Research reveals Medicaid expansion is still improving hospital finances

A new study analyzes critical data at state and national levels

UNIVERSITY OF COLORADO ANSCHUTZ MEDICAL CAMPUS

Research News

A new study published in Medical Care Research and Review found that the Affordable Care Act, which expanded Medicaid programs to cover people previously uninsured, provided a financial boost to hospitals.

The study conducted by faculty at the Colorado School of Public Health on the University of Colorado Anschutz Medical Campus is the first to investigate the effects of Medicaid expansion by comparing estimates using data from both the Internal Revenue Service (IRS) and the Centers for Medicare and Medicaid Services (CMS).

"The IRS and CMS data sources serve as primary resources for assessing the impact of Medicaid expansion on hospitals' financial status. The comparison of the two is timely and can inform the decisions of health practitioners, policymakers and regulators at a state and national level," said lead author Tatiane Santos, MPH, PhD, faculty at the Colorado School of Public Health and fellow at the Wharton School and Leonard Davis Institute of Health Economics at the University of Pennsylvania.

Santos adds, "This is especially relevant in the context of the recently passed American Rescue Plan Act of 2021, which provides additional incentives for the 12 states that have not yet expanded Medicaid."

The researchers examined the state-level impact of Medicaid expansion on hospital finances and based on the IRS data found that uncompensated care costs declined by 28 percent in states that expanded Medicaid relative to uncompensated care costs in 2013, the year before Medicaid expansion (9.3 percent of operating expenses in 2013). The findings based on the CMS data showed that there was a 32 percent decline in uncompensated care costs relative to costs in 2013 (5.0 percent of operating expenses in 2013).

These results are in line with previous studies that have reported that expansion has resulted in substantial reductions in hospitals' uncompensated care costs and increases in their Medicaid shortfalls (these shortfalls are the difference between Medicaid reimbursement and what it costs providers to care for patients).

Nationally, the estimated net effect of expansion reduced not-for-profit hospital costs by two percentage points based on IRS data and 0.83 percentage points based on CMS data. Across expansion states, the estimated net effects varied widely with approximately a 10-fold difference for hospitals based on IRS data and a two-fold difference based on CMS data.

Another key finding revealed that the increase in hospital's Medicaid shortfalls has been occurring more gradually, a result that may be partially attributable to a growing Medicaid population in expansion states.

The authors mention that while Medicaid expansion has clearly had an impact on hospitals' financial status, assessment of the actual magnitude of the effects is sensitive to the data sources used.

"Expansion effects have also varied by state, which may be an indicator of how states may potentially weather the COVID-19 pandemic financial shocks, including unemployment and increasing Medicaid enrollment. These are important findings for future consideration as Medicaid expansion continues to be a source of debate across the United States as a health policy initiative," added Santos.

The authors suggest that future studies should further explore the differences across IRS and CMS data. They suggest that as the pandemic unfolds Medicaid will be especially critical in serving the most vulnerable populations. States will need to make difficult financial decisions to protect their safety net hospitals and hospitals at highest risk of financial distress.

###

About the University of Colorado Anschutz Medical Campus

The University of Colorado Anschutz Medical Campus is a world-class medical destination at the forefront of transformative science, medicine, education, and patient care. The campus encompasses the University of Colorado health professional schools, more than 60 centers and institutes, and two nationally ranked independent hospitals that treat more than two million adult and pediatric patients each year. Innovative, interconnected and highly collaborative, together we deliver life-changing treatments, patient care, professional training, and conduct world-renowned research. For more information, visit http://www.cuanschutz.edu.

AMERIKAN FASCISM
The GOP's devotion to Trump threatens to destroy American democracy

With its cultish devotion to Donald Trump, the majority of the Republican Party is choosing a wannabe-autocrat over the political system that made the United States the world's most powerful nation and its dominant democracy.

 Former U.S. President Donald Trump acknowledges people as he gets in his SUV outside Trump Tower in the Manhattan borough of New York City, New York, U.S., March 9, 2021. REUTERS/Carlo Allegri

The ex-President is showing that he doesn't have to be in the Oval Office to damage faith in US elections and to trash truth, as his movement based on lies and personal homage takes an increasingly firm grip of the Republican Party. The widespread mistrust he continues to foster in the fairness of the US political system among millions of voters poses grave risks to democracy itself.


Trump, using his bond with the conservative grassroots, has effectively made fealty to his false claims of a fraudulent election last year the price of entry for any Republican candidate in any race. Under his influence, one of America's two great political parties has effectively shed its belief in democracy -- a dereliction that is massively significant for the country's future.

As he seeks personal revenge, Trump is also mobilizing to try to destroy the political viability of any GOP office holders who tell the truth about the Capitol insurrection he inspired like Rep. Liz Cheney of Wyoming and Sen. Lisa Murkowski of Alaska.

He is celebrating the boos that Sen. Mitt Romney, a former Republican presidential nominee, received from activists in Utah over the weekend, after voting to convict Trump over his abuses of power in two separate impeachment trials.

The former President retains an extraordinary ability to dictate the beliefs of his followers and the orthodoxy of the GOP on a daily basis.

"The Fraudulent Presidential Election of 2020 will be, from this day forth, known as THE BIG LIE!" Trump decreed in a statement Monday, literally reversing the facts about last November's free and fair election that he lost.

Cheney may well be sacrificing her own political career as one of the few GOP lawmakers with the guts to speak truth about Trump's anti-democratic attacks. A new effort is underway among the ex-President's acolytes in Congress to strip her of her No. 3 position in the House only three months after she comfortably retained it in a secret ballot election. Cheney's ability to fight off a pro-Trump primary opponent in her home state of Wyoming is questionable. Her transgression is to simply keep pointing out the truth: that last year's election wasn't stolen by President Joe Biden.

CNN reported Monday that Cheney said at a behind-closed-doors conference in Georgia that Trump's behavior was a "poison in the bloodstream of our democracy." She added: "We can't whitewash what happened on January 6 or perpetuate Trump's big lie. It is a threat to democracy. What he did on January 6 is a line that cannot be crossed."


Trump's power grows out of office

Trump is answering one question that was often asked in his dark last days in office -- would he be as powerful in private life as he was with the trappings of presidential office? If anything the former President wields even more control of his party now than he did over the last five years , a fact made more remarkable by the social media silence enforced by bans from major social media platforms.

And there are very clear signs that Trump's assault on American democracy is working. In a CNN poll released last week, only 23% of Republican voters believed that Biden legitimately won sufficient votes to win the election last year. This follows a Quinnipiac poll in February that showed that 76% of Republicans believe that there was widespread fraud in the election.

Court after court threw out Trump's spurious claims of election fraud after his defeat to Biden. There is no evidence that he was unfairly deprived of office. In fact, the only person who tried to steal the election was Trump, with his bid to disrupt Congress certifying the results by inciting a crowd of supporters that mobbed the Capitol, sending lawmakers fleeing.

Trump's manufactured crisis of legitimacy will effectively taint the midterm polls in 2022, which the former President is trying to use to tighten his stamp on the party. And even if Trump doesn't try to reclaim the White House in 2024, his pernicious influence will mean that the idea that the last election was stolen will remain a false article of faith for Republicans going forward.

A flurry of recent developments prove Trump's power in the GOP and his undiminished threat to trust in the electoral system, and show that the fight for American democracy merely entered a new phase when he left office.

A slew of Republican state legislatures have passed laws making it more difficult for Democrats, and especially Black voters, to cast ballots. They often cite voter mistrust in the electoral system as a rationale for those changes. But the chief cause of that mistrust is the relentless campaign by Trump to discredit the election he lost, both before and after voters went to the polls.

In another sign of Trump's malign influence, the state Senate in Arizona is conducting a sham recount of votes in crucial Maricopa County that helped Biden win the state, despite repeated statements and rulings by electoral officials and courts that the President's narrow victory was genuine.

Republican officials who once had the courage to condemn Trump's insurrectionist rhetoric are now seeking to ingratiate themselves with his supporters -- especially those who may run for President in future, including former South Carolina Gov. Nikki Haley and ex-New Jersey Gov. Chris Christie. House Minority Leader Kevin McCarthy, who at first said Trump bore responsibility for the January 6 riot, quickly visited the former President at his Mar-a-Lago resort and is anchoring his effort to win back the House for Republicans next year on the former President and his movement.

Any idea that the GOP will shed its fealty to Trump was exposed as a pipe dream by the poor showing of Marine veteran Michael Wood, who ran in a special election for a House seat in Texas at the weekend on an anti-Trump platform and lost badly in a jungle primary with only 3% or the vote.

"There is a sickness in our party that must be acknowledged and addressed," Wood wrote in a message to voters after his defeat.

"We are too much a cult of personality and a vehicle for the grievances of Donald Trump. We are too comfortable with conspiracy theories."

The former President sent out a statement claiming credit for the showing of Susan Wright, the wife of Rep. Ron Wright who died from Covid-19, after she moved into a run-off for the seat following the ex-President's endorsement.


Trump sketches a new alternate reality for his followers

The secret of Trump's appeal from the start of his presidential campaign in 2015 was that he channeled the distrust many conservatives felt towards the Washington establishment and the political system itself. He gave people a kind of permission to believe in what they felt viscerally rather than facts and truth. His attempt to destroy trust in the electoral system is creating another false reality with a built-in belief system that is deeply attractive to his voters. The fact that none of it is true does not detract from the power of his appeal.

But it is still extraordinary that the Republican Party, which in recent memory styled itself as the guardian of democracy and boasted about winning the Cold War against tyranny, could transform in this manner.

"It is just mind boggling to me that Republicans could be this way," said Dave Millage, who was forced to resign his post as chair of the Scott County, Iowa, Republican Party after backing Trump's impeachment over the Capitol insurrection. Millage slammed his fellow Republicans for "worshipping at the altar of Trump" during an appearance on CNN's "Newsroom" on Monday.

"He was attacking American democracy itself. Yet they are standing by him. It just astounds me."

The electoral impact of Trump's dominance over his party will be tested next year as Republicans have a historically good chance of overhauling the thin Democratic majority in the House, since new Presidents often get a rebuke. Since most mid-terms, especially House races, are heavily influenced by base turnout, the GOP may profit from Trump's continuing ability to inspire the party's most loyal voters.

But it is less clear that a slate of pro-Trump, Capitol insurrection denialists will help Senate Minority Leader Mitch McConnell's bid to reclaim control of the Senate -- or that this message carried by Trump or anyone else is a winning one in 2024.

After all, the former President managed to lose control of the House, the Senate and the White House with an approach that electrified the GOP base but alienated many suburban voters and those horrified with his handling of the pandemic.

Former Arizona Sen. Jeff Flake, who paid with his political career for being an early critic of Trump's presidency, warned that his party was making a huge mistake by not shaping a more compelling appeal to a wider group of voters.

"With the Democratic Party moving more progressive, there is plenty of room there," Flake told CNN's Jim Sciutto on Monday. "And we could do well in the midterms but not if we continue this craziness of questioning the last election and going after those who aren't completely devoted to the former President."

KULTURKAMPF
Gov. Noem: Biggest cultural challenge is 'defeating anti-American indoctrination'

Morgan Matzen, Sioux Falls Argus Leader 


The biggest cultural challenge of this lifetime is “defeating anti-American indoctrination,” Gov. Kristi Noem said in a Fox News opinion piece co-signed by Dr. Ben Carson and published Monday morning.

© Erin Bormett / Argus Leader Governor Kristi Noem gives the State of the State address on Tuesday, January 12, in the House of Representatives at the South Dakota State Capitol in Pierre.

The politicians shared they’ve signed on to the "1776 Pledge to Save Our Schools," which commits that K-12 public education will restore “honest, patriotic education that cultivates in our children a profound love for our country.”

Noem is widely considered a potential 2024 Republican presidential candidate. Her signature comes as she proclaims Monday through Friday is Teacher Appreciation Week in South Dakota.

Carson was the 17th U.S. secretary of Housing and Urban Development, and a member of President Trump’s advisory 1776 Commission.

In the column, Noem and Carson criticize President Joe Biden for canceling and disbanding President Trump’s 1776 Commission, which released a controversial 1776 Report two days before the end of Trump’s term, on Martin Luther King Jr. Day, and attempted to end a “radicalized view of American history.”


More: Republican state lawmakers want to punish schools that teach the 1619 Project

The pledge also promotes curriculum that teaches all children are created equal, prohibits curriculum that “pits students against one another on the basis of race or sex,” and prohibits any curriculum that requires students to protest and lobby during or after school.

In the column, Noem shares concerns about giving up and abandoning altogether “the teaching of our children the true and inspiring story of America,” and that children should be taught about the country’s values, history and heroes. LIKE CUSTER

Noem and Carson also said it’s “alarming” that students are “being subjected to the radical concept known as critical race theory, which pits them against one another on the basis of race and gender under the guise of achieving ‘equity.’”

Critical race theory sows division and cripples the nation from within, “one brainwashed and resentful student at a time,” the pair argue.

America’s most defining principle, the pair argue, is that as individuals, “we are all created equal by God.”

Noem has shared similar concerns about the concept of indoctrination in the past. She's written a column for the Federalist with worries about the nation’s failure “to educate generations of our children about what makes America unique,” and for the “left’s indoctrination” of students.

At the time, local educators like Tim Eckart, president of the Sioux Falls Education Association, were not happy. Eckart said the suggestion that educators were indoctrinating students was "incredibly insulting."

The conservative governor also successfully pushed for $900,000 in state funding to create new civics curriculum to meet her goal of educating why the "U.S. is the most special nation in the history of the world," while efforts to mandate instruction on the state's tribal history, culture and government failed in the legislative session this spring.

A new state-specific curriculum has yet to be seen months after Noem pushed for it, but the South Dakota Department of Education has a two-year project to develop and prepare it for schools to use if they wish to do so.

This article originally appeared on Sioux Falls Argus Leader: Gov. Noem: Biggest cultural challenge is 'defeating anti-American indoctrination'

GHOST IN THE MACHINE

House hearing interrupted by sound from 'Galaxy Quest' and the Village People

By Kristin Wilson, CNN 

A year after Zoom hearings became an everyday reality for much of America, technical glitches are still tripping up Congress.

A hearing of the House Appropriations Subcommittee on Energy and Water Development on Monday was interrupted and briefly recessed by audio of the Village People's "In the Navy" and the audio of the movie "Galaxy Quest"

The committee continued holding the hearing with the movie and song playing in the background for nearly 20 minutes before subcommittee Chairwoman Marcy Kaptur, a Democrat from Ohio, was forced to call a recess to fix the technical difficulties.

"We've been informed that we have to take a brief recess now because we're having technical issues," Kaptur said. "And we're going to be briefly recessing for a second here, let them address those and we'll be back very quickly."

"Sorry to do this, this hasn't happened before, but it's a new age," she said.

To their credit, members were able to continue testifying while the movie track and music played in the background. During the testimony of Democratic Rep. Sheila Jackson Lee of Texas, a character in the movie could be heard cheering, "Never give up!"

The hearing later resumed but was somewhat less interesting without the heroic music playing.

LIKE ALBERTA' S

Manitoba education reform bill built on ‘false, divisive premises’: former administrators

WHEN TORIES CHANGE CURRICULUM 

IT'S FORWARD TO THE PAST

By Maggie Macintosh, 

Local Journalism Initiative 

Winnipeg Free Press
Mon., May 3, 2021


Thirty retired superintendents have signed an open letter against Bill 64, in the hopes of halting the province’s sweeping reforms to K-12 education.

The collective of former Manitoba educators, who have worked in all corners of the province, argues the Education Modernization Act will lead to the politicization of public education and harm the collaborative culture in and among schools.

The legislation, which the province unveiled March 15, alongside the education review and a plan to act on its recommendations, aims to replace English school boards with a centralized authority run by government appointees.

The province claims the changes will boost student outcomes and amplify parent voices through new school councils.

“Bill 64 is based on false and divisive premises and promises — of quality (test scores vs. poverty); participation (individual parents vs. school boards); collegiality and professionalism (principals vs. teachers); and, efficiency (extreme centralization vs. local discretion),” states the superintendents’ letter, which was sent to provincial officials and education stakeholders.

Coralie Bryant, co-author and signatory, takes issue with plans to eliminate paid, elected trustee positions and hand off some of their current roles, such as budget planning, to volunteer parents. Many caregivers do not have time to engage with existing parent councils, let alone revamped ones with robust responsibilities, said the retired superintendent of Seven Oaks School Division.

“The current government does not have our permission to do this. They didn’t mention it in the election of 2019,” said Ken Klassen, a former superintendent in the Hanover School Division, adding he fears the new set up could see any government appoint partisan directors of education.


Among the group’s concerns: the removal of principals from the teachers union, how all students will be represented (particularly in Winnipeg, if the capital is home to only one region), and the impact child poverty continues to have on Manitoba’s lagging test scores.

In a prepared statement, Education Minister Cliff Cullen said the province has asked educational leaders to put their names forward for new task forces and advisory panels to shape the new system.

Cullen added: “We all share the same common goal and that is to ensure student success is the top priority, so we welcome their input on our engagement, task forces and advisory panels.

Eye protection next on pandemic classroom list

Faced with rising COVID-19 cases and highly infectious variants, Manitoba schools are adding another item to their arsenal of personal protective equipment: eyewear.

Public health officials are now supporting the use of both medical masks and eye protection by teachers and staff “who are unable to consistently and reliably maintain t
wo metres of distance,” a government spokesperson confirmed Friday.

Manitoba Education has received orders for upwards of 85,000 “frames with lenses” and 4,700 face shields from 34 school divisions.

In Winnipeg, St. James-Assiniboia, Pembina Trails, River-East Transcona and Louis Riel school divisions have all ordered the new eyewear for staff.

“We’re definitely in a third wave, and what I hope is we’re going to take evidence-based approaches in all that we do. We see evidence-based approaches in the health sciences, and we’re trying our best here in LRSD to have evidence guide our decisions,” said superintendent Christian Michalik.

Should the supply chain co-operate, Michalik said the division will soon be able to provide each staff member with three medical-grade face masks daily, as well as eye protection, until the end of June.

Officials have informed divisions eye protection should be cleaned daily and disposed of once every week, he said.

Some educators have already started wearing eye protection, as COVID-19 exposures in schools spike and more classes are forced to pivot to temporary remote learning.

Families at Collège Jeanne-Sauvé, Lavallee School and Dalhousie School all learned Friday their children’s schools are shifting fully to distance learning on Monday. Earlier in the week, École South Pointe School and École St. Avila made similar announcements.

“From the perspective that the virus spreads as an aerosol and your eyes are vulnerable because that’s a potential entry point into your body, then definitely, having some protection over your eyes is beneficial,” said Thomas Tenkate, an associate professor at Ryerson University’s School of Occupational and Public Health in Toronto.

Tenkate, however, said schools, which require engaged two-way conversations, are much different than other workplaces such as hospitals or construction sites, where eyewear is typically used as extra protection.

EYEWEAR IS USED IN HIGH SCHOOL TRADES, MECHANICAL AND SCIENCE CLASSES

Given how uncomfortable eye protection can be, he said it’s worth considering what is actually feasible and safe for school staff working in those environments.

Tenkate added: “From a health and safety perspective, we’re trying to create conditions where people don’t have to wear PPE because PPE is the last line of defence.”

Maggie Macintosh, Local Journalism Initiative Reporter, Winnipeg Free Press

A BIG SCAM

Schools spending millions on air purifiers often sold using overblown claims

By Lauren Weber and Christina Jewett, Kaiser Health News

MAY 3,2021

Last summer, Global Plasma Solutions wanted to test whether the company's air-purifying devices could kill Covid-19 virus particles, but could find only a lab using a chamber the size of a shoebox for its trials. In the company-funded study, the virus was blasted with 27,000 ions per cubic centimeter. The company said it found a 99% reduction of virus

.

 PROVO, UT - FEBRUARY 10: A teacher prepares her classroom before students arrive for school at Freedom Preparatory Academy on February 10, 2021 in Provo, Utah. Freedom Academy has done in person instruction since the middle of August of 2020 with only four days of school canceled due to COVID-19 outbreak. (Photo by George Frey/Getty Images)

The report doesn't say how this reduction was measured, and in September, the company's founder incidentally mentioned that the devices being offered for sale would actually deliver a lot less ion power -- 13 times less -- into a full-sized room.

The company nonetheless used the shoebox results in marketing its device heavily to schools as something that could combat Covid in classrooms far, far larger than a shoebox.

School officials desperate to calm worried parents bought these devices and others with a flood of federal funds, installing them in more than 2,000 schools across 44 states, a KHN investigation found. They use the same technology — ionization, plasma and dry hydrogen peroxide — that the Lancet COVID-19 Commission recently deemed "often unproven" and potential sources of pollution themselves.

In the frenzy, schools are buying technology that academic air-quality experts warn can lull them into a false sense of security or even potentially harm kids. And schools often overlook the fact that their trusted contractors — typically engineering, HVAC or consulting firms — stand to earn big money from the deals, KHN found.

Academic experts are encouraging schools to pump in more fresh air and use tried-and-true filters, like HEPA, to capture the virus. Yet every ion- or hydroxyl-blasting air purifier sale strengthens a firm's next pitch: The device is doing a great job in the neighboring town.

"It's a self-fulfilling prophecy. The more people buy these technologies, the more they get legitimacy," said Jeffrey Siegel, a civil engineering professor at the University of Toronto. "It's really the complete wild west out there."

Marwa Zaatari, a member of the American Society of Heating, Refrigerating and Air-Conditioning Engineers' (ASHRAE) Epidemic Task Force, first compiled a list of schools and districts using such devices.

Schools have been "bombarded with persistent salespersons peddling the latest air and cleaning technologies, including those with minimal evidence to-date supporting safety and efficacy" according to a report released Thursday by the Center for Green Schools and ASHRAE.

Zaatari said she was particularly concerned that officials in New Jersey are buying thousands of devices made by another company that says they emit ozone, which can exacerbate asthma and harm developing lungs, according to decades of research.

"We're going to live in a world where the air quality in schools is worse after the pandemic, after all of this money," Zaatari said. "It's really sickening."

The sales race is fueled by roughly $193 billion in federal funds allocated to schools for teacher pay and safety upgrades — a giant fund that can be used to buy air cleaners. And Democrats are pushing for $100 billion more that could also be spent on air cleaners.

In April, Global Plasma Solutions said further tests show its devices inactivate Covid in the air and on surfaces in larger chambers. The company studies still use about twice the level of ions as its leaders have publicly said the devices can deliver, KHN found.

There is virtually no federal oversight or enforcement of safe air-cleaning technology. Only California bans air cleaners that emit a certain amount of ozone.

U.S. Rep. Robert "Bobby" Scott (D-Va.), chair of the House Committee on Labor and Education, said the federal government typically is not involved in local decisions of what products to buy, although he hopes for more federal guidance.

In the meantime, "these school systems are dealing with contractors providing all kinds of services," he said, "so you just have to trust them to get the best expert advice on what to do."

These go-between contractors — and the air cleaner companies themselves — have a stake in the sales. While their names might appear in school board records, their role in selling the device or commission from the deal is seldom made public, KHN found.

A LinkedIn job ad with the logo for one air purifier company, ActivePure Technology, which employs former Trump adviser Dr. Deborah Birx as its chief medical and science adviser, recruited salespeople this way: "Make Tons of Money with this COVID-killing Technology!!" The commission, the post said, is up to $900 per device.

"We have reps [who] made over 6-figures in 1 month selling to 1 school district," the ad says. "This could be the biggest opportunity you have seen!"


'A tiny bit of ozone'

Schools in New Jersey have a particularly easy time buying air cleaners called Odorox: A state education agency lists them on their group-purchasing commodity list, with a large unit selling for more than $5,100. Originally used in home restoration and mold remediation, the devices have become popular in New Jersey schools as the company says its products can inactivate Covid.

In Newark, administrators welcomed students back to class this month with more than 3,200 Odorox units, purchased with $7.5 million in federal funds, said Steven Morlino, executive director of Facilities Management for Newark Public Schools.

"I think parents feel pretty comfortable that their children are going to a safe environment," he said. "And so did the staff."

Environmental health and air-quality experts, though, are alarmed by the district's plan.

The Pyure company's Odorox devices are on California air-quality regulators' list of "potentially hazardous ozone generators sold as air purifiers" and cannot be sold in the state.

The company's own research shows that its Boss XL3 device pumps out as much as 77 parts per billion of ozone, a level that exceeds limits set by California lawmakers for the sale of indoor air cleaners and the EPA standard for ground-level ozone — a limit set to protect children from the well-documented harm of ozone to developing lungs.

That level exceeds the industry's self-imposed limit by more than 10 times and is "unacceptable," according to William Bahnfleth, an architectural engineering professor at Penn State who studies indoor air quality and leads the ASHRAE Epidemic Task Force.

Jean-Francois "JF" Huc, CEO of the Pyure company, pointed out that the company's study was done in a space smaller than they would recommend for such a powerful Odorox device. He cautioned that it was done that way to prove that home-restoration workers could be in the room with the device without violating work-safety rules.

"We provide very stringent operating guidelines around the size of room that our different devices should be put in," he said. But school staffers are often not warned about the potential problems if a too-powerful device is used in a too-small room, he acknowledged.

You can't see or smell ozone, but lungs treat it like a "foreign invader," said Michael Jerrett, who has studied its health effects as director of the UCLA Center for Occupational and Environmental Health.

Lung cells mount an immune-like response, which can trigger asthma complications and divert energy from normal lung function, he said. Chronic exposure has been linked to more emergency room visits and can even cause premature death. Once harmed, Jerrett said, children's lungs may not regain full function.

"Ozone is a very serious public health problem," Jerrett said.

Newark has some of the highest childhood asthma rates in the state, affecting one in four kids. Scholars have linked outdoor ozone levels in Newark to elevated childhood ER visits and asthma is the leading cause of school absenteeism there.

Adding ozone into the classroom is "just nightmarish," Siegel, of the University of Toronto, said.

Morlino said the district plans to monitor ozone levels in each classroom, based on the federal Occupational Safety and Health Administration level for working adults, which is 100 parts per billion.

"In our research of the product," he said, "we've determined it's within the guidelines the federal government produces."

While legal for healthy working adults, the work-safety standard should not apply to developing children, said Michael Kleinman, an air-quality researcher at the UC Irvine School of Medicine. "It's not a good device to be using in the presence of children," he said.

But the devices are going into schools throughout the state that will not be monitoring ozone levels, acknowledged Dave Matisoff, owner of Bio-Shine, a New Jersey-based distributor of Odorox. He said the main safeguard is informing schools about the appropriate-size room each device should be deployed to, a factor in ozone concentration.

Huc, the CEO, said his team has measured levels of ozone that are higher outdoors in Newark than inside — with his company's units running.

"There is a tiny bit of ozone that is introduced, but it's very, very low," he said. "And you get the benefit of the antimicrobial effect, you get the benefit of reduction of pathogens, which we've demonstrated in a number of studies, and you get the reduction of VOC [volatile organic compounds]."

Meanwhile, despite expert concerns, the devices continue to pop up in classrooms and school nurses' offices across the state, said Allen Barkkume, an industrial hygienist for the New Jersey teachers union.

He doesn't blame schools for buying them, as they're a lot less expensive than overhauling ventilation systems. Teachers often push for the devices in their classrooms, he said, as they see them in the nurses' offices and think it'll keep them safe. And superintendents are not well-versed in air quality's complex scientific concepts.

"Nothing sounds better than something that's cheap, quiet, small and easy to find, and we can stick them in every classroom," Barkkume said.

Tested in shoebox, sold for classrooms

While New York officials are "not permitting" the installation of ionization devices due to "potential negative health effects," schools across the state of New Jersey are installing ionizing devices.

Ten miles away from Newark in Montclair, New Jersey, parents have been raising hell over the new Global Plasma Solutions' ionizing devices in their children's classrooms. The company website promises a product that emits ions like those "created with energy from rushing water, crashing waves and even sunlight."

The devices emit positive and negative ions that are meant to help particles clump together, making them easier to filter out. The company says the ions can also reduce the viral particles that cause Covid-19.

But Justin Klabin, a building developer with a background in indoor air quality and two sons in the district, was not convinced.

He spent hours compiling scientific evidence. He created YouTube videos that painstakingly pick apart the ionizers' viability and helped organize a petition signed by dozens of parents warning the school board against the installation.

Even so, the district spent $635,900 on installing ionizers, which would go in classrooms serving more than 6,000 kids. The devices are often installed in ducts, an important consideration, the company founder Charles Waddell said, because the ions that are emitted lose their power after 60 seconds.

But the company's shoebox study and inflated ion blast numbers that helped sell the product last year leave a potential customer with little sense of how the device would perform in a classroom, Zaatari said.

"It's a high cost for nothing," Zaatari said. The company has sued her and another air-quality consultant for criticizing their devices. Of the pending case, Zaatari said it is a David-versus-Goliath situation, but she will not be deterred from speaking on behalf of children.

"Size of the [test] chamber has proved not to play a role in efficacy results but rather ion density," GPS spokesperson Kevin Boyle said in an email. The company notes by its Covid-inactivating test results that they "may include ... higher-than-average ion concentrations."

He also said the company is proud to meet the ASHRAE "zero ozone" certification.

Glenn Morrison, a professor of environmental science and engineering at the University of North Carolina, reviewed a March GPS study on a device combating the Covid virus in the air. The device appears to reduce virus concentrations, he said in an email, but noted it would not be very effective under normal building conditions, outside a test chamber. "A cheap portable HEPA filter would work many times better and have fewer side effects (possibly ozone or other unwanted chemistry)," he wrote.

Other parents joined Klabin's campaign, including Melanie Robbins, the mom of a kindergartener and a child in pre-K. Armed with her background in nonprofit advocacy, she reached out to experts. She and other parents spoke at local government meetings about their concerns.

In April, the superintendent told parents the school would turn off the devices, but parents say they haven't turned them all off.

"As far as I understand, the district has relied only on information from GPS, the manufacturer," Robbins said during a Montclair Board of Education meeting via Zoom on April 19. "This is like only listening to advice from Philip Morris as to whether smoking is safe or not."

Dan Daniello, of D&B Building Solutions, an HVAC contracting company, defended GPS products during the meeting. He said they are even used in the White House, a selling point the company has made repeatedly.

The catch: A GPS contractor installed its ionization technology in the East Wing of the White House after it was purchased in 2018 — before Covid emerged, according to GPS' Boyle. But the company was still using the White House logo as a marketing image on its website when KHN asked the White House about the advertising in April. It was taken down shortly thereafter.

Boyle said GPS was "recently informed that the White House logo may not be used for marketing purposes, and promptly complied."

The Montclair school district did not respond to requests for comment.

"I want to bang my head against the wall, it's so black-and-white," Robbins said. "Admit this is a poor purchase. The district got played."


Selling 'the Big Kahuna'

Academic air-quality experts agree on what's best for schools: More outside air pumped into classes, MERV 13 filters in heating systems and portable HEPA filters. The solution is time-tested and effective, they say. Yet as common commodities, like a pair of khaki pants, these items are not widely flogged by a sales force chasing big commissions.

After Covid hit, Tony Barron said the companies pitched air purifying technology nonstop to the Kansas district where he worked as a facility manager last fall.

Pressure came from inside the school as well. Teachers sent links for air cleaners they saw on the news. His superintendent had him meet with a friend who sold ionization products. He got constant calls, mail and email from mechanical engineering companies.

The hundreds of phone calls from air cleaner pitches were overwhelming, said Chris Crockett, director of facilities for Turner USD 202 in Kansas City, Kansas. While he wanted to trust the contractors he had worked with, he tested four products before deciding to spend several hundred thousand dollars.

"Custodial supply companies see the writing on the wall, that there's a lot of money out there," he said. "And then a lot of money is going to be spent on HVAC systems."

ActivePure says on its website that its air purifiers are in hundreds of schools. In a news release, the company said they were "sold through a nationwide network of several hundred franchises, 5,000 general contractors/HVAC specialists and thousands of individual distributors."

Enviro Technology Pros, founded in January, is one company pitching ActivePure to HVAC contractors. In a YouTube video, the founders said contractors can make $950 for each air-cleaning device sold, and some dealers can make up to $30,000 a month. Citing the bounty of the billions in federal relief, another video touted ready-made campaigns to target school principals directly.

After KHN asked ActivePure for comment, the Enviro Technology Pros YouTube videos about ActivePure were no longer accessible publicly.

ActivePure did not respond to requests for comment but has said its devices are effective and one is validated by the Food and Drug Administration.

An Enviro Technology Pros founder, Rod Norman, told KHN the company was asked to take the posts down by Vollara, a company related to ActivePure. He called sales to schools "the big kahuna."

Shortly after he spoke with KHN, the website for his own company was taken down.

In an Instagram post that also disappeared, the company had asked: "4000 classrooms protected why not your kids?"

Man United violence the peak of toxic fan-owner relationship

THERE WAS NO VIOLENCE FROM FANS, INTERUPTTING THE GAME IN PROTEST WITH FLARES ETC,

MANCHESTER, England — The storming of Old Trafford crystalized 16 years of disconnect between Manchester United fans and its distant ownership.

 Provided by The Canadian Press

While choosing not to engage with the supporters who are the lifeblood of any club, the Glazer family can't have avoided seeing the levels of rage against them on Sunday. Not when it led to the unprecedented postponement of a Premier League game due to fan unrest, especially one of the biggest matches of the season between United and Liverpool.

Three months after celebrating success in the Super Bowl with the Tampa Bay Buccaneers, it was the Glazers' ill-fated bid to lead United into a European Super League that made their relationship with fans in England more toxic than ever before.

That led to co-owner Joel Glazer insisting he was “committed to rebuilding trust with our fans,” but there was no sign of that happening in the 10 days between the open letter and Sunday's protests.

THE PROTESTS

A rabble of more than 100 fans were able to stand on the field setting off flares after breaching the coronavirus-necessitated biosecure perimeter of the stadium. Outside, thousands more supporters spent two hours crammed onto the concourse demanding the Glazers sell the club.

AND WHO CAUSED THE VIOLENCE
Even though officers eventually managed to disperse the crowd just before the scheduled kickoff — with a combination of force using batons and a charge of police horses — the Premier League abandoned any hope of playing the game.

ORIGINS OF ANGER

The takeover of United in 2005 began with protests outside Old Trafford that featured burning effigies of the incoming ownership.

Fans were angered that a club without debt was loaded with liabilities that reached a high of 717 million pounds (then $1.1 billion) during the 2008-09 season. It's a debt that has had to be serviced and cost United, along with dividends to the Glazer family, more than 1 billion pounds in 16 years. It stood at 456 million pounds in December.

But protests against the Glazers that previously peaked with a visible display of dissent during a 2010 Champions League game faded amid the team's success. The club won the Premier League five times between 2007 and 2013 to become the record 20-time champions of England, usurping Liverpool. But since the retirement of Alex Ferguson in 2013 after more than 26 years in charge, the Premier League trophy has proved elusive.

“Your family’s ownership of the club has driven us into debt and decline,” the Manchester United Supporters' Trust wrote on Monday to Joel Glazer, “and we have felt ever more sidelined and ignored.”

It is only two weeks since Glazer tried to lead United into the breakaway European competition as vice chairman of the Super League. Fans were not consulted before the group of European clubs launched the closed European competition to replace UEFA's open access Champions League. The rebellion imploded inside 48 hours amid an outcry from government and fans.

Despite the lack of silverware, even as Manchester City emerged as England's dominant force fueled by Abu Dhabi investment, the protests at United have largely been dormant, simmering only in the background. While the Glazers wouldn't speak to MUST, the group toned down its public comments against them and seemed to focus instead on engagement with the administration in Manchester about the matchday experience to secure improvements.

FAN DEMANDS

The tone has shifted again with the letter to Joel Glazer requesting by Friday a response to a four-point list of demands to:

— Back a government review and “rebalance the current ownership structure in the favour of supporters";

— Appoint independent directors;

— Adopt a share scheme giving fans the same voting rights as the Glazer family with the New York Stock Exchange-listed business;

— Fully consult fans on any significant changes to the club.

COMMERCIAL SUCCESS

To end the current four-year trophy drought, United says there has been more than $200 million invested in players over the past two years — more than any other major European club. That has been funded by the growth of the commercial side of the business, with revenue almost quadrupling since the takeover to 627 million pounds before the pandemic. United has a self-sustaining business model with profit for the owners the priority, which enables them to draw dividends.

OTHER FOREIGN OWNERS

Across Manchester at City, it's been about an owner pumping money in since 2008. Funded by the wealth of Abu Dhabi, City is a means of a soft power being exerted by the United Arab Emirates, which has been criticized for its human rights and limited political freedoms, as much as it is about transforming men's and women's teams and the surrounding areas. While City fans did oppose the Super League there have been no protests demanding the sale of the club or the exit of club officials.

Chelsea owner Roman Abramovich has also invested more than a billion pounds in the west London club since 2003 to turn it into a European power. The aborted Super League plan produced protests in the streets around Stamford Bridge centred on trying to unseat chairman Bruce Buck.

Protests more akin to the vociferous ones at Old Trafford came at Arsenal in the week of the Super League announcement, with fans of the north London club also demanding the exit of their NFL franchise-owning chairman Stan Kroenke. Unlike the Glazers, Arsenal's ownership has engaged with fans through Stan Kroenke's son Josh, who subjected himself to a video call to take a battering of questions over the Super League debacle.

The Super League reignited concerns in Liverpool about John Henry's Fenway Sports Group ownership and its lack of investment demanded by fans since the club ended its 30-year English title drought. Protests in the streets in 2010 helped to oust the previous American owners — Tom Hicks and George Gillett Jr. — as the club become burdened with debt it could not repay.

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More AP soccer: https://apnews.com/hub/soccer and https://twitter.com/AP_Sports

Rob Harris, The Associated Press

Glazers still 'not interested' in selling Man Utd with further protests planned

The Glazer family are not interested in selling Manchester United, despite supporters continuing to call for their heads to roll in the wake of the Super League scandal.

© Provided by 90min The Glazer family remain committed to Man Utd | Michael Regan/Getty Images

Supporters stormed Old Trafford recently to voice their frustrations towards the Glazers, which date back all the way to 2005, forcing the postponement of the Premier League match against Liverpool as a result of their actions.

OLI SCARFF/Getty Images United fans broke into Old Trafford in protest | OLI SCARFF/Getty Images

According to The Times, those fans involved are already planning further protests, with the rescheduled Liverpool game expected to be a target alongside the upcoming home match against Leicester City, but The Guardian do not expect the protests to work.

Per the report, the Glazers intend to stay on at Old Trafford as they plan to grow the club's value from £3bn to £7bn in the coming years.

The American owners are not thought to have been scared off by the protests and remain committed to the club, insisting they are the right people to help the business side of the club grow over years to come.

Can you believe it? They're only thinking about money? Shock.

© The Glazers have plans to increase Man Utd's value 

| Michael Regan/Getty Images

The Times do add, however, that the Glazers would be forced to think about any offers of around the £4bn mark.

With current shares in the club worth around £2.1bn, any potential buyer would need to offer up more than that to give the Glazers a profit, and the American owners could also encounter fees from banks and lenders which they would ask a buyer to cover, which would take the price to closer to that £4bn.

If nobody can come up with that kind of money, the Glazers will continue their mission to grow United's brand

.

 United must brace themselves for further protests | Charlotte Tattersall/Getty Images

With the owners not going anywhere, United's immediate focus will be on preparing themselves for these upcoming protests. They are already facing an FA investigation over their failure to adequately prepare first time around and club officials will be adamant that will not happen again.

United were angered by suggestions that they had allowed protesters on to the pitch, instead condemning the supporters who chose to force their way through locked doors to escalate the situation.

For more from ​Tom Gott, follow him on ​Twitter!

#NOOLYMPICS2020
Tokyo Games need 500 nurses; nurses say needs are elsewhere


TOKYO — Some nurses in Japan are incensed at a request from Tokyo Olympic organizers to have 500 of them dispatched to help out with the games. They say they’re already near the breaking point dealing with the coronavirus pandemic

.

© Provided by The Canadian Press

Olympic officials have said they will need 10,000 medical workers to staff the games, and the request for more nurses comes amid a new spike in the virus with Tokyo and Osaka under a state of emergency.

“Beyond feeling anger, I was stunned at the insensitivity," Mikito Ikeda, a nurse in Nagoya in central Japan, told the Associated Press. “It shows how human life is being taken lightly.”

The appeal for more nurses is typical of the impromptu changes coming almost daily as organizers and the International Olympic Committee try to pull off the games in the midst of a pandemic.

The Olympics are set to open in just under three months, entailing the entry into Japan — where international borders have been virtually sealed for a year — of 15,000 Olympic and Paralympic athletes and thousands of other officials, judges, sponsors, media and broadcasters.

In a statement from the Japan Federation of Medical Workers' Unions, secretary general Susumu Morita said the focus should be on the pandemic, not the Olympics.

“We must definitely stop the proposal to send as Olympic volunteers those nurses, tasked with protecting the fight against the serious coronavirus pandemic," Morita said.

“I am extremely infuriated by the insistence of pursuing the Olympics despite the risk to patients' and nurses' health and lives.”

A protest message saying that nurses were opposed to holding the Olympics went viral on Japanese Twitter recently, being retweeted hundreds of thousands of times.

Even before the pandemic, Japanese nurses were overworked and poorly paid compared with their counterparts in the United States or Britain.

Nursing is not only physically taxing but also emotionally draining, said Ikeda, who has been a nurse for 10 years. He said many nurses worry about getting infected themselves, with vaccination rates in Japan reported at only 1-2%.

“It’s hard for any hospital to go without even one nurse, and they want 500,” Ikeda said. “Why do they think that’s even possible?”

Deaths attributed to COVID-19 in Japan have just passed 10,000.

The British Medical Journal last month said that Japan should “reconsider” holding the Olympics, arguing that “international mass gathering events ... are still neither safe nor secure.”

Haruo Ozaki, chairman of the Tokyo Medical Association, has said it will be “extremely difficult” to hold the Olympics because of the new variants that are spreading.

He also explained that Japan’s medical community has been stretched while treating coronavirus patients and also doing the vaccine rollout.

“We have heard enough of the spiritual argument about wanting the games,” he said. "It is extremely difficult to hold the games without increasing infections, both within and outside Japan.”

Japanese Prime Minister Yoshihide Suga suggested that nurses who have quit their jobs could help with the Olympics, although some resignations are tied to the stressful work dealing with coronavirus patients.

“I hear many are taking time off, and so it should be possible,” Suga said last week, in a widely criticized remark.

Athletes will operate in a “bubble” at the Olympics, housed in the Athletes' Village on Tokyo Bay and moved around in designated buses to venues and training areas. Hundreds of rooms are also reportedly being set up outside the village to take in those who fall ill.

Organizers will require daily testing for athletes and other participants, a momentous task for medical staff. It also contrasts with how little testing is being done for the Japanese public.

Public opinion surveys show up to 80% of the Japanese want the Olympics cancelled or postponed again. Much of the bill for holding the Olympics, estimated officially at $15.4 billion, falls on Japanese taxpayers.

“The situation is extremely serious," opposition lawmaker Tomoko Tamura said recently. "Nurses don’t know how they can possibly take care of this situation. It is physically impossible.”

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More AP Olympics: https://apnews.com/hub/olympic-games and https://twitter.com/AP_Sports

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Yuri Kageyama is on Twitter https://twitter.com/yurikageyama

Yuri Kageyama And Stephen Wade, The Associated Press

What History Can Tell Us About Working as an Immigrant Nurse in Canada

By Johna Baylon,

 Local Journalism Initiative Reporter

New Canadian Media

Mon., May 3, 2021

Editor’s note: This story was first published on April 28. This version corrects the acronym OIIQ to OIIAQ.

Like many internationally educated nurses (IENs) in Canada, Jeff Kua came to the country through the Live-in Caregiver Program.

It was 2010. His grandmother in Ontario had suffered a stroke, so his uncle suggested that Kua come to Toronto as her caregiver.

With his experience as an operating room nurse in the Philippines, however, Kua knew he’d eventually return to the profession he once served and trained for.

He started preparing for his nursing registration a year after he arrived. Back then, the College of Nurses of Ontario (CNO) considered work experience as a registered nurse (RN) within the last five years as valid. This means that by the time Kua could pursue working as an RN—after completing his two-year caregiving work requirement for permanent residency, and applying for an open work permit—his clinical experience would still count.

But things had changed by the time he received his assessment from the CNO, sometime between 2013 and 2014.

“They said I had to go back to school because they changed their policy—instead of accepting nursing experience in the last five years, they [changed] it to three years,” says the 37-year-old.

“So in the time they took to assess my documents, I basically ran out of experience. So I needed to go back to school.”

Kua took the Academic Pathway for Internationally Educated Nurses Program, a graduate certificate program at George Brown College, in 2015.

Still, it wasn’t enough.

After completing the program in 2017, Kua was told he now needed university-equivalent credentials.

This requirement wasn’t mentioned in his earlier assessment letter, which outlined the ‘gaps’ in his nursing experience and provided a list of colleges that offered programs to cover those gaps.

“After I finished the two-year program at George Brown, they sent my transcript to the CNO. The response I got back was that I didn’t meet the education requirements,” says Kua. “They updated my ‘gaps’, and added more requirements.”

Kua’s experiences are not uncommon. Many IENs come to Canada through the caregiver pathway and later find it difficult to practice as RNs.

This is due to many factors, including the time and financial resources it takes to complete bridging programs and language proficiency requirements that come with expiry dates, particularly the International English Language Testing System (IELTS), where results are valid for two years. Delays in paperwork, such as PR backlogs and document retrievals from educational and professional institutions overseas, make the process more time-consuming and expensive.

This hasn’t always been the case, however.

According to Valerie Damasco, a lecturer and researcher at the Ontario Institute for Studies in Education at the University of Toronto, interviews with nurses and historical documents reveal Canada’s recruitment of nurses from the Philippines in the early 1960s—among whom was her aunt.

“I’m not sure if the correct word to use here is ‘easy,’ but certainly [Filipino] nurses fit the criteria [of nurses] they needed here,” Damasco says, referring to the ease with which IENs from the Philippines were then able to work as RNs in Canada.

Damasco is currently completing a book based on her doctoral thesis, which explores the migration of Filipino nurses to Canada from 1957 to 1969. She found that Filipino nurses arrived through direct recruitment from hospitals in the Philippines, or through the U.S., where nurses who completed an exchange program would migrate northward instead of returning to Asia.

With the shortage of nurses in Canada, it wasn’t difficult for Filipino IENs to start working in Canadian hospitals right away, says Damasco. It also helped that the nurses who were educated in the Philippines went through an American curriculum, and eventually worked in hospitals with an Americanized setup.

“If you were to ask these nurses what they did as soon as they arrived in Canada, they said they didn’t have an orientation. They started working the next day. They already knew how to manage the floors, without having to receive additional training from the hospital. They knew what they were doing,” says Damasco.

“So these were candidates that [Canadian hospitals] really wanted, who fit the criteria that they were looking for.”