Making Sen$e chatted with three experts on the pay gap on Equal Pay Day. Here’s what they had to say on the pay gap, where it stems from and why it persists. Photo by Lucy Nicholson/Reuters

April 4 marks Equal Pay Day — how far into 2017 women would have to work to make what men made in 2016.

Making Sen$e chatted with three experts on the pay gap: economist Francine D. Blau of Cornell, managing director of the MacArthur Foundation Cecilia Conrad and economist Claudia Goldin of Harvard.

Here’s what they had to say on the pay gap, where it stems from and why it persists:

Francine D. Blau: Even when you level the playing field, women are still paid less

“It is important to know that we have made a great deal of progress in reducing the pay gap, but a significant gap remains, and it’s still a big issue,” said Blau, noting that in 1980, women earned about 60 percent of what men earned.

Today, women make 77 cents or 80 cents on a man’s dollar, depending on whether you look annual or weekly earnings of full-time workers, respectively.

But these are unadjusted figures, Blau said, and what one really wants to look at is how much women with similar qualifications earn relative to a man.

“In my most recent research with professor Lawrence Kahn, if you look at women and men with the same education and actual labor market experience, we find that women earn 82 percent of what the men earned,” Blau said. “If you also control for the occupation and industry, then the women earn 92 percent of what the men earned.”

Weighted, the pay gap is smaller, she said, but it’s still sizeable.

Cecilia Conrad: The pay gap affects all women, some more so than others

“Is it an education gap? Most of the evidence says no,” Conrad said. “People might also say [men and women] work different hours. And if we still control for that, the pay gap persists.”

Are the occupations women choose to blame for the pay gap? While women tend to go into occupations that pay less, there’s another question to ask, Conrad said: do women choose low-paying jobs or “are jobs that women do paid less?” New research from Cornell suggests the latter plays a factor.

“The other piece to [the pay gap] is that some of this is related to the constraints reflected in the work that women and men do at home,” Conrad said. Women’s professional choices may be constrained, because they have a heavier share of workload at home, caring for children and doing housework.

“It is important to recognize that the pay gap carries across ethnic and racial groups,” Conrad said. But it’s worse for some than it is for others.

Black women working full time make 71 cents on a man’s dollar. For Hispanic Women, that’s just 61 cents. White women, on the other hand, make 85 cents on a man’s dollar.

Claudia Goldin: The pay gap is real, but it has to do with some women’s choices.

The pay gap is real, Claudia Goldin said. “It’s not fake news.” The question is: Where does the difference in pay come from?

“There are a lot of people who talk about how women are worse negotiators, and when they bargain hard, they get punished. These topics get talked about a lot, because they seem like just the thing we can do something about,” Goldin said. “We can give employers implicit bias tests, we can train women to become better negotiators — but I think that the weight of the evidence is that we can do all of that and that we won’t move the needle as much as we want to.”

The fact is, she said, there are other factors at play: the ones women make their own choices about. “Women demand less work hours, they want more flexible hours,” Goldin said. “That costs something.”

“A lot of people will talk to you about the sexy issues” —  discrimination and negotiation — “and they can make them into the biggest things on earth, but trust me, if they were, they wouldn’t be here anymore,” Goldin said. In other words, the pay gap is partially women’s own making.

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U.S. Border patrol agents stand at an open gate on the fence along the Mexico border to allow Luis Eduardo Hernandez-Bautista to hug Ty’Jahnae Williams and his father Eduardo Hernandez (not in view) at the Border Field State Park in California. Photo by REUTERS/Mike Blake.

WASHINGTON – Homeland Security Secretary John Kelly says parents and children caught crossing the Mexican border illegally won’t be separated unless the “situation at the time requires it.”

Kelly said border agents could separate parents and children if, for instance, the mother is sick or addicted to drugs. But he said it won’t be routine.

Kelly’s comment to a Senate committee appears to reverse earlier statements that his agency was considering separation as a deterrent to would-be border crossers, mostly from Central America.

In his written testimony, Kelly said about 1,100 people traveling as families were caught trying to cross the Mexican border into the United States illegally last month.

Immigrant families and children traveling alone have accounted for hundreds of thousands of arrests at the border in recent years.

Kelly says the sharp decline in people crossing the southern border illegally won’t continue unless his agency gets the resources needed to secure the border. Kelly says a wall in the right places will do that job. He told a Senate panel that the wall won’t be from “sea to shining sea,” but in places where border agents say it would be most effective.

In his written testimony, Kelly says that fewer than 12,500 people were caught crossing the Mexican border illegally in March. It was the lowest monthly tally of arrests at the border in at least 17 years. The decline in arrests is a sign that fewer people are trying to cross the border illegally, he said.

This story will be updated as it develops

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White House Senior Advisor Steve Bannon attends a March roundtable discussion held by President Donald Trump with auto industry leaders in Ypsilanti Township, Michigan. Trump has removed Bannon from the National Security Council, reversing a controversial early decision to give Bannon access to the high-level meetings.Photo by Jonathan Ernst/Reuters

President Donald Trump has removed chief strategist Steve Bannon from the National Security Council, reversing an earlier, controversial decision to give Bannon access to the high-level meetings.

A new memorandum about the council’s composition was published Wednesday in the Federal Register. The memo no longer lists the chief strategist as a member of the Principals Committee, a group of high-ranking officials who meet to discuss pressing national security priorities.

Tom Bossert, the assistant to the president for homeland security and counterterrorism, also had his role downgraded as part of the changes.

A senior White House official said Wednesday that Bannon was initially placed on the National Security Council after Trump’s inauguration as a measure to ensure implementation of the president’s vision, including efforts to downsize and streamline operations at the NSC.

Trump’s first national security adviser, Michael Flynn, was at the helm of the NSC at the time, but the official said Bannon’s role had nothing to do with the troubles facing Flynn, who was asked to resign in early February for misleading the administration about his communication with Russian officials.

Flynn’s replacement, Lt. Gen. H.R. McMaster, was given free rein to reorganize the NSC as he saw fit. McMaster immediately expressing a desire to run a less hierarchical organization and be more accessible to his staff, something that created widespread frustration when Flynn was in charge, according to three current and former administration officials familiar with the changes.

As a participant of the Principals Committee, Bannon would have had the authority to call a vote if the president’s vision for the NSC was not being implemented. The committee, which includes top officials from various government agencies, meets regularly to address important policy issues.

The official said Bannon’s removal from the NSC was not a reflection of any change in his standing as one of Trump’s closest advisers. Bannon will maintain his security clearance as is standard for most top West Wing officials.

Steve Bannon, appointed chief strategist and senior counselor to President Donald Trump, arrives Jan. 20 for the Presidential Inauguration at the US Capitol in Washington, D.C. Photo by REUTERS/Saul Loeb/Pool.

Trump’s White House is facing allegations that it funneled secret intelligence reports to a Republican congressman leading an investigation into his campaign’s possible ties to Russian officials as well as Moscow’s interference in the 2016 election.

The New York Times last week identified two NSC officials as having helped House intelligence committee chairman Devin Nunes view secret reports. A U.S. official confirmed to The Associated Press that Ezra Cohen-Watnick had access to those kinds of intelligence materials, but maintained he did not play a role in helping the congressman gain access the documents. The official pointed instead to the other official named in The New York Times report, Michael Ellis, a White House lawyer who previously worked for Nunes on the House committee.

Senior administration officials said McMaster was out of town when these revelations occurred.

The senior White House official would not comment on who was responsible for the changes, but said they were a reflection of the confidence the president has in McMaster and were not in response to the recent controversy linked to the NSC.

The officials spoke anonymously because they were not authorized to discuss the changes or other details that have not been formally announced.

The new memo also restores the director of national intelligence and the chairman of the Joint Chiefs of Staff to the principals committee.

Bannon’s addition to the NSC sparked concerns from Trump critics, who said it was inappropriate for the political adviser to play a role in national security matters.

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Andrew Hawk, 52, displays a gun he made for his girlfriend, Jen, in his shop in Anchorage, Alaska. Hawk, a gunsmith, works from home along with Jen Jolliffe, an acupuncturist. Both receive health care coverage through the ACA and are concerned about what a GOP plan for health coverage would mean for them. (Photo by Ash Adams for Kaiser Health News)

ANCHORAGE, Alaska — When Andy Hawk needed hernia surgery last year, his biggest worry wasn’t the operation’s cost — it was whether he’d heal in time to lead a spring bear-hunting expedition on Kodiak Island.

For the first time, the self-employed gunsmith in the state with the nation’s highest medical costs and most volatile insurance market had some protection. He had coverage for all but $10,000 of the $45,000 tab.

“Before that, I was just damn lucky,” said Hawk, 52, who joined the Affordable Care Act marketplace in 2013.

But neither Hawk nor his girlfriend, Jennifer Jolliffe, 55, a self-employed acupuncturist also covered under the ACA, is resting easy.

The couple was relieved last month when Republican congressional leaders hastily withdrew the American Health Care Act, a GOP bill described by Sen. Lisa Murkowski (R-Alaska) as “a flawed replacement” for Obamacare, the common name for the ACA.

The bill’s failure left Obamacare intact while Republicans regroup on how to address rising insurance costs and other weaknesses with health care delivery. The issues are particularly acute in Alaska, the fourth most expensive state in the U.S., where a standard knee replacement might cost five times what it does in Seattle and pricey air ambulance rides are common in emergencies.

Individual health insurance premiums here climbed almost 40 percent annually after the ACA went into effect, and high health care costs drove all but one provider, Premera Blue Cross Blue Shield, out of the market in 2017.

Now, Hawk and Jolliffe are watching closely as state leaders grapple with preventing the online marketplace from collapsing in Alaska. Officials are seeking a $51.6 million federal waiver to shore up the individual insurance market.

“I just want everyone to have health insurance,” said Jolliffe, who suffered a life-threatening bacterial infection in 2009 that for her underscored the need for coverage.

Most of Alaska’s more than 738,000 residents receive health insurance through employers or government programs. About 30,000 obtained insurance under the Medicaid expansion in 2015 enacted under the ACA — the health law that was largely opposed by the 51 percent of Alaska voters who voted for President Donald Trump.

Even fewer residents buy insurance on the ACA’s marketplace. In that small private insurance pool, rates have soared because health insurers in the vast but sparsely populated state couldn’t sign up enough healthy people to offset costs for high-risk patients with expensive conditions such as end-stage renal disease and cancer.

Premera reported that last year it paid about $67 million in claims for individual members on the Alaska exchange, but about a quarter — more than $16 million — came from just 20 patients.

“Alaska has been quite a story over the last few years,” said Premera spokeswoman Melanie Coon. “It’s not like other states.”

With the market approaching collapse, Alaska lawmakers tackled the problem last year in a novel way, said Eric Earling, a senior vice president with State of Reform, a nonpartisan health policy communication group with a focus in the West.

State officials voted to levy a 2.7 percent tax on all insurers to create a $55 million reinsurance fund that covers bills for high-cost patients, stabilizing the individual market for the rest of the customers.

“The reinsurance program could be a model for others across the U.S.,” he said.

In the short run, it worked. Instead of an expected premium increase of more than 40 percent for 2017, Premera’s rates rose just 7.3 percent, Coon said.

The insurer reported March 29 that it made $20 million in the individual market in Alaska in 2016. That figure included $4 million in direct profits, $8 million in adjusted income carried over from 2015 and $8 million in federal risk adjustment funds, which help compensate insurers for enrolling high-risk patients, according to Jim Grazko, president of Premera’s Alaska operations. The new report cuts Premera’s losses in the state’s individual market through the ACA from more than $25 million to about $7 million over three years, he said.

Still, premiums remained the nation’s highest, $904 a month for a 40-year-old nonsmoker in Anchorage on Premera’s second-lowest silver plan, which sets the benchmark for subsidy levels. Enrollment on the Alaska individual exchange fell from about 23,000 people in 2016 to about 19,145 this year, according to the Centers for Medicare & Medicaid Services.

“I think we lost about 3,800,” said Lori Wing-Heier, director of the state Division of Insurance. “Some of them just could not afford it.”

The reinsurance fund — approved by a Republican-dominated Legislature and signed by an independent governor — was a one-year deal designed to prevent the state’s insurance market from imploding.

For a longer-term solution, state officials in December submitted a proposal to federal health officials known as a Section 1332 waiver, which allows states to seek “innovative strategies” for providing insurance. Alaska is asking that the federal government funnel $51.6 million that would have been paid for premium subsidies in 2018 into the reinsurance program. It would be authorized for five years, with a renewal option.

Such waivers have been encouraged by new Health and Human Services Secretary Tom Price, and Wing-Heier said she expects it to be approved “quite quickly” after state legislators tweak final language.

“It is a way of stabilizing the ACA in Alaska,” said Wing-Heier, who emphasizes that cutting health care costs is also crucial.

Alaska’s all-Republican congressional contingent — including Murkowski, Sen. Dan Sullivan and Rep. Don Young — have remained steadfastly opposed to Obamacare but did not support the Republican House bill.

“Healthcare is broken as it is today,” Young said in a March 21 press release that detailed his reservations. “We’ve seen the numbers — skyrocketing premiums, soaring deductibles and the loss of all but one insurer. Ultimately, I support efforts to repeal and replace the Affordable Care Act, but I also recognize that it’s very difficult to put the toothpaste back in the tube.”

Murkowski called the push for the AHCA “a reckless repeal process” and vowed that she wouldn’t support plans to cap federal funds for Medicaid that could endanger the newly insured.

“I don’t support pulling the rug out from people who have received coverage,” she said in a Facebook Live town hall on March 23. Murkowski has also opposed efforts to strip federal funding for Planned Parenthood.

That was welcome news to people like Cindy Stark, 61, who runs a small sewing and embroidery business outside Anchorage and gained health insurance through the state’s Medicaid expansion. She was badly injured in horse-riding accidents in 2003 and 2008 and had previously struggled to pay a $950 monthly premium and $5,000 deductible with private insurance. She hopes that recent efforts to cap Medicaid funding, possibly cutting enrollment, are over.

“I have asthma and the chronic pain,” said Stark, who voted for Hillary Clinton in the 2016 presidential election. “My medicine now keeps me on track.”

But constituents such as Sam Trotzke, 48, a partner in an accounting firm in North Pole, Alaska, criticized Murkowski, whom he called “a Democrat in Republican’s clothes,” for not working harder to repeal Obamacare.

Trotzke turned down his firm’s insurance in favor of a Christian health care sharing ministry called Medi-Share. It’s one of several growing programs across the U.S. in which medical care is paid for through monthly payments — called “shares” — of faith-based followers.

Wing-Heier estimates that such programs have become popular with some Alaskans on the wrong side of the ACA’s “subsidy cliff,” a reference to the cutoff for federal premium subsidies at 400 percent of the poverty level.

Instead of more than $2,600 a month in health insurance premiums, Trotzke said he pays $634 for coverage for himself and his wife, Shauna, 44, and their daughters, Tessa, 12, and Anna, 8. Preventive care, dental visits and eye appointments come out of his pocket.

“It’s the way health insurance should be. They’re paying the big costs. I’m paying the doctors’ visits. Health insurance shouldn’t be covering every little thing,” said Trotzke, who voted for Trump.

With the cost-sharing plan, Trotzke said he feels as if he has more control over his health care spending. He’d like to see the ACA repealed and replaced with a plan with fewer regulations.

“It’s our overlords in Washington, D.C., dictating to us how we have to run our business,” he said. “That just rubs me the wrong way.”

Back at the Anchorage gunsmith shop, where custom rifles and rebuilt shotguns line the walls beneath moose antlers and a wolverine pelt, Hawk has a different take.

The ACA isn’t perfect, he said, but the insurance plan means that he and Jolliffe can lead active Alaskan lives — hunting, fishing, skiing — without worrying about costs of a medical catastrophe.

Hawk, a Clinton voter, worries about Trump’s vows to “let Obamacare explode” and said he fears the administration will go out of its way to undermine the health care law — even without a full repeal.

“We don’t smoke, don’t drink, we’re doing our part,” said Hawk, who added: “I don’t understand why they couldn’t just fix it.”

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Don’t hurt yourself, but Beyoncé has a new video out.

On Tuesday, Beyoncé released a music video to celebrate nine years since Jay Z decided to put a ring on it.

The song isn’t new. “Die With You” first emerged in 2015 for the celebrity couple’s seventh anniversary. The video, in some respects, is a spiritual cousin to “All Night,” another home footage homage on “Lemonade,” Beyoncé’s 2016 visual album. But “All Night” largely kept Jay Z’s presence to a minimum, a creative choice that was consistent throughout the album that doubled as an ode to black womanhood.

Here, in the video for “Die With You,” Jay Z shares the frame with Beyoncé at their wedding, vacations and with their daughter Blue Ivy. (Jay Z is also seen presumably playing backgammon.) If “All Night” was a hopeful outlook on mending a fractured relationship in the wake of infidelity, the images in “Die With You” (publicly) show the logical progression of rebuilding trust.

The video was released on the music streaming service Tidal. No surprise there. Nor is it a surprise that Beyoncé continues to release these repeated, brief glimpses into the couple’s lives. It’s “Beyoncé pulling a Beyoncé,” as Salamishah Tillet of the University of Pennsylvania once told the NewsHour, reminding us of her ability “to tightly control her narrative, whether it’s around issues of marital infidelity or simply what she wants to say politically.”

Beyoncé’s sixth studio album, “Lemonade,” made an immediate impact with its innovative release as a visual album on HBO and through the music streaming service Tidal. For more on the groundbreaking work, which addresses both her personal troubles and the larger history of black women, Jeffrey Brown talks to Salamishah Tillet of the University of Pennsylvania.

Still, the collective freak-outs over anything coming from the Knowles pipeline is to be expected — and welcomed. (Did you catch a pregnant Beyoncé, Blue Ivy in belly, in the video?) The comparisons to Nina Simone, who was unapologetically black and political in her time, are also apt. Beyoncé’s career is an example of how a black artist can wrestle control of her work, an option not always available to black women. She has also used that platform to elevate other black artists, ones seen and heard in “Lemonade.”

Jamilah King of Mic said it best: “Black art has always been profitable, but it’s rare for a black artist — and a black woman, at that — to reap those profits. But Beyoncé is proof that it’s possible.”

Amen.

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WASHINGTON — President Donald Trump says a suspected chemical attack by the Syrian government against civilians “crossed a lot of lines.”

At a joint press conference Wednesday with Jordan’s King Abdullah II, Trump told PBS NewsHour’s John Yang that his attitude about Syria’s President Bashar Assad and about Syria has “changed very much.”

He repeated his accusations that the Obama administration issued a “blank threat” to the Assad government that using chemical weapons would result in consequences.

Trump says it was “not one of our better days as a country” when the previous administration failed to act on those threats. He acknowledged that now “I have that responsibility and I will carry it proudly.”

Watch Trump answer a question from PBS NewsHour’s John Yang in the player above.

The United States and Russia were trading conflicting assertions Wednesday about who launched a chemical weapons attack in Syria that killed 72 people, as world leaders grasped for a response to the latest atrocity in Syria’s intractable civil war.

As Trump stood by his charge that Assad’s forces were responsible, Russia disagreed. The staunch Assad ally insisted that the chemicals were dispersed when Syrian warplanes bombed a facility where rebels were building chemical weapons.

At the United Nations, Trump’s envoy threatened unilateral U.S. action if the world body failed to act.

“When the United Nations consistently fails in its duty to act collectively, there are times in the life of states that we are compelled to take our own action,” Haley declared. She addressed an emergency meeting of the Security Council, which was weighing a resolution condemning chemical weapons use in Syria. Russia, which has veto power, is opposed.

Yet in Moscow, Russian Foreign Ministry spokeswoman Maria Zakharova focused her attention elsewhere: “It’s necessary to demand that the rebels offer full access to study the area and collect necessary information.”

MORE: What we know about the chemical weapon attack in Syria

Leaders and officials in other countries, including Britain and Israel, joined the U.S. in saying Assad’s forces were responsible.

A U.S. official said an American review of radar and other assessments showed Syrian aircraft flying in the area at the time of the attack. Russian and coalition aircraft were not there at that time, said the official, who wasn’t authorized to discuss intelligence publicly and requested anonymity. Washington hasn’t yet concluded what type of chemical was used.

On Tuesday, President Donald Trump split the blame between Syria’s embattled leader and former President Barack Obama for the country’s worst chemical weapons attack in years.

While calling the attack “reprehensible” and intolerable, Trump said Obama “did nothing” after Assad crossed the former U.S. leader’s “red line” in 2013.

“These heinous actions by the Bashar al-Assad regime are a consequence of the past administration’s weakness and irresolution,” Trump said.

The political tone of Trump’s statement took many U.S. officials by surprise. They noted that U.S. presidents have rarely attacked their predecessors so aggressively for events like chemical weapons attacks that Democrats and Republicans both abhor.

“My attitude toward Syria and Assad has changed very much,” Trump said.

Several officials involved in internal administration discussions said Trump’s National Security Council had been preparing a different statement, until the president’s closest advisers took over the process. The officials weren’t authorized to speak publicly on the matter and demanded anonymity.

Heartbroken and outraged by the images coming out of Syria following the atrocious chemical attack yesterday.

— Ivanka Trump (@IvankaTrump) April 5, 2017

The president’s eldest daughter and top adviser, Ivanka Trump, took a more compassionate tone, tweeting Wednesday, “Heartbroken and outraged by the images coming out of Syria following the atrocious chemical attack yesterday.”

At least 72 people died in the town of Khan Sheikhoun. The World Health Organization said victims seemed to show symptoms consistent with nerve agent exposure. Videos from the scene showed volunteer medics using firehoses to wash the chemicals from victims’ bodies and lifeless children being piled in heaps.

A flurry of activity across the U.S. government signaled fresh urgency on the Syria crisis. Days earlier, White House and others officials suggested removing Assad from power was no longer a priority. They said the focus was defeating the Islamic State group.

Secretary of State Rex Tillerson planned to discuss the attack and the Syria crisis next week when he makes his first official trip to Moscow, the State Department said.

Trump addressed the attack in Syria during a joint news conference with Jordan’s King Abdullah II on Wednesday.

For Trump’s critics, though, it wasn’t enough. Sen. Bob Casey, D-Pa., criticized the White House by noting that Trump hadn’t mentioned Russian President Vladimir Putin or Russia’s role in the U.S. response. Tillerson accused both Russia and Iran, Syria’s other top ally, of sharing moral responsibility in his own statement Tuesday.

“This was a moment the president could have spoken with moral authority and with the beginning of an outline of a strategy,” Casey said. “And we don’t see it.”

Four years ago, after warning Assad that a chemical attack would cross a red line and trigger U.S. action, Obama failed to follow through. Rather than authorizing military action against Assad in response to a sarin gas attack that killed hundreds outside Damascus, Obama opted instead for a Russia-backed agreement to remove Syria’s chemical weapons stockpiles.

That was seen internationally as a major blow to U.S. credibility and, for Obama’s critics, a prime example of weak leadership. Syrian chemical weapons attacks continued after the deal.

Yet Trump was in agreement with Obama’s ultimate decision. Among his tweets on the matter, he urged Obama in all caps, “DO NOT ATTACK SYRIA — IF YOU DO MANY VERY BAD THINGS WILL HAPPEN.”

Associated Press writers Vivian Salama and Lolita C. Baldor in Washington, Vladimir Isachenkov in Moscow and Edith M. Lederer at the United Nations contributed to this report.

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Dr. Scott Gottlieb testifies before a Senate Health Education Labor and Pension Committee confirmation hearing on April 5 on his nomination to be commissioner of the Food and Drug Administration on Capitol Hill in Washington, D.C. Photo by REUTERS/Aaron P. Bernstein.

WASHINGTON — President Donald Trump’s nominee to head the powerful Food and Drug Administration told senators Wednesday that tackling the opioid crisis would be a top priority and pledged that science will prevail despite his extensive financial ties to medical companies the agency regulates.

Dr. Scott Gottlieb is a physician-turned-health consultant who has criticized what he calls unnecessary FDA regulations and has what critics call his unprecedented financial entanglements. But Gottlieb told a Senate health committee that impartial science does and must continue to guide FDA’s decisions.

Gottlieb said that as a cancer survivor, he knows firsthand the importance of “what the FDA does for every one of us” and stressed the balance between speeding drugs to the market and making sure enough is known about their safety.

“We save lives by allowing good things to happen, but we also save lives when we prevent bad things from happening,” Gottlieb said, calling FDA’s enforcement rules “the bedrock of its mission.”

Among his top priorities, Gottlieb said, would be tackling opioid addiction, what he called “the biggest crisis facing the agency,” through development of non-addictive alternatives as well as addiction treatments.

Gottlieb is no stranger to the FDA, which regulates products that affect about a quarter of all consumer spending — everything from new drugs and medical devices to food safety, nutrition labeling, tobacco and e-cigarettes and cosmetics. He was a deputy commissioner under President George W. Bush.

“My hope is that you will help move the agency forward so that America’s patients benefit from the remarkable discoveries our nation’s researchers are working on,” said Sen. Lamar Alexander, R-Tenn., who chairs the health committee.

But critics have focused on Gottlieb’s finances, citing government data showing he received hundreds of thousands of dollars in consulting or other fees from several FDA-regulated companies in recent years, including giant GlaxoSmithKline and Vertex Pharmaceuticals.

In ethics documents filed last week, Gottlieb said that if confirmed he would recuse himself for a year from decisions involving about 20 companies. He also said he would resign from positions in a venture capital firm and investment bank that fund health companies, and as a board member or consultant to nine other health-related companies. Gottlieb’s day job is as a resident fellow at the conservative American Enterprise Institute, from which he said he also would resign.

But Sen. Patty Murray of Washington, the committee’s senior Democrat, questioned whether recusals are enough to erase the bias of being a pharmaceutical industry insider when dozens of drugs being developed by those companies could come before the FDA.

“What I’m concerned about is how your involvement with so many companies shapes your priorities,” she said.

Gottlieb responded, “I get it. I understand how important the impartiality of this agency is so people continue to have trust in the decisions FDA makes.”

“I want to earn and keep the public’s trust,” he said.

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The Obama administration praised Baltimore’s efforts to combat the opioid epidemic. Under the Trump administration, it is unclear how the nation will face this public health crisis. Photo by Frank Carlson/NewsHour

BALTIMORE — Anthony Green says he woke up one morning in January and decided to quit drinking. “I said to myself, ‘If I want something better, I’ve got to do better.’ ” That’s what landed him at Gaudenzia, a residential drug and alcohol treatment center here in North Baltimore.

Green, 38, went through alcohol withdrawal on his own and two weeks later walked into Gaudenzia’s recently constructed one-story gray and white clapboard building. He was admitted the same day and the city agreed to pay his bill through a limited grant for city residents.

“Anthony was extraordinarily lucky,” said Greg Warren, regional manager of Gaudenzia’s treatment centers in Maryland, Delaware and Washington, D.C. “Walking in and getting admitted the same day almost never happens.

“That motivational moment Anthony had is fleeting,” Warren said. “If you don’t capture that moment, people will disappear.”

But in the throes of an opioid epidemic that killed more than 33,000 people in 2015 alone, the nation’s supply of residential treatment slots falls far short of the number needed to serve everyone who walks in, gets dropped off by police, or is transferred from a hospital or crisis center. Waitlists persist almost everywhere, primarily because of a growing number of people addicted to heroin and prescription painkillers.

READ MORE: In the war on heroin, Baltimore drug programs face an uncertain future

To boost the number of beds available for low-income residents, the federal government has granted California, Maryland, Massachusetts and New York a waiver of an obscure Medicaid rule that prohibits the use of federal dollars for addiction treatment provided in facilities with more than 16 beds. Seven other states — Arizona, Indiana, Illinois, Kentucky, Michigan, Utah and Virginia — are seeking similar permission.

In March, the Trump administration’s new Health and Human Services secretary, Tom Price, told governors that the agency would continue the Obama administration’s waiver policies for residential facilities with 16 or more beds.

For Gaudenzia, which has four residential treatment centers in Maryland, the waiver is a game changer, Warren said. “It’s going to explode access.”

An Outdated Rule
The 16-bed provision was originally intended to discourage investment in what the 1965 Medicaid law called “institutions for mental disease,” and to instead promote the expansion of smaller, community-based mental health and substance abuse centers.

But for Gaudenzia and other behavioral health providers struggling to meet the surging demand for addiction services, the rule has curtailed much-needed federal funding to accommodate all the people who needed help.

Sidestepping the 16-bed prohibition means millions in new federal Medicaid dollars will flow to treatment centers that now rely on limited state and local grants.

The federal government is encouraging all states to seek a waiver of Medicaid’s residential treatment rule, but only if the care is offered as part of a comprehensive set of addiction services for low-income people.

In addition to offering inpatient treatment to patients who need it, state Medicaid addiction programs must include all available addiction medications, intensive outpatient therapy, recovery support services such as job training and housing, substance abuse prevention programs, case management and physical health services.

States also must prove that adding more residential treatment slots to the list of Medicaid treatment options will cost no more than continuing to prohibit it.

That should be easy, said Chuck Ingoglia, senior vice president for public policy at the National Council for Behavioral Health, which represents treatment providers. The long-term cost of not treating people with addictions far exceeds the cost of all levels of treatment, including residential care.

According to the National Institute on Drug Abuse, every dollar invested in addiction treatment yields a return of up to $7 in reduced drug-related crime and criminal justice costs. When health care savings are included, the return on investment can exceed $12.

READ MORE: Here’s what Trump’s new executive order means for opioid addiction

Rising Demand
An estimated 22 million Americans have a drug or alcohol addiction that needs treatment, yet only one in 10 receive it. Because loss of income is a symptom of addiction, inability to pay is among the biggest barriers.

The Affordable Care Act, with its Medicaid expansion to non-elderly low-income adults — a group that is more susceptible to substance abuse than the general population — went a long way to making treatment more available, at least in the 31 states and Washington, D.C., where the option has been adopted.

Medicaid expansion, plus the federal health law’s requirement that all insurance carriers reimburse for addiction services, along with the Mental Health Parity and Addiction Equity Act’s requirement that addiction treatment be paid for at the same level as medical and surgical services, together hold out the potential that billions of dollars for addiction treatment will be available in the years ahead.

Lifting the 16-bed limit will free even more federal money, making it possible for addiction treatment providers to expand their capacity, Ingoglia said. But, he said, it’s not likely to result in treatment on demand overnight.

California was the first state to receive a federal Medicaid waiver, in December 2015. More than two years later, California’s counties, which operate separate Medicaid programs, are still ironing out details on reimbursement rates and quality standards.

Maryland’s waiver program, approved in December, is slated to take effect July 1. In the meantime, the state will set licensing and staffing requirements, and develop reimbursement rates and billing rules.

Gaudenzia’s Warren said it’s uncertain whether the rates Maryland adopts will adequately cover new staffing requirements. But he already has plans to triple the number of beds available for people who want to withdraw from the substances they are addicted to.

That’s a critical first step in the path to recovery that has been a bottleneck here in Baltimore and in many other places. Next, he said, Gaudenzia plans to double the number of slots for 28-day residential therapy following withdrawal.

In Massachusetts, the new waiver program is projected to increase the number of residential treatment beds by 20 percent in the first three years, said Vic DiGravio, CEO of the state Association for Behavioral Healthcare, which represents treatment providers. Unlike Maryland, Massachusetts has an adequate number of detox beds for people who want to withdraw from drugs or alcohol, but not enough beds for intensive 28-day treatment after that.

READ MORE: Opioids as a first response to pain? Hospitals are rethinking that policy

“We have a four-lane highway leading into detox,” DiGravio said. “But it quickly turns into a one-lane gravel road into lower levels of residential care.” As a result, too many people cycle through detox, he said. Adding more follow-up residential treatment slots will lower patient relapse rates, which ultimately will save the state money.

Not for Everyone
In Baltimore, Green voluntarily committed himself to six months of residential care to beat his alcohol addiction. He said he was drinking a fifth of vodka and at least two 40-ounce beers every day, and his life was going downhill fast.

He tried to stay sober after a three-year stint in prison that ended in 2008. But the frustration of repeatedly being rejected for jobs because of his criminal record led him to drink again, he said.

“This is the first time in my life I’ve been so sincere about anything. I want to get back on track and move my life forward,” Green said. Staying at Gaudenzia and attending motivational classes six hours every day feels right, he said.

“They push you to want better and achieve your best even if you don’t believe you can do it. Outside these doors, that doesn’t happen.”

But not everyone with a drug or alcohol addiction wants or needs residential treatment. Unlike other addictive substances, including cocaine and amphetamines, opioid addiction can be kept at bay with medications and outpatient therapy. Medications also can successfully treat alcohol addiction, but depending on a patient’s home environment and support system, medications alone may not work.

For Green, staying away from his community made the most sense. “I don’t want anyone to distract me,” he said. “I have to distance myself away from friends because a lot of my friends don’t want what I want, and I know that road all too well.”

Although greater use of addiction medications, including methadone, buprenorphine and Vivitrol, has been advocated at the federal and state level, residential care is still considered an essential treatment option for many.

It can be the only effective option for people with addictions to alcohol, cocaine, amphetamines or marijuana, for example. And it is often needed for people with opioid addictions who are also hooked on other substances, according to treatment guidelines set by the American Society of Addiction Medicine.

In general, publicly funded residential care is recommended for people at high risk of harm from their addictions, including those who have recently been released from jail or prison, pregnant women, people who have mental health conditions and the homeless.

In public hearings on the Medicaid waiver in Maryland, state Medicaid Director Shannon McMahon said, “We heard no objections, only screaming loud supportive voices.”

The post This obscure Medicaid waiver opens up more beds for opioid treatment appeared first on PBS NewsHour.

In a new book, NPR science reporter Richard Harris picks through a pestilence that is corroding health research: the reproducibility crisis. Photo by Rhoda Baer/via NIH Flickr

In his new book, NPR reporter Richard Harris picks through a problem that may corrode the future fortunes of health research if it isn’t fixed: the reproducibility crisis.

As a former biomedical researcher, I would describe “Rigor Mortis: How Sloppy Science Creates Worthless Cures, Crushes Hope, and Wastes Billions” as a frustrating read — frustrating and timely. Science is a pyramid. Researchers build on each other’s findings, and this founding creed relies on being able to replicate experiments conducted by other labs. But scientists in biomedicine are struggling to reproduce the work of others, hence the reproducibility crisis. And as Harris explains in 240 or so pages, the problem is costing taxpayers:

The issue of reproducibility in biomedical science has been simmering for many years. As far back as the 1960s, scientists raised the alarm about well-known pitfalls—for instance, warning that human cells widely used in laboratory studies were often not at all what they purported to be. In 2005, John Ioannidis published a widely cited paper, titled “Why Most Published Research Findings Are False,” that highlighted the considerable problems caused by flimsy study design and analysis.

…
At issue is not simply that scientists are wasting their time and our tax dollars; misleading results in laboratory research are actually slowing progress in the search for treatments and cures. This work is at the very heart of the advances in medicine.

Basic research — using animals, cells, and the molecules of life such as DNA — reveals the underlying biology of health and disease. Much of this endeavor is called “preclinical research” with the hope that discoveries will lead to actual human studies (in the clinic). But if these preclinical discoveries are deeply flawed, scientists can spend years (not to mention untold millions of dollars) lost in dead ends.

Taken out of context, Harris’ book could be used to question the annual $30 billion budget for the National Institutes of Health, which supports 27 different institutes and centers along with hundreds of thousands at universities and organizations. Yet the book is less a laundry list of serious shortcomings, and more a blueprint for ways to improve academic research on the whole.

READ MORE: Do taxpayers get their money’s worth from the National Institutes of Health?

Once a problem reserved for backroom discussions at conferences, the reproducibility crisis has become firmly mainstream. Last Week Tonight with John Oliver touched on this concept last year with his imprecisely named segment “Science Studies” — most of the research mentioned in the piece involved health, not general science.

Explorations in physics, chemistry and much of biology are readily repeatable. But as Harris explains, such sloppy maneuvers are more dangerous for biology, where “there are many variables and a great deal of natural variation. It’s harder to see phenomena and harder to make sure personal biases don’t creep in.”

“The rate of new-drug approval has been falling since the 1950s. In 2012, Jack Scannell and his colleagues coined the term “Eroom’s law” to describe the steadily worsening state of drug development. “Eroom,” they explained, is “Moore” spelled backward.” — Richard Harris, Rigor Mortis. Photo by National Cancer Institute, National Institutes of Health/Flickr

Each page of Harris’ book expands on this idea, outlining major flaws in biomedical research conducted in academic settings. Popular promises made with stem cells, genomics and personalized medicine unravel under his pen. Part of one cringeworthy chapter dives into repeated examples of misinterpreted statistics that make results sound more valid than they are. Another was completely devoted to drug studies in mice and their inability to yield remedies that work in humans:

Malcolm Macleod, a neurologist at the University of Edinburgh, worries about biomedicine’s dubious reliance on mice. He has spent much of his career trying to find ways to reduce the brain damage caused by strokes. In hundreds of animal experiments, mostly using mice, drugs have shown promise for treating stroke. Billions of dollars have gone into this research, and yet not one single drug acting on brain cells has been shown to be helpful when tested in people (the drug tPA is effective by breaking down clots and helping restore blood flow, but it doesn’t act on nerve cells damaged by a stroke). Neurologists started calling this long string of failures a “nuclear winter” for stroke research.

“My reading of the animal data for stroke is that it’s not possible to say if they’re good or bad models,” Macleod told me. It could be that experimentally induced strokes in mice are so radically different from a human stroke that there are no real lessons to learn. Or it could be that the experiments have been carried out so loosely that they have led the entire field astray.

Or could it be that stroke and other unremedied conditions, especially neurological ones, are extraordinarily complicated? Rigor Mortis does a great job of exposing pitfalls in modern biomedicine, but on occasion, it overstates these problems and their possible solutions, such as in this example with stroke.

Our brains demand more energy than any other organ. So, when a stroke cuts blood flow to the brain, even for a few minutes, havoc ensues. Some brain cells burst open, leaking inflammatory contents everywhere. Other cells persist and may take days to weeks to perish for myriad underlying reasons.

In an ideal world, doctors would be able to monitor or tinker with individual cells in a human brain, but right now, poking around inside a human head isn’t a feasible or ethical option. Biomedical researchers use mouse models to tease apart what’s behind this mess because rodents, as mammals, share many genetic and physiological traits with humans.

An intestinal organoid. Photo by St Johnston D (2015) The Renaissance of Developmental Biology. PLoS Biol 13(5): e1002149. doi:10.1371/journal.pbio.1002149

Harris mentions emerging alternatives, like induced pluripotent stem cells or clumps of cells called organoids, which are essentially new-age ways to test drugs in petri dishes. But if you think these models can act as a substitute for the complexity of any organ in a living creature, good luck.

Throughout the narrative, Harris points out several attempts to improve reproducibility. Companies responsible for lab supplies are taking extra precautions to validate materials before selling them. Some research facilities, such as the ALS Therapy Development Institute in Cambridge, Massachusetts, are now devoted to double checking experiments performed by others.

Pharmaceutical companies have taken on some of the burden, given academia feeds private-sector searches for new drugs. A false lead for a clinical trial can cost a company millions of dollars. Yet based on Harris’ book, pharmaceutical companies conduct much of their reproducibility testing in-house and the results aren’t always made public. Also, given pharma’s dependence on academia, one might expect hefty investments into universities, but a 2012 Congressional report found private companies provide only six percent of the nation’s basic research funding.

Harris highlights the competition for research funding as part of the problem. Due to factors like inflation, the rising costs of conducting research and the recession, funds for the National Institutes of Health have fallen 25 percent over the past decade. Tight budgets mean less room for scientists to rigorously test their hypotheses.

Yet the main takeaway from Harris’ discussions of mouse models and other examples of wasteful research is that science needs to slow down. The race for breakthroughs has caused researchers to cut corners when it comes to rigorous exploration — and the book features a number of memorable human patients who are paying the price with their lives:

If we curb our enthusiasm a bit, scientists will be less likely to run headlong after dubious ideas like transdifferentiation, and the public will be less likely to embrace the latest dietary fad. Of course this is a discouraging point of view for patients and advocates looking for rapid progress in the search for treatments and cures. But it’s important to distinguish between speed and haste.

The post Why bad science is plaguing health research — and how to fix it appeared first on PBS NewsHour.

John Glenn, the first American to orbit the Earth and one of NASA’s original seven Mercury astronauts, will be laid to rest Thursday at Arlington National Cemetery in Arlington, Virginia.

The ceremony is expected to begin around 9 a.m. on Thursday, April 6. Watch live in the player above.

Glenn died in December at age 95. Thursday would have been his 74th wedding anniversary with his widow, Annie Glenn.

Before joining NASA, the Ohio native was a highly decorated Marine pilot in World War II and the Korean War, flying 149 combat missions. In 1957, he set a transcontinental speed record, flying from Los Angeles to New York in 3 hours and 23 minutes.

He worked for NASA from 1959 to 1964 before working as an executive for Royal Crown Cola and then launching a bid for the U.S. Senate. He served for 25 years before retiring in 1999.

Space also beckoned again: In 1998, he blasted off aboard the space shuttle Discovery as part of a mission to study space’s impact on elderly bodies. Here, he set another record, as the oldest person ever to fly in space.

“I think if we can help some of these events of the past help bring alive some of those experiences for our young people today,” Glenn said when asked by PBS NewsHour’s Judy Woodruff what it means to him to be seen as a hero, “where we whet their interest in science and technology and engineering and math, it will all be well worthwhile.”

The post WATCH LIVE: Astronaut John Glenn laid to rest at Arlington National Cemetery appeared first on PBS NewsHour.

Photo by Molly Riley/Reuters

Many are the accusations. Deep is the muck. Here are some crisp answers about the filibuster and nuclear option in play in the battle over Neil Gorsuch’s nomination to the U.S. Supreme Court.

What is a filibuster? Exactly. It is a broad term. And misunderstood. The U.S. Senate states that a filibuster is “any attempt to block or delay Senate action on a bill or other matter by debating it at length, by offering numerous procedural motions, or by any other delaying or obstructive actions.” A more fun fact: the word “filibuster” comes from the Dutch word for pirate.

Where do 60 votes come in? This involves history. For its first 127 years, the Senate allowed any member to speak as long as they wanted. There was no way to stop them. Only decorum. This increasingly was used to derail bills, and in 1917 the Senate passed a rule (rule XXII) to curb the potential madness: a ⅔ vote could end debate. This is called cloture. The cloture standard was decreased to a ⅗ vote in 1975. With 100 senators, that means 60 votes.

What does that have to do with the “nuclear option?” Or Harry Reid? Now we are getting there. As President Obama took office, Republicans started blocking more nominees, requiring more 60-vote cloture motions. (Both sides used filibusters in modern times.) By 2013, Democrats faced a relative backlog on courts and filibusters of key players like Defense nominee Chuck Hagel. Then-Majority Leader Harry Reid decided if they could not win under the rules, Democrats would rewrite the rules of the Senate. (How he did it and how it works is a bit more complicated.) From then on, nominees only needed 51 votes, not 60.

Except Supreme Court nominees. That’s right, Reid lowered the bar for all nominees except the Supreme Court. Which is why GOP Leader Mitch McConnell, who does not have 60 votes, is considering going nuclear to confirm Judge Gorsuch.

Why is it so “nuclear?” The idea goes back to the ‘70s, but parliamentary master and former senator Trent Lott is credited with the term “nuclear option.” This is because it wipes out hundreds of years of a defining Senate trait — that the minority can wield substantial power. And it is dangerous to deploy. What helps your party now when you control power, could be toxic when you are once again in the minority.

So, what will it mean if McConnell goes nuclear? That remains to be seen, but at the least it will fundamentally change the calculus for selecting Supreme Court nominees. Presidents with control of the Senate will no longer need to pick nominees that can garner bipartisan support. Some argue it could open the door to abandon the 60-vote threshold on bills as well. But McConnell is a historian and devotee of the Senate and had given no indication such a change is on the table.

The post Analysis: What you need to know about the filibuster and the Supreme Court appeared first on PBS NewsHour.

Under the Trump administration’s budget proposal, SHIP’s modest $52 million budget would be obliterated by $49 million, leaving the program with only $3 million. Photo by Mike Segar/Reuters

Editor’s Note: Journalist Philip Moeller is here to provide the answers you need on aging and retirement. His weekly column, “Ask Phil,” aims to help older Americans and their families by answering their health care and financial questions. Phil is the author of the new book, “Get What’s Yours for Medicare,” and co-author of “Get What’s Yours: The Revised Secrets to Maxing Out Your Social Security.” Send your questions to Phil.

The State Health Insurance Assistance Program (SHIP) once again finds its neck on the federal chopping block. SHIP provides free Medicare counseling from local folks who can talk about the many state and local rules that can affect how Medicare works in different communities.

Under the Trump administration’s budget proposal, SHIP’s modest $52 million budget would be obliterated by $49 million, leaving the program with only $3 million. I’d love to see the new spin doctors at the U.S. Office of Management and Budget (OMB) explain why they kept even $3 million. Maybe it’s for legally mandated severance pay.

The Medicare Rights Center (MRC), a nonprofit that also helps people with their Medicare needs, provided a summary of what SHIP does as it protested the proposed cut:

In 2015, SHIPs helped about 7 million people with Medicare sift through more than 20 prescription drug plans, 19 different choices of Medicare Advantage plans, and various Medigap supplemental insurance policies, all of which come with different premiums, provider networks, rules around coverage, and out-of-pocket costs.

Here is OMB’s explanation for its decision:

The State Health Insurance Assistance Program (SHIP) makes competitive grants to states to provide information and assistance to Medicare eligible individuals about health insurance coverage. This level [of funding] would eliminate all grants and leverage alternative sources for Medicare beneficiaries to obtain access to reliable information to better understand and manage benefits (e.g., 1-800-Medicare).

Ah, 1-800-MEDICARE. I feel better already!

“Unfortunately, contractor-administered services like 1-800-MEDICARE cannot replace the essential, localized one-on-one assistance provided by SHIPs,” the MRC said. “SHIPs are extremely efficient and volunteer driven, and SHIP grants are vital to ensure comprehensive counseling is available to people with Medicare and their families.”

READ MORE: Column: As Republicans debate health bill, let’s remember why Americans want Obamacare repeal

SHIP has been threatened before by some congressional Republicans with the loss of funding, but this latest threat carries the weight of the White House.

I regularly recommend SHIP to help readers and only wish there was more money for such education efforts. I wrote an entire book about what consumers need to know about Medicare and had to leave out enough valuable information to fill two or three more books. I simply cannot understand why the government spends more than half a trillion dollars every year on Medicare services, but nearly nothing to help consumers understand and use these invaluable benefits.

I know I am starting to sound like a broken record here, but if you have a phone, use it to call your representative. Better still, read more about other proposed federal cuts to senior programs. Then call.

I want to begin this week with a return to some Social Security basics. I continue to get many questions on these matters, and while I’ve answered them before, I hoped it might be helpful for new and returning readers to review them here. Let me know if there are Medicare or other Social Security basics that you would find useful for me to update.

Mary: I am confused. Even after reading your Social Security book and talking to local Social Security Administration personnel, I do not understand what I can do or cannot do.

I am 63 and divorced after almost 20 years of marriage, with no alimony. I still work full-time for a municipality and devote 12 percent of my pay to a pension. My ex is 74 and started collecting his Social Security at 62.

The Social Security Administration told me I must collect on my account first — approximately $400 a month — but that I cannot do this because I make too much money ($48,000).

A woman I work with was in the same situation as myself, but after she got on the telephone with the Social Security Administration, she started collecting immediately on her ex’s earnings while still working full time. Furthermore, she was told she could have started collecting on her ex’s earnings two years earlier! All done with a telephone conversation.

What am I missing here? And where should I go, who do I ask, and what do I ask? I live a very meager life because of lack of funds. I am caring for my adult son who suffers severe depression, and I keep getting turned down by government agencies for financial assistance, because again, I earn too much.

I will not live to be 80 or 90, my savings are almost depleted now, and I am one paycheck away from financial disaster. I am alive now, and if I can get a little more help, I’ll be happy to just keep my head above water.

Phil Moeller: I am sorry you are having such a hard time. These rules are complicated, so let me walk through them to give you an idea of your options. You can find further details by going to the web pages that I’ve linked to.

Social Security has what are known as “deeming” rules. If you tried to file a claim for an ex-spousal benefit right now, the Social Security Administration would deem you to also be filing for any other benefit to which you are eligible. In your case that would be your own retirement benefit.

READ MORE: How does Social Security’s cost of living adjustment affect Medicare?

However, as you found out, there is another Social Security Administration rule that is now preventing you from getting benefits. It’s called the earnings test. At your age, it would reduce your benefits by $1 for every $2 you earn in excess of $16,920 this year. Since you earn more than $28,000 above this threshold, the test would wipe out your benefits.

The earnings test, however, is no longer applied to people once they reach what Social Security calls full retirement age. For you, this is 66 years of age. This means that any benefits you claim at that age will not be reduced by the earnings test.

In your case, full retirement age might also be significant for another reason.

Your note says you’re now 63. In your case, the date you turned 62 is very important. If you celebrated your 62nd birthday on or before the beginning of 2016, you qualify for a Social Security claiming strategy that was eliminated last year by Congress for younger people.

If you were 62 by then and you can wait to claim benefits until age 66, you can file what’s called a restricted application for just your ex-spousal benefit while letting your own retirement benefit grow by 8 percent a year until you turn 70. As it turns out, 66 is also the age at which your ex-spousal benefit would reach its maximum value.

This strategy only makes sense if your own retirement benefit is or would be greater if you file for just your ex-spousal benefit at age 66 while allowing your retirement benefit to grow. If it isn’t, then you should just file for your ex-spousal benefit at age 66 and keep receiving it for the rest of your life.

In either event, it is important for you to figure out the amount of your ex-spousal benefit and how it compares with your own retirement benefit. I’m guessing from your note that your ex-spousal benefit is larger. You can open an online Social Security account to get access to details about your benefits, but you’ll need Social Security’s help to access your former husband’s earnings record and find out about your ex-spousal benefit. I don’t know if Social Security has already done this for you or not, and sometimes it can be a hassle to get this information.

This is complicated stuff, so read it over a few times if needed until it makes sense!

I know that delaying your Social Security could create serious financial problems, but I urge you to try and hold out until age 66. Your benefits will be much bigger, and they won’t be affected by the earnings test.

If you can hold out, you should claim your ex-spousal benefit then. If delaying your retirement benefit until age 70 would allow it to grow to be larger than your ex-spousal benefit (and you are old enough to take advantage of the restricted application rule), you should file a restricted application at age 66 for just your ex-spousal benefit.

Then, at age 70, you would file for your own retirement benefit. Your monthly payment then would increase by the amount by which your retirement benefit exceeded your ex-spousal benefit. (This is because Social Security rules say that you can’t collect the full value of two benefits at once, but just an amount that roughly equals the larger of the two benefits.)

If your ex-spousal benefit is always going to be the greater of the two, as I indicated, you should just claim that benefit at age 66 and keep it the rest of your life. Or, if you are not old enough to take advantage of the restricted application rule and you need benefits at age 66, you would just file then for the larger of either your ex-spousal or own retirement benefit.

READ MORE: Should we raise the retirement age for Social Security and Medicare?

On another front, do you pay Social Security payroll taxes at work now? If so, this means you can receive your pension income plus any Social Security benefits you deserve. If not, your future pension income may reduce your Social Security benefits under what’s called the Windfall Elimination Provision.

In terms of your son, is he disabled enough to qualify to collect Social Security Disability payments? These payments are not related to your income, but he would have had to work long enough at jobs where he paid Social Security payroll taxes to qualify for disability payments.

Alternatively, if he was disabled as a child and has never been able to work, he might have been eligible for what are called child-in-care benefits based on the earnings record of either you or your former husband — whichever earned more money. These benefits normally end when a child turns 18 or 19, but they can continue during the life of a disabled child and would even convert into disabled survivor benefits when the parent died. You would need medical confirmation of your son’s disability, and this process can be long and complicated. But it might be a possibility.

I know this is a lot to absorb. I hope it helps.

Jean – New Hampshire: My 27-year-old daughter was on Social Security Disability, but for the last year has been off it, trying to make it on her own. She has a part-time job and bought marketplace insurance through Obamacare.

In the last month, she has been diagnosed with a very serious illness that may cause disability. This is a rare disease that is treated with off-label medicines. She needs to see specialists outside of her current state of New Hampshire. She has been offered Medicare, which could kick in, in July. She is trying to decide between her marketplace plan, which doesn’t cover out-of-state visits, and Medicare, which does, but may not cover expensive, off-label medicines.

Phil Moeller: I’m sorry to hear about your daughter’s medical problems. I hope things turn out well for her or as well as you might hope based on her condition.

If she must get care out of state and an exchange plan won’t cover her, then I’d say Medicare is her only option.

Medicare has a very inclusive policy toward covering drugs, but of course the private insurers that provide Part D drug coverage are free to offer alternatives or, in some case, don’t have to cover a drug or its equivalent at all.

So the first thing I’d do is use Medicare’s Plan Finder online tool to look for the drugs she will need to take. If you can find any Medicare drug plans that accept them, that would argue in favor of taking Medicare.

If you can’t find a Medicare plan that covers her medications, I’d go directly to the drug manufacturer(s) and see if they have payment assistance programs that can help you. Many of them do, but often these programs are not offered to people on Medicare.

READ MORE: Column: What can we do to protect Medicare and Social Security?

If that’s the case, then you should determine if it makes any sense for her to self-insure for this care. This would mean getting an exchange plan, but handling this illness outside of the plan. In that event, you’d likely need to strike a deal with the doctor so that he or she agreed to bill you a reduced rate.

I wish I had more comforting options, but as you know, there are big holes in our health insurance system, and your daughter may have fallen into one of them.

I work a lot with non-profit agencies who help people with their Medicare needs. Two that I suggest you reach out to are the Medicare Rights Center and the Center for Medicare Advocacy.

Please feel free to ask me further questions if needed.

Paulette – Michigan: I have turned 65, am still working and have good insurance through my employer. I did not sign up for Medicare, as the Social Security office told me I didn’t have to. I plan on working for another year or so. My tax man told me I may have to pay higher premiums if I wait to sign up. Should I sign up or can I avoid higher premiums?

Phil Moeller: I think your tax man is off base. He or she may be referring to the “hold harmless” provision of Social Security. The provision is complicated, so please bear with me.

People getting Social Security who sign up for Medicare must by law have their Medicare Part B premiums deducted from their Social Security payments. Also by law, Social Security premiums are not allowed to decline from one year to the next.

As a consequence, people receiving Social Security are protected from Medicare Part B premium increases should the rate of inflation be zero or so small that Social Security’s annual cost of living adjustment, or COLA, do not cover projected increases in Part B premiums.

This has happened the past two years, created disparities between what existing and new Social Security beneficiaries pay for Part B. Many people have been protected and now pay about $109 a month for Part B. Newer enrollees, who were not held harmless (because they weren’t yet getting Social Security) are paying $134 a month this year.

If we continue to have zero or low rates of inflation, there could be a modest benefit in locking in this $134 monthly rate. However, if COLAs increase, then Part B rates will be adjusted for everyone. This means that people now paying $109 would pay more, while those paying $134 would pay less. Eventually, everyone would once again pay the same amount for Part B.

By now, your head may be spinning! The point I’m laboring to make is that signing up now would produce at most a modest premium benefit, and even this benefit could disappear. Meanwhile, you’d be shelling out $134 a month for coverage you don’t really need!

So if your current employer insurance is acceptable, I would advise you not to sign up for Medicare until you are near retirement.

For more perspectives on health care, view our continuing coverage of the American Health Care Act.

The post Column: Why we need to save Medicare counseling from the federal chopping block appeared first on PBS NewsHour.

The U.S. women’s national soccer team ratified a new five-year collective bargaining agreement Tuesday following a bitter yearlong dispute over demands for equal pay.

The deal with U.S. Soccer, the team’s governing body, outlines better working conditions, travel arrangements and accommodations, along with increased per diem stipends and match bonuses. The agreement lasts through 2021, meaning the women’s soccer team won’t have to renegotiate terms for major events, including the 2019 World Cup and the 2020 Tokyo Olympics.

The deal would allow some players to “double their incomes to between $200,000 and $300,000 in a given year — and even more in a World Cup year,” The New York Times calculated.

U.S. Soccer president Sunil Gulati hailed the agreement as an “important step” for the growth of women’s soccer.

“This agreement helps to ensure the strength of the women’s national team, provide stability and growth potential for the National Women’s Soccer League, and over time strengthen the elite player development process at the grassroots level,” he said in a statement Wednesday.

pic.twitter.com/G941W08UC8

— Sunil Gulati (@sunilgulati) April 5, 2017

“We believe our continued partnership will ensure a bright future for our sport for years to come,” he added.

U.S. national team veteran Megan Rapinoe said she was “incredibly proud” of the women’s team throughout the process.

“While I think there is still much progress to be made for us and for women more broadly, I think the WNTPA [Women’s National Team Players Association] should be very proud of this deal and feel empowered moving forward,” she added.

👏🏼👏🏼 Happy an agreement has been reached. 😃 https://t.co/roXWP5YInh

— Carli Lloyd (@CarliLloyd) April 5, 2017

Happy to hear that @ussoccer_wnt & @ussoccer have reached terms on a new CBA. They worked incredibly hard to improve the future of the game.

— Mia Hamm (@MiaHamm) April 5, 2017

The agreement follows other high-profile wage gaps in other sports, including tennis and basketball. Last week, the U.S. women’s hockey team reached a similar agreement for increased pay with their governing body after threatening to boycott the world championships.

Last year, five World Cup-winning athletes from the women’s national team — Hope Solo, Alex Morgan, Carli Lloyd, Megan Rapinoe, and Becky Sauerbrunn — filed a complaint with the Equal Employment Opportunity Commission highlighting the large pay gap between the women’s and men’s soccer teams. The EEOC investigation has yet to be resolved.

The women argued their work was comparable to their male counterparts, and the women’s team was consistently better ranked and more profitable.

Throughout the labor dispute, the players’ union repeatedly failed to reach common ground with U.S. Soccer, cycling through several different directors before talks made some headway.

Also notable is that the agreement does not necessarily mean equal pay, as Becky Sauerbrunn, co-captain of the women’s national team, pointed out to the Planet Fútbol podcast on Tuesday.

The U.S. women’s team has a different pay structure than the men’s team, Sauerbrunn said, adding that the team was negotiating for “equitable” pay instead.

“Equal isn’t the right word. It would be equitable, because we are asking for a different structure,” she added.

READ MORE: Equal pay for equal play. What the sport of tennis got right

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Photo by Olivier Douliery/Getty

There’s plenty of politics covered in a 24-hour news cycle’s time, but not everything gets the attention it deserves. Here are five political stories you may have missed the past week:

1. Why The Freedom Caucus Shouldn’t Worry About Primary Threats From President Trump — 4/2. In a series of tweets, Trump blamed the House Freedom Caucus’ members for blocking the GOP’s ACA repeal and replace bill. – NPR
2. The Roots of the Battle Over Neil Gorsuch: ‘They Started It’ — 3/31. Supreme Court confirmations haven’t always been so partisan. – New York Times
3. Mystery at the center of Russia probe: How to pronounce Nunes — 3/30. House Intelligence Chairman Devin Nunes continues making headlines, but many have trouble pronouncing his last name. – Politico
4. Joe Manchin’s high-wire act: Working with Trump — and criticizing both parties — 4/1. The Democratic Senator is up for reelection in 2018 in a state that overwhelmingly supported Trump. – Washington Post
5. Trump’s Drug Policy Takes Shape, With Split Personality — 3/31. New Jersey Governor Chris Christie and Attorney General Jeff Sessions are taking different approaches towards shaping drug policy in the Trump era. – Wall Street Journal

READ MORE: 5 important stories that don’t have anything to do with politics

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China’s President Xi Jinping and his wife Peng Liyuan arrive April 6 at Palm Beach International Airport in West Palm Beach, Florida, for two days of meetings with President Donald Trump. Both as a candidate and president, Trump has taken an aggressive posture toward China, labeling Beijing “tremendous problem” and arguing that lopsided trade deals with China shortchange American businesses and workers. Photo by REUTERS/Joe Skipper.

PALM BEACH, Fla. — President Donald Trump opens a high-stakes summit Thursday with Chinese President Xi Jinping, with the urgent threat of North Korea’s nuclear ambitions and tensions over trade on the agenda for the first in-person meeting between the leaders of the world’s two largest economies.

The leaders were arriving in South Florida separately Thursday afternoon for the summit at Trump’s Mar-a-Lago estate, a location the White House said was selected to give the two days of discussions a more relaxed feel.

Xi landed in West Palm Beach, Florida, and was greeted by Secretary of State Rex Tillerson. Trump and Xi, joined by their wives, were slated to attend a welcome dinner Thursday night, followed by policy discussions on Friday.

Both as a candidate and president, Trump has taken an aggressive posture toward China, labeling Beijing “tremendous problem” and arguing that lopsided trade deals with China shortchange American businesses and workers. Last week, the president predicted in a tweet that his meeting with Xi would be “very difficult.”

The White House has downplayed expectations for a breakthrough on issues like trade and tariffs, insisting that the 24-hour summit is mostly an introductory meeting for the two leaders. And within Trump’s administration, there are still divisions over how to approach China.

According to U.S. and foreign officials, Treasury Secretary Steven Mnuchin and economic adviser Gary Cohn are leading the charge for boosting bilateral relations with China and exploring the potential for greater economic cooperation. But economic adviser Peter Navarro, author of the book “Death by China: Confronting the Dragon — a Global Call to Action,” prefers trying to isolate China, in keeping with Trump’s “America First” mantra.

Patrick Cronin, a China expert with the Center for a New American Security, said the Trump administration does not have “a reconciled trade and economic policy yet, and the differing views on China in the White House underscore that.”

Ahead of the summit, Trump signed a pair of executive orders focused on reducing the U.S. trade deficit. The moves appeared to be a shot at China, which accounted for the vast bulk — $347 billion — of last year’s $502 billion trade deficit. Chinese exports to the U.S. totaled some $388.1 billion last year.

Anthony Ruggiero, an East Asia expert at the Foundation for Defense of Democracies, said China may be may be more willing to accommodate Trump on trade and economic issues than on regional security issues, including North Korea. Xi, a shrewd political operator, is unlikely to want to rock the boat ahead of a Communist Party conclave later this year that will install new leadership.

The urgency about North Korea is expected to be at the forefront of the leaders’ discussions. A senior White House official said this week that the “clock has now run out” on Pyongyang, though officials have not detailed what steps Trump is willing to take to halt North Korea’s nuclear ambitions.

Like his predecessors, Trump is pressing China to exert more economic pressure on North Korea, though there is no sign he will be any more successful than past American presidents. In an interview last week with the Financial Times, Trump said that if China doesn’t take a tougher stand, the US is prepared to act alone.

Xi is also expected to seek assurances that Trump will not interfere in the territorial dispute over the South China Sea or question the “One China” policy by reaching out to Taiwan’s leader again, as he did during the transition. The move infuriated Beijing, leading Trump to eventually reiterate his commitment to the decades-old policy.

Previous White Houses have held China accountable for its human rights record, something this administration has made very little mention of, whether in China or elsewhere. It also remains to be seen whether the Obama administration’s deal with Beijing to curb Chinese cybertheft for economic gain and its hacking of U.S. companies will be addressed.

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President Donald Trump is suggesting that Syrian President Bashar Assad may have to leave power after this week’s chemical weapons attack.

Speaking to reporters aboard Air Force One, Trump said Thursday that what happened in Syria is “a disgrace to humanity.” Asked if Assad should go, Trump said, “He’s there, and I guess he’s running things so something should happen.”

The president would not discuss what, if anything, the United States might do in response to the deadly chemical attack. He said the attack “shouldn’t have happened, and it shouldn’t be allowed to happen.”

Trump said he may talk to Russian President Vladimir Putin about the situation in Syria. Russia is a key supporter of the Assad government.

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Senate Majority Leader Mitch McConnell, R-Ky., gives a thumbs up after the Senate invoked the “nuclear option” which will allow for a majority vote to confirm a Supreme Court justice nominee. The vote for nominee Neil Gorsuch is scheduled for Friday. Photo By Tom Williams/CQ Roll Call.

WASHINGTON — Republicans invoked the “nuclear option” in the Senate on Thursday, unilaterally rewriting the chamber’s rules to allow President Donald Trump’s nominee to ascend to the Supreme Court.

Furious Democrats objected until the end, but their efforts to block Judge Neil Gorsuch failed as expected. Lawmakers of both parties bemoaned the long-term implications for the Senate, the court and the country.

“We will sadly point to today as a turning point in the history of the Senate and the Supreme Court,” Minority Leader Chuck Schumer of New York said.

The maneuvering played out in an atmosphere of tension in the Senate chamber with most senators in their seats, a rare and theatrical occurrence.

First Democrats mounted a filibuster in an effort to block Gorsuch by denying him the 60 votes needed to advance to a final vote. Then Republican Majority Leader Mitch McConnell of Kentucky raised a point of order, suggesting that Supreme Court nominees should not be subjected to a 60-vote threshold but instead a simple majority in the 100-member Senate.

McConnell was overruled, but appealed the ruling. And on that he prevailed on a 52-48 party line vote. The 60-vote filibuster requirement on Supreme Court nominees was effectively gone, and with it the last vestige of bipartisanship on presidential nominees in an increasingly polarized Senate.

Supreme Court showdown looms with far-reaching consequences

A final confirmation vote on Gorsuch is expected Friday and he could then be sworn in in time to take his seat on the court later this month and hear the final cases of the term.

The maneuvering played out with much hand-wringing from all sides about the future of the Senate, as well as unusually bitter accusations and counter-accusations as each side blamed the other. The rules change is known as the “nuclear option” because of its far-reaching implications.

McConnell accused Democrats of forcing his hand by trying to filibuster a highly qualified nominee in Gorsuch, 49, a 10-year veteran of the 10th U.S. Circuit Court of Appeals in Denver with a consistently conservative record. McConnell vowed that the rules change would block the Gorsuch filibuster, and all future ones, a change many lawmakers lamented could lead to an even more polarized Senate, court and country.

“This will be the first, and last, partisan filibuster of a Supreme Court nominee,” McConnell declared. “This is the latest escalation in the left’s never-ending judicial war, the most audacious yet, and it cannot and will not stand.”

Supreme Court filibusters have been nearly unheard of in the Senate, but the confrontation is playing out amid an explosive political atmosphere with liberal Democrats furious over the Trump presidency and Republicans desperate to get a win after months of chaos from Trump.

WATCH LIVE: Congress to vote on Neil Gorsuch for Supreme Court

Democrats also remain livid over McConnell’s decision last year to deny consideration to then-President Barack Obama’s Supreme Court nominee, Judge Merrick Garland, who was ignored for the better part of a year by Senate Republicans after the death of Justice Antonin Scalia. Instead, McConnell kept Scalia’s seat open, a calculation that is now paying off hugely for Republicans and Trump, who will be able to claim the biggest victory of his presidency to date if Gorsuch is confirmed as expected.

“We believe that what Republicans did to Merrick Garland was worse than a filibuster,” Schumer said.

Emotions were running high ahead of the votes with raised voices on the floor where proceedings are normally sedate. All involved were keenly aware of the long-term implications of the proceedings, some of them hard to predict for the future of Trump’s presidency and the 2018 midterm elections, when Republicans will be defending their slim 52-48 Senate majority and 10 vulnerable Democrats in states Trump won will be up for re-election.

Senators on both sides of the aisle lamented the trajectory they were on, though they themselves were in position to prevent it from happening and failed to do so.

Moderate Republican Sen. Susan Collins of Maine said roughly 10 senators of both parties worked over the weekend to come up with a deal to stave off the “nuclear option,” but couldn’t come to agreement. In 2005, a bipartisan deal headed off GOP plans to remove the filibuster barrier for lower-court nominees, but in 2013 Democrats took the step, leaving the filibuster in place only for Supreme Court justices.

Now it too is gone. For now the filibuster barrier on legislation will remain, though many fear it could be the next to go.

Explainer: What is the ‘nuclear option’? And how will it affect Neil Gorsuch’s nomination?

“I fear that someday we will regret what we are about to do. In fact, I am confident we will,” said Sen. John McCain, R-Ariz. “It is imperative we have a functioning Senate where the rights of the minority are protected regardless of which party is in power at the time.”

Nonetheless, McCain voted with McConnell on the rules change, saying he felt he had no choice.

With the final vote set for Friday, Gorsuch counts 55 supporters in the Senate: the 52 Republicans, along with three moderate Democrats from states that Trump won last November — Joe Manchin of West Virginia, Heidi Heitkamp of North Dakota and Joe Donnelly of Indiana. A fourth Senate Democrat, Michael Bennet from Gorsuch’s home state of Colorado, refused to join in the filibuster but announced Thursday he would vote against Gorsuch’s confirmation.

Associated Press writers Mark Sherman and Mary Clare Jalonick contributed.

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Brian Dowdall, with one of his animal spirit paintings. Credit: American Visionary Art Museum

Somewhere in northeast Baltimore, where four roads and a forest meet, there is a sprawling wood-shingled house that is nearly impossible to find. Because of a mapping error, it has two addresses. Like a kind of Bermuda Triangle, neither address leads to the house. For years it was inhabited by a city groundskeeper. Then, for two decades, it lay vacant. Since 2011, it has been occupied by an idiosyncratic artist named Brian Dowdall, his partner, Alison Spiesman, who is also an artist, and some 5,000 pieces of what is known, variably, as “outsider,” “visionary” or “self-taught” art — art that is outside of the mainstream.

Call Dowdall on the phone and this message will greet you: “You’ve reached visionary! Please leave a message,” along with what sounds like the vibrations of a sitar. Meet him in person and the first thing you will notice is his hair: thick, curly, white and long. On most days, it is covered by a baseball cap printed with a single eye, the logo of Baltimore’s American Visionary Art Museum, or AVAM, where Dowdall’s work is on display.

Enter Dowdall’s house and you will notice that it is far more museum than residence, so chock-a-block with art — starting in the kitchen and extending to the bedroom — that it almost swallows Dowdall whole. Dowdall, despite being 69, is very spry, and also very short. He and Spiesman call the house their own “Howl’s Moving Castle,” like the magical flying castle in the 2004 anime film of the same name.

Alison Spiesman and Brian Dowdall, in front of their Baltimore home, which they moved into in 2011. In the left of the yard sit cement faces made by outsider artist Mr. Imagination. Photo: Elizabeth Flock

About half the art inside the house was made by Dowdall, who is known for colorful, ecstatic paintings of “animal spirits” and goddesses, which he says he “calls up… from his inner being.” Mostly, he works with tempera or house paint, and usually on cardboard. The remaining art in the house was made by other well-known outsider artists, many of whom were Dowdall’s friends and have since passed away. He acquired these pieces over the course of decades, often by gift, barter or trade.

For years, this collection — a treasure trove of what is essentially the first wave of outsider or visionary art in the United States, created before the turn of the century — sat jammed inside storage containers and Dowdall’s house in Cocoa Beach, Florida, which he lovingly called “the cave.” But when Rebecca Hoffberger, who runs AVAM, which itself has over 4,000 pieces, saw Dowdall’s collection in 2010, she thought: “We’ve got to do something” to preserve it.

As if “by grace,” Hoffberger learned that a house on Baltimore city park land had long sat abandoned. By further kismet, the city, in an uncommon arrangement, agreed to have the artists come live there indefinitely; in exchange, they’d provide art for the city.

The house, though, was in rough shape, with unpainted walls, no heat and rusty pipes. No one had lived there for years. No one wanted to. But Dowdall and Spiesman jumped at the idea of being so close to AVAM — a museum that showed the kind of art Dowdall made — and at having a real home for their collection.

In the years since they’ve arrived in Baltimore, Dowdall and Spiesman have created large-scale murals in several city parks, so brightly colored and filled with fantastical creatures they are impossible to miss. Soon, they’ll start a program to make art with kids in recreation centers and schools in a “satellite visionary experience”; in the second floor of their house, a collection of stuffed animals — which they call their “petting zoo” — lies ready.

“I don’t know how this happened,” Ron Rudisill, a parks district manager for Baltimore, said of the arrangement. “But it’s working.”

And, perhaps most importantly, Dowdall and Spiesman are now at the beginning of a years-long process to catalogue their collection, noting how and where each piece was acquired. Someday, they hope, all of this outsider or visionary art — which spans more than 50 years of the 20th century — will finally be seen by the public. “We’ll leave it as a gift after we’re dead,’” Spiesman said.

A mural created by Brian Dowdall and Alison Spiesman at Clifton Park in Baltimore. The mural includes the Baltimore flag and Dowdall’s animal spirit paintings. Courtesy of Alison Spiesman and Brian Dowdall.

It is not easy to precisely define outsider, or visionary, art. It is, however, a clear offshoot of a European art movement known as “art brut,” or “raw art,” a term coined in the 1940s by French artist Jean Dubuffet, to describe art outside of conventional culture.

But while Dubuffet focused on art made by the mentally ill, outsider or visionary art in the United States has come to mean something much broader. At its most basic level, it is art made intuitively, by an artist who is self-taught, in a visual language often very much their own.

In the decades since Dubuffet’s art brut collection was donated to the City of Lausanne in Switzerland in 1971, this kind of art has increasingly appeared in museums — from AVAM, America’s official museum for self-taught, intuitive art, to England, Germany and Holland, which have recently featured outsider artists such as peasant farmers and psychiatric patients. Outsider art fairs and festivals have also become more common, in places like Paris and New York.

When I ask Hoffberger to define visionary art, she laughs. “We don’t say that if you have three years of art school you’re damaged goods, but almost,” she said.

But then she grows serious. “Visionary artists are creative in all the ways they live. If they happen to manufacture something the world calls art, it’s because of how they think and live … and they don’t watch themselves be artists.”

In 1999, a Florida newspaper tried to ask Dowdall about his work, and whether he considered himself an outsider or visionary artist, or something else. “I’m a turnip farmer,” Dowdall said.

When I visit Dowdall at his Baltimore house, he said those labels, “have too much baggage,” and brings out an encyclopedia of folk art, in which he is included, to show how many different ways this kind of art can be classified.

“I told them that I’m a turnip farmer,” he says, eyes twinkling now, “because you can’t squeeze blood out of a turnip.”

Brian Dowdall in his living room in his Baltimore home, standing with recent animal spirit paintings, and other outsider art. Photo: Elizabeth Flock

Outsider artists often do not have much interest in selling their work. Bill Traylor, a self-taught artist and former slave who did distinctively flat, bare compositions on cardboard, often let his work blow away in the wind. Clyde Jones, who is famous for making wooden “critters,” gives all of his sculptures away. Dowdall gifts or barters his work, including for root canals and attorney services; he and Spiesman live their lives almost entirely on the barter system. When they first arrived in Baltimore, and their tabby cat Sonnie fell ill, Dowdall offered the local veterinarian a painting in exchange for his services.

“He was new in town. The cat had a urinary tract infection. He gave me one piece. It just kind of stuck. Now I have five,” said Baltimore veterinarian Duane Mangini, including paintings of a Cheshire cat, guitar-playing dog and juggling fish. “People look at them, double take, and look again.”

People look and look again at outsider art, Dubuffet argued back in the 1940s, because of how it is made. And once a person sees outsider art, “these flourishings of an exalted feverishness,” Dubuffet wrote, “we cannot avoid the feeling that in relation to these works, cultural art in its entirety appears to be the game of a futile society, a fallacious parade.”

The outsider artist, on the other hand, lives life fully and intensely, he wrote. And the outsider artist often experiences some kind of dramatic event that takes him or her away from a conventional life and toward making this kind of art.

“When a life experience is too big for words, either a great ecstasy but more often a devastation, the best work comes out,” Hoffberger said.

Take, for example, outsider artist Mose Tolliver, whose legs were crushed in a factory accident. He made flat portraits and landscapes from his bed, reportedly cleaning his brushes on the sheets. Or Mary T. Smith, who had a hearing impairment and made art out of tin strips she found on the road, and later, paintings in her back garden. Or Mr. Imagination, who suffered from dyslexia, seizures and was shot twice selling jewelry on the street, and found spirituality in found objects and recycled materials, like bottle caps. (Dowdall was friends with Mose Tolliver and Mr. Imagination. All three artists are in the collection.)

These kind of events, Dowdall said, are “a crack in their life that switched the railroad track.” For him, he says, the track switched at age 9.

Brian Dowdall in his studio in his Baltimore home, surrounded by outsider art he’s collected over the years. Photo: Elizabeth Flock

Dowdall grew up in a big Irish Catholic family in the mountains of Anaconda, Montana, where he attended Catholic school. There, strict nuns taught about the consequences of mortal and venial sins, and encouraged regular confession. If he didn’t do the rosary, he was told, he’d go to hell.

“It drove me cuckoo,” Dowdall said. “I’d say ‘I have 30 sins.’ I’d make up sins. I got into this the numbers game, about how many times I sinned … and then I had a nervous breakdown.”

But that nervous breakdown, he said, was a bit like the famous Leonard Cohen line that the crack “is how the light gets in.” And that crack, he said, is when he started to paint.

Dowdall kept painting when he left Montana at 18, and as he spent decades crisscrossing the country. In these years, he worked a series of odd jobs: picking cherries, making porcelain teeth, working a worm farm, tarring roofs, filling jelly donuts. He lived on the street, in a commune and in caves. Throughout his travels, a few things held constant — one being the feeling that animals protected him, or at the very least, wouldn’t hurt him. He’d catch snakes, get bit and survive. Or sleep with rattlesnakes in a cave and not get bit at all. Or walk, unharmed, beside mountain lions in the hills.

“I’ve always felt that people had an agenda, but animals are pretty pure,” he said. “In my paintings the animals are always together, like the peaceable kingdom.”

Brian Dowdall’s paintings on display at the American Visionary Art Museum in Baltimore. Credit: AVAM

The other constant was his appreciation of women, though not in a prurient sense. As a child, he trusted the women in the bible — “the men always seemed too harsh” — and after growing up, was attracted to the powerful women described by mythologists such as Joseph Campbell, and to stories of early matriarchal societies, such as in Merlin Stone’s “When God Was a Woman.” Soon, he was making goddess paintings, too.

“In a lot of the ancient mythologies, the goddess and an animal would be one,” he says, as if that explained everything. “The more I started painting goddesses and animal spirits, the more it flew out of me.”

For many years, Dowdall’s paintings were not shown in museums or galleries. Instead, they were traded among other outsider artists, many of whom became his friends. Or they were gifted between people in New York’s art and music scene, including Dave Brubeck, Johnny Cash and Van Morrison, he says. By the early 80’s, Dowdall’s work began to make it into smaller folk, visionary and outsider shows, and then into larger ones in New York, Edinburgh and Paris.

Last January, his and Spiesman’s murals went up at the Carlton Arms, an art hotel in New York City — and, after an initial display of his work at Baltimore’s AVAM, in a large show called “What Makes Us Smile?” — Dowdall’s work is now part of the museum’s permanent collection.

“There is a lot of new age work or psychedelic work that looks generic to me. Or sometimes people say they are self-taught, but their work looks like fake Rothkos,” Hoffberger said. “But Brian has a particular style and way of looking, almost like his own language. He has a happy cat, a happy dog, his mermaids. He is a very big lover of women in the sacred sense, and that is reflected in a lot of his work” — particularly his goddess paintings.

Brian Dowdall and Alison Spiesman’s bedroom at their Baltimore home, where Dowdall’s goddess paintings are hung over the bed. Photo by Elizabeth Flock

Among Dowdall’s goddess paintings are many of Spiesman, including of her as Mona Lisa and as a mermaid. They first met almost two decades ago, in Florida, because Spiesman and her then-husband were collectors of Dowdall’s art. When Spiesman, who is a classically-trained painter, held a show of her work, Dowdall went to see it.

Spiesman had always liked Dowdall’s work, but in 2001, it became something more intimate. Her brother had fallen into a coma, and doctors were ready to disconnect life support. Spiesman tried everything to get a response from him: playing his favorite music, showing photos of her nephew, tickling him with her paintbrushes. Finally, in desperation, she asked her husband to bring over one of Dowdall’s blue dog paintings. “That was literally the first thing his eyes followed,” she said. Later, her brother came out of the coma.

Two years after this incident, Spiesman lost her husband to cancer. In the same period, Dowdall lost his best friend, another artist. “We were both in pretty bad shape. It was extremely difficult and dark,” Spiesman said. “And so we kinda got together on the buddy system,” Dowdall said. “She’d call me up and say ‘Have you eaten today?’”

After they got together, Spiesman’s grief persisted. For an entire decade, she said, she stopped painting, struck “mute” by the loss of her husband. It was only because of Dowdall, she said, that she eventually began to paint again. Now, her paintings are less academic and more narrative — almost visionary. In the Baltimore house, her and Dowdall’s studios are down the hall from one another.

Alison Spiesman in her studio, with their tabby cat Sonnie. Photo: Elizabeth Flock

“There’s something very good about Brian,” Hoffberger said. It comes through in his relationships, his demeanor and his paintings. “His work is happy, mystical, playful, colorful and doomed to make you smile.”

Joseph Rudolph, a professor at Towson University in Maryland, said he and his wife decided to buy Dowdall’s work after they lost almost everything in a house fire; they saw it exhibited at the hotel where they’d started to eat dinner. “It was bright and bold and more cheerful” than the art they usually collected, he said, and so an animal spirit painting of Dowdall’s became the first piece of their new collection.

“I’ve seen these responses [to Brian’s art], it’s a different response than to most art,” Spiesman said.

Now that he and Spiesman have settled into the Baltimore house, Dowdall, pushing 70, is as productive than ever. His most recent works, animal spirits painted on bright red cardboard, look different than what he’s done before. The animals themselves are less colorful, painted mostly in white, as if they are older, wiser creatures.

“It feels like this house has been waiting for us all its life,” Dowdall said. “It’s like we were looking for El Camino without a map,” but then found it, Spiesman said.

Dowdall felt this way from the moment they arrived in Baltimore and discovered large feline tracks in the house’s front yard. When he saw them, he called over Hoffberger, who told him they were the tracks of a puma. A puma … in Baltimore.

“To me it seemed like a gesture — like okay, this is a visitation, this is your house,” said Dowdall, who hopes to make art in the house until he dies. “Like a little kiss on the cheek, welcome.”

This diptych, which hung in the Renaissance Hotel in Baltimore, features animal spirits and represents Dowdall’s impresssions of Baltimore. Courtesy: Alison Spiesman

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