voters believe that the NFL is right in its new policy, while only 42 percent feel that they are wrong. Among independent voters 49 percent are supportive of the policy, while 44 percent think it's wrong.

Complicating matters, however, is the fact that 51 percent of American voters oppose fining NFL teams for allowing players on the field to not stand for the National Anthem. Among men, 47 percent support fining the players and 48 percent oppose it. Among women 54 percent oppose fining the measure and 40 percent support it.

"Voters are clearly torn on the National Anthem issue. They seem to be saying, ‘You can still love your country and kneel during its Anthem,’ but the NFL’s new ‘must stand’ mandate is fine with them, too. As for teams that defy the new rule, Americans say, ‘Don’t throw a flag on them,’" Tim Malloy, assistant director of the Quinnipiac University Poll, explained in a statement.

One of the harshest recent criticisms of the NFL owners came from Deadspin editor David Roth, who in an editorial earlier this week argued that they had severely miscalculated as to who the president is and whether their attempted accommodation would even work.

"NFL owners are selfish; their unwillingness or inability to prioritize anything about their league over their own avarice is, much more than one rancid grandpa’s gummy slurs, the thing that most urgently threatens to kill the NFL," Roth wrote. "This makes it stranger that they whiffed so hard on what Trump is, and what he’s about. They thought he was selfish like them, but they were only right about the first part."

He added, "The owners still seem to believe that they can give Trump what he wants, but that’s not on the table. He wants more than they can give and no less than that. The owners, like the cultists and cynics who have fallen all over themselves to serve Trump, still seem not to know what they’ve invited in. They have misidentified the snake."

NFL’s racial divide
Salon talked with former NFL player Wade David and an attorney for professional athletes about the player protests.

It started with an “Apprentice” audition. Then he was hired to teach at Trump University

AP/Dennis Van Tine

Of the many scandals swirling around Donald Trump prior to his surprise election as president in 2016, perhaps the most telling — if tragically underplayed by the mainstream media — was the legal drama around Trump University. Trump sold the alleged "school" as a place for aspiring entrepreneurs to gain the necessary skills to make money in real estate. But the lawsuits that followed paint a different picture.

"Instead of a fast route to easy money, these Trump University students say they found generic seminars led by salesmen who pressured them to invest more cash in additional courses," wrote Emma Brown of The Washington Post. "The students say they didn’t learn Trump’s secrets and never received the one-on-one guidance they expected."

Stephen Gilpin, who taught courses at Trump University, concurs with this assessment. In his book “Trump U: The Inside Story of Trump University,” Gilpin tells the story of how he went from being an admirer of Trump to a fierce critic. Gilpin sat down with Salon's Amanda Marcotte to tell his side of the story of how he got caught in the legal spider's web created by the Trump University scandal and why he's speaking out now.

This transcript has been edited for length and clarity.

How is it that you ended up becoming an instructor at Trump University?

I applied for "The Apprentice" at Universal Studios. Then that's how they think they got my resume, but then what happened was, I received a phone call. I owned a mortgage brokerage business and I employed about 3,000 other agents at Mortgage Max Direct Lending and my company.

We were down in the Fort Lauderdale area and down in the Miami area and Palm Beach County area where Donald Trump had his house that had purchased that same year. I've worked with a couple of friends and staff of Donald Trump's and people that knew him, and of him in that were associates basically of him. I received a phone call from a woman named Sandra in Florida to ask me to come up to interview for Trump.

They asked me several questions about real estate, real estate transaction, my credentials, how many houses I bought, fixed and flipped, my teaching abilities, my licensing. Did I ever file bankruptcy? Did I ever file foreclosure and stuff like that? I didn't know what I was interviewing for, which was kind of funny.

It was like a cheesy B movie where they sat in the conference room and they slid a paper across [the table]. I'll never forget it. I think I probably still have it. And it had a dollar amount on it. They were offering me, I guess, a job.

I accepted the job and that's when they started telling me that Donald Trump owns the school, and it's a company that is about Donald Trump and the way Donald Trump invests in real estate.

The company has been accused of being basically a con job. It's been accused of cheating students, claiming that they were going to get an education but not doing that. What were your experiences of it?

The first two years when I started working there, it actually was a very good program. They had legit professors and all. At the time I started, I didn't realize they were getting rid of all these legit professors and these legit instructors who actually were credentialed people. I understand businesswise why they got rid of them because they were high-paying professors who were credentialed, and they weren't making as much money. And it's a business, and for the business to run, Donald Trump, he himself will say, you got to bring in the money. They changed the way they did business to live events [designed to] sell.

They hired high professional — I call them sharks.

They hired sharks whose own purpose was to go out there and sell [customers] into the Trump University package and the Trump University way of doing business in real estate. That's when it was just high-pressured sales, and that's when it really started changing, and the people that were doing the high-pressured sales really didn't have any real estate background knowledge.

How did you react to realizing that the company was kind of sliding towards this grifting model?

I brought it to the owners' attention. Because first off, we had to fix it. You couldn't do it.

They're like, “You've got to keep quiet. You're giving away too much and you got to let them sell.”

I was thinking to myself that was bizarre, because these people paid for an education, and the one thing I knew and how to give is I'm going to give them an education.

How did you decide to start speaking out about this?

I was subpoenaed three different times, three different states. Eric Schneiderman, the attorney general's office had subpoenaed me, and basically I didn't know what to do. I was frantic. I started my new career over, teaching real estate again at another school, and I got scared about it and they got me an attorney.

I had to make a decision — if I was going to go state evidence or if I was going to put my faith with Donald Trump and [leave] all that to his attorneys and stuff. I put my faith with Donald Trump and his attorney.

One night my Aunt Debbie calls me up from Florida and said, “Steve, I don't understand this. They're calling everybody inside a bunch of con men who don't know anything about real estate. They even referred on a CNN report that they were hamburger flippers.”

She said, “You've got to get your story out there.” And that's when I said, “OK.”

From that point on that night, I took vigorous notes throughout the whole entire process, and that's how the book came about.

I write about Michael Cohen — I call him a pitbull — how he attacked me and accused me of stealing money and how he screamed and yelled at me.

He actually said, “Gilpin, what do you know? Somebody is stealing money from Mr. Trump and somebody is stealing money from Trump University, and what do you know about it?”

Accused me of it, basically. Then belittled me by saying you'll never "eff" your spouse again.

My spouse had died of cancer and I was fighting for my life. I was raising two daughters on my own as a single dad and burying my spouse.

I'm so sorry.

For him to belittle me and to treat me like that, and then to have Donald Trump come on speakerphone and never apologize or anything, and they basically destroyed my career. Because after that, who wants to hire somebody who's linked to all these subpoenas and questions?

I still buy, fix and flip homes. I mean, that's what I do, and that's what I love to do, and they are never going to squash that, even though I can probably never work for corporate America again.

With respect to Trump and Trump University, he really believed that the company was a university and that somehow it deserved the same status as Harvard. In Donald Trump's mind, in the Donald Trump world, if you were involved in something in the definition, it has to be great.

If Donald Trump accepted something as true and great, then it had to be true for all the people around him, and all the people in this business. If you didn't see it his way, you are a loser or even a dangerous enemy, and he had to validate his wild aspirations.

When you started, it seems like you admired Donald Trump, but what would you say about him now as a man, having been through all this?

He’s less of a man, probably I would say. I don't want to insult. I don't want to stoop to his level and insult his character, so I take that back. Actually, I apologize. But anyway, it's just his business persona and the way he comes across. It's just not there.

I personally think that he's ethically and morally bankrupt and all. I did admire him in the beginning. That is true, but now that I look at him, especially when in our country and all the chaos and everything that's going on, I don't admire him at all anymore.

I just look for the day I wake up either he's impeached or gone or the day he's no longer re-elected. That would be the best insult to his ego, [making him] a one-term president.

How would you recommend to people to avoid getting taken by a grift like this, a con job like this? How should people protect themselves?

That's a very good question because a lot of students to this day fall for the same type of programs that Trump University offers.

You have to really look at the reality of the whole process. And when somebody asks you to pay you $35,000 or something like that, look for the other people out there. There's people that have passion in real estate that can teach you it and it will be a hell of a lot cheaper. Do your due diligence, watch out. Don't fall for the sales pitch.

Robert Kennedy, improbable liberal hero

AP

This article was originally published on The Conversation.

There is something about middle children, especially in large families. They often struggle to define themselves. Robert Francis Kennedy was the ultimate middle child. Until shortly before his untimely death 50 years ago, he was still embarked on that struggle of self-determination.

Kennedy’s early career included working as a Senate staff member for the right-wing demagogue Sen. Joseph McCarthy. It would have been reasonable to conclude that as a young conservative he could only move farther right as he aged.

Kennedy turned the tables on the conventional wisdom by moving — both by circumstance and by calculation — in a more liberal direction. But it was a distinctive liberalism that was shaped by his origins in a family that, despite their enormous wealth, were regarded as outsiders.

I’m a political scientist who studies American government and U.S. legislative politics and I’ve worked as an adviser to Democrats in the Senate and House. It is clear to me that Robert, much more than his older brother John, was shaped by the tribalism of Massachusetts politics in the 1950s.

From tribalism via religion to liberalism

For all of their money and efforts to cultivate the outward signs of WASP affluence, the Kennedys were scorned by the first families of Massachusetts the way any group with long-established wealth regards parvenues. And it wasn’t just their Irish heritage that placed them at the margins of elite Bay State society, it was their Catholicism.

Of all of the four Kennedy brothers, Robert was the most emphatically Catholic.

Struggling to distinguish himself in his sprawling family – all clamoring for attention from their father, Joseph P. Kennedy – Robert sought out his mother, Rose, who took her religion seriously.

Competitiveness within the family also bred in him a combativeness that could verge on harshness that he struggled, sometimes unsuccessfully, to control. He made an early enemy of Senate Democratic leader Lyndon B. Johnson, while as a junior staff member, by publicly rebuking Johnson. As a former staffer myself, I remain astonished at such boldness, even from a Kennedy.

Robert worked tirelessly to promote the political fortunes of his brother Jack, first in his campaign for the House and then, in 1952, when he challenged Henry Cabot Lodge for the U.S. Senate.

It was this campaign in which Joe McCarthy intervened to boost Jack’s candidacy. McCarthy, a Kennedy family friend, prevailed on the Republican Senate Campaign Committee to go easy on Jack and do as little as possible to help fellow Republican Lodge.

Bobby’s role as a staff member on McCarthy’s Senate subcommittee on investigations would have caused the casual observer to mark him as a rising right-winger. Added to that was his service as counsel to Sen. John McClellan’s investigation of corruption in American labor unions, and his conservative credentials were cemented.

The transformation

The change in Kennedy came with his controversial appointment as attorney general in the administration of his brother at a time of great tumult in race relations. The criticism was that the appointment smacked of nepotism and that Kennedy was unqualified for the position; President Kennedy’s flip response was “I can’t see that it’s wrong to give him a little legal experience before he goes out to practice law.”

It was the era of the Freedom Riders, the mostly African-American young people who boarded buses to the South to challenge segregation. Their confrontation with local authorities often led to violence.

Kennedy’s initial reaction was that disorder made the United States and his brother the president look bad in the eyes of the world: hardly the reaction of a bred-in-the-bone liberal. Also, his first dealings with Martin Luther King Jr. were tense. Kennedy authorized FBI surveillance of King, saying “He’s not a serious person. If the country knew what we know about King’s goings-on, he’d be finished.” King, for his part, resented having to ask Kennedy for help.

But ultimately, Kennedy’s experience dealing with the resistance of Southern governors to racial integration caused him to sympathize with the struggle for equality. He also recognized the importance to the Democratic Party of the black vote in the North, especially in presidential elections.

After his brother John’s assassination, Robert Kennedy left the Justice Department and ran for senator in New York. He won, and during this period, his embrace of the plight of minorities broadened to include Mexican farm workers in their struggle to unionize.

In 1968, embattled Democratic President Lyndon Johnson declined to seek re-election in the wake of almost losing the New Hampshire primary to challenger Eugene McCarthy, the liberal anti-war Minnesota senator.

Kennedy then joined the race, belatedly and reluctantly.

“I run to seek new policies,” said Kennedy at his announcement. “Policies to end the bloodshed in Vietnam and in our cities. Policies to close the gaps that now exist between black and white, between rich and poor, between young and old, in this country and around the rest of the world.”

While he shared McCarthy’s opposition to the Vietnam War, Kennedy emphasized the need to combat racial injustice and economic inequality. His appeal to minority voters broadened, especially after his eloquent impromptu eulogy to Dr. King in Indianapolis endowed Kennedy with an exalted status even among the most alienated African-Americans.

Kennedy’s own death – assassinated right after he won the California Democratic primary just a few months after King’s – was a crushing blow to Americans who sought to right the wrongs of the nation both domestically and in the larger world. Americans hopeful for change were leaderless. Many rejected conventional politics and sought solutions in radical movements, in drugs, and in the panaceas of false prophets.

For those who stayed in the fight, Kennedy’s belated embrace of social justice was readily forgiven.

Ross Baker, Distinguished Professor of Political Science, Rutgers University

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