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Analysis, background reports and updates from the PBS NewsHour putting today's news in context.

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    Iranian protesters chant slogans as they hold pictures of Shi'ite cleric Sheikh Nimr al-Nimr during a demonstration against the execution of Nimr in Saudi Arabia, outside the Saudi Arabian Embassy in Tehran Jan. 3, 2016. Photo By Raheb Homavandi/Reuters

    Iranian protesters chant slogans as they hold pictures of Shi’ite cleric Sheikh Nimr al-Nimr during a demonstration against the execution of Nimr in Saudi Arabia, outside the Saudi Arabian Embassy in Tehran Jan. 3, 2016. Photo By Raheb Homavandi/Reuters

    Saudi Arabia severed diplomatic ties with Iran on Sunday, as tensions rose for a second day following the execution of a prominent Shiite cleric and subsequent attacks on a Saudi embassy and a consulate in two Iranian cities.

    The Saudi monarchy announced it would not allow Iran to undermine the Sunni kingdom’s security as the reason for the move, the Associated Press reported.

    Saudi Arabia executed 47 people this week including leading Shia Cleric Nimr al-Nimr, who was accused of inciting violence and was often critical of Saudi’s royal family. The execution follows years of antagonism between Shiites in Iran and conservative Saudi Sunnis, the majority of whom follow the strict Islamic sect of Wahhabism, Reuters reported.

    On Saturday and Sunday, hundreds of protesters attacked the Saudi embassy in Tehran and Saudi consulate in Iran’s second-largest city of Mashad. The U.S. State Department had called for calm and a deescalation of rhetoric between Iran and Saudi officials.

    Smoke rises from Saudi Arabia's embassy during a demonstration in Tehran. Iranian protesters stormed the Saudi Embassy in Tehran early on Sunday morning. Photo By Mehdi Ghasemi/Reuters

    Smoke rises from Saudi Arabia’s embassy during a demonstration in Tehran. Iranian protesters stormed the Saudi Embassy in Tehran early on Sunday morning. Photo By Mehdi Ghasemi/Reuters

    Iranian protestors broke into the Saudi embassy early on Sunday to protest the Sheik’s execution. The protestors destroyed furniture and started several fires before police removed them from the building, Reuters reported. Iranian state media also reported that some protestors used petrol bombs and rocks.

    Iranian President Hassan Rouhani said the the fire was “not justifiable,” also announcing that 40 people have been arrested over the blaze.

    On Sunday, Iran’s Supreme Leader Ayatollah Ali Khamenei indicated that retribution would come for the cleric’s execution he described as a “crime” and carried out by tyrants would would face “divine revenge.”

    “The politicians, executives and policymakers of the Saudi government should have no doubt that this blood will catch up with them, and it will give them hell,” he said. “Almighty God will not ignore blood of the innocent.”

    Saudi Foreign Minister Adel al-Jubeir said Iran’s diplomatic envoy would have 48 hours to leave the country.

    The post Saudi Arabia cuts diplomatic ties with Iran after Shiite cleric’s execution appeared first on PBS NewsHour.


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    ARNOLD, MO - JANUARY 2:  A flooded out football field is seen at the Jefferson County Youth Association on January 2, 2016 in Arnold, Missouri. After the record crest of the Meremac River after days of rainfall, the community looks to start the cleanup efforts and relief for victims of area flooding. (Photo by Michael B. Thomas/Getty Images)

    ARNOLD, MO – JANUARY 2: A flooded out football field is seen at the Jefferson County Youth Association on January 2, 2016 in Arnold, Missouri. After the record crest of the Meremac River after days of rainfall, the community looks to start the cleanup efforts and relief for victims of area flooding. (Photo by Michael B. Thomas/Getty Images)

    During the holiday season, El Niño stunned and terrorized much of the nation. In New York City, people ice skated in shorts and T-shirts. Meanwhile, unseasonably warm storms fueled deadly tornadoes in Texas and doused the Midwest with floods, claiming more than 50 lives.

    These storms are a sobering prelude for 2016, and if history has its way, El Niño could spawn a slate of topsy-turvy happenings in the new year, influencing everything from the price of crops to the flight patterns of migratory birds to the abundance of infectious diseases, like West Nile virus. This is the first of a two-part story on those possible changes.

    El Niño and next summer’s supply of baking flour and marijuana

    First, some background. The El Niño Southern Oscillation (ENSO) is a patch of warmer-than-normal water in the eastern and central Pacific Ocean that develops around the equator. Picture it as a spoon stirring a cup of coffee, said Brad Rippey, a meteorologist with the U.S. Department of Agriculture.

    The heat acts like the spoon bowl, pushing huge currents around the Pacific. But then some of this warmth seeps upward from the moving water, like an invisible spoon handle, and begins stirring the air.

    “Eventually everything is moving in tandem,” Rippey said, and that’s when things get weird for the planet’s weather.

    The U.S. started seeing major weather disruptions as early as last spring, Rippey said, when storms and floods ripped through Oklahoma and Texas. But recent events have surpassed temperature expectations and grown into what’s called a super El Niño. Though ENSOs happen every two to seven years, this current El Niño is only the third supersized version since 1950 and the first since 1998.

    Super El Niños: past and present. The maps above show a comparison of sea surface temperature (SST) anomalies in the Pacific Ocean as observed during the 1997 and 2015 El Niño events. NASA suggests that 2015's El Niño is as big as if not bigger in heat content than the 1997 El Niño. Image by National Center for Atmospheric Research VisLab

    Super El Niños: past and present. The maps above show a comparison of sea surface temperature (SST) anomalies in the Pacific Ocean as observed during the 1997 and 2015 El Niño events. NASA suggests that 2015’s El Niño is as big as if not bigger in heat content than the 1997 El Niño. Image by National Center for Atmospheric Research VisLab

    “We had a bit of a lull as we often do with El Niño during the summer months, but then the effects came roaring back as we moved back into the cold season,” Rippey said. “You can’t blame individual storms on an El Niño, but the pattern is conducive to the formation of these very strong, energetic storms that we’ve been seeing rolling across the United States, one after the other, creating all kinds of problems like heavy rain, blizzard condition and flooding.”

    Farmers are sometimes victims and sometimes benefactors, during and after an El Niño. The dramatic weather patterns cleave the country in half. Southern regions become wetter and colder than usual, while the north becomes dryer and warmer.

    In a general sense, El Niño “rain makes grain,” Rippey said, but this year may have one exception: red winter wheat. Winter wheat is planted in late autumn and allowed to briefly mature before snows hit. The snow insulates the seeds, and its moisture favors the plants during their cold dormant months. Winter wheat accounts for 70 to 80 percent of total U.S. wheat production, according to the USDA, but this year’s batch is being threatened by El Niño.

    Winter wheat has three major production areas in the U.S.: The Great Plains, the Pacific Northwest, the mid-South/lower Midwest. This last region, which stretches from the Mississippi Delta into the Midwest, is known as the “soft red winter wheat belt.” And it’s too wet right now, Rippey said.

    Chances of possible temperature outcomes for January 2016-March 2016: above normal (red), near normal, or below normal (blue). Above or below normal means temperatures in the upper or lower third of the range of historical temperatures. White does not mean "near normal;" it show places where the chances for above-, below-, and near-normal temperatures are equal. Maps by NOAA/Climate Prediction Center.

    Chances of possible temperature outcomes for January 2016-March 2016: above normal (red), near normal, or below normal (blue). Above or below normal means temperatures in the upper or lower third of the range of historical temperatures. White does not mean “near normal;” it show places where the chances for above-, below-, and near-normal temperatures are equal. Maps by NOAA/Climate Prediction Center.

    Chances of possible precipitation outcomes for January 2016-March 2016: above normal (dark green), near normal, or below normal (brown). Above or below normal means preciptation in the upper or lower third of the range of historical precipitation. White does not mean "near normal;" it show places where the chances for above-, below-, and near-normal precipitation are equal. Maps by NOAA/Climate Prediction Center.

    Chances of possible precipitation outcomes for January 2016-March 2016: above normal (dark green), near normal, or below normal (brown). Above or below normal means preciptation in the upper or lower third of the range of historical precipitation. White does not mean “near normal;” it show places where the chances for above-, below-, and near-normal precipitation are equal. Maps by NOAA/Climate Prediction Center.

    If these fields remain underwater, the quality of the crop will be compromised. A temperature drop in the region could also freeze the soil and cause heaving, wherein the roots are compromised. Wheat in the Midwest and mid-South accounts for nearly a quarter of U.S. supply.

    Red winter wheat supports the supply of flour, so time will tell if these weather trends hurt the price of cookies, pastries, flat bread, crackers and other snack foods. The Great Plains have received a favorable dusting of snow this winter, Rippey said, and precipitation in the Northwest has been robust so far, though it’s expected to taper. Earlier this year, El Niño-driven rain in the American Midwest put “upward pressure on wheat prices,” according to Nasdaq. But Rippey believes the extra precipitation should be a boon for crops planted in the spring, such as corn and soybeans.

    El Niño: A boost and bane for weed cultivation

    For an example of what El Nino is doing to spring crops in the Pacific Northwest and California, consider marijuana. In Washington, growers are hoping the warmer-than-normal conditions expected in spring 2016 can repair damage caused by surprise snowstorms that hit the region this past November.

    “It caused a bunch of our crops to freeze before we could harvest. We lost about half our crop. Economic damages were probably half a million dollars,” said Grant Guelich of American Farms in Entiat, Washington. “There’s so much extra snow this year. Usually you have ample time to winterize your farms, but we didn’t really have time this year.”

    Guelich expects November’s freeze to hurt the supply of recreational cannabis in Washington, raising its price, but he wonders if the snow might hurt product quality overall.

    Further south in California, extra rainfall from El Niño is welcome relief for drought-stricken land — and the environmental strain caused by cannabis farms. Marijuana fields boomed in Northern California around the same time the state’s four-year drought began, said Scott Bauer, a senior environmental scientist with the California Department of Fish and Wildlife.

    Around 2010, he and his colleagues started noticing a substantial increase in marijuana cultivation in the hills of Humboldt, Trinity and Mendocino County, a region already nicknamed the Emerald Triangle because of its reputation for cannabis production. This team ultimately discovered that these extra farms were straining the region’s streams. Using satellite imagery, low-altitude aircraft flights and field surveys, they found three out of four watersheds in the Emerald Triangle were almost sapped dry by marijuana cultivation. They published the findings in March.

    Bauer says the precipitation brought by El Niño might not rectify the situation. Storms are currently fortifying snowpacks in the Sierra Nevada mountains, but this major water source for California “isn’t a big influencing factor for streamflow in the Emerald Triangle,” Bauer said. He is also worried that heavy rain will wash away dirt roads constructed by farm owners.

    “We’re talking about weed being grown on hills that are very steep. It’s highly erosive soils, and you see a lot of amateur construction activities,” Bauer said “Some roads fail and then all that sediment washes into the stream and harms the habitat.”

    If precipitation from El Niño plows into late spring, as expected, it may relieve some of the burden caused when cannabis planters start their growing season in April, but there’s a catch. The last two super El Niños were immediately followed by its counterpart, La Niña, which tends to trigger drought in California.

    “Two is a small sample size, but it wouldn’t be surprising to see a rapid development of La Niña, which comes with the enhanced risk of hot, dry summers in some part of the U.S.,” Rippey said. “This could bring a risk of perhaps expanding droughts in various areas as we move on through next winter and into 2017.”

    But for now, Rippey is enthusiastic about El Niño and the prospects for agriculture in the coming year.

    “From a positive standpoint, we have our lowest level of U.S. drought in about five years — since the tail end of the previous El Niño in 2009 to 2010. We entered a period of elevated drought starting in 2011, and we’re finally easing away from that,” Rippey said. “Less drought is always good for agriculture.”

    Early Bloom

    Finally, a floral fireworks display has begun across much of the East Coast due to the warm, wet conditions. Here’s what’s happening at the U.S. Botanic Garden in D.C.

    Japanese apricots (Prunus mume) are in full bloom right now at the U.S. Botanic Garden Conservatory, according to their supervisor of gardens and grounds John Walsh.

    Japanese apricots (Prunus mume) in full bloom right now at the U.S. Botanic Garden Conservatory. Photo by U.S. Botanic Garden

    Japanese apricots (Prunus mume) in full bloom right now at the U.S. Botanic Garden Conservatory. Photo by U.S. Botanic Garden

    Daffodils, Lenten roses and snowdrops have bloomed early too, Walsh said. The same may occur with Washington D.C.’s famous cherry blossoms. Last year, the nation’s capitol had a very mild November and December, which was followed by a very cold spring, Walsh said. As a result, the cherry blossoms bloomed very late.

    “It was probably the latest that they had bloomed for several decades,” Walsh said. “I think that it’s too early to tell what might happen this year, because it depends on what happens over the next few months. If it’s warmer than normal, then they would bloom early, but if it gets cold, like during 2015, then it’ll be delayed.”

    Blooming ahead of schedule doesn’t harm the plants, Walsh said, but you should enjoy these early arrivals while you can. Most perennial flowers only bloom once a year.

    Daffodils (Narcissus spp.) blooming this week at the U.S. Botanic Garden Conservatory. They normally bloom in February Photo by U.S. Botanic Garden

    Daffodils (Narcissus spp.) blooming this week at the U.S. Botanic Garden Conservatory. They normally bloom in February, said John Walsh, U.S. Botanic Garden supervisor of gardens and grounds. Photo by U.S. Botanic Garden

    Lenten Rose, Helleborus spp. Photo by U.S. Botanic Garden

    Lenten Rose, Helleborus spp. Photo by U.S. Botanic Garden

    Snowdrops (Galanthus spp.). Photo by U.S. Botanic Garden

    Snowdrops (Galanthus spp.). Photo by U.S. Botanic Garden

    The post Think El Niño is weird now? Just wait for this summer appeared first on PBS NewsHour.


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    One of the protesters, who gave the name "Captain Moroni," guards the entrance to the refuge Sunday. "Moroni" said he was disappointed that more protesters did not arrive after a widespread call on social media. photo by Amanda Peacher/OPB

    One of the protesters, who gave the name “Captain Moroni,” guards the entrance to the refuge Sunday. “Moroni” said he was disappointed that more protesters did not arrive after a widespread call on social media. photo by Amanda Peacher/OPB

    “I’m Captain Moroni, from Utah.”

    That’s how one militiaman at the Malheur National Wildlife Refuge responded to OPB’s Amanda Peacher when she asked for his name.

    That name is not a silly response to deflect responsibility: In many ways, it encapsulates a deeply intertwined anti-federal sentiment mixed with Mormon symbolism. Captain Moroni is a crucial figure in the Church of Latter-day Saints. He’s also a heroic figure for anti-federalist extremists.

    READ MORE: What’s next for the armed militiamen in Oregon?

    In the modern day west, Captain Moroni has become one of several powerful symbols for the Bundy militia’s anti-governmental extremism.

    Who Is Captain Moroni?

    According to LDS scripture, Captain Moroni took command of the Nephites when he turned 25. Moroni innovated weaponry, strategy and tactics to help secure the safety of the Nephites, and allow them to worship and govern as they saw fit.

    In LDS texts, Moroni prepares to confront a corrupt king by tearing off part of his coat and turning it into a flag, hoisting it as a “title of liberty.” This simple call to arms inspired a great patriotism in the Nephites, helping to raise a formidable army. Vastly outnumbered, the corrupt king fled. According to the Book of Mormon, Captain Moroni continued to push for liberty among his people.

    “And it came to pass that Moroni was angry with the government, because of their indifference concerning the freedom of their country.”

    An Embrace Of The “Title of Liberty”

    During an April 2014 standoff with federal officials, supporters and members of the Bundy militia cited Book of Mormon passages centering on Captain Moroni. There were also several flags quoting Captain Moroni’s own writing on his “title of liberty.” Often next to American flags, these banners read “In memory of our God, our religion, and freedom, and our peace, our wives, and our children.”

    Cliven Bundy — the Nevada Rancher who called on militia and anti-government forces to help him in the showdown with the Bureau of Land Management — cited his own Mormon faith as a reason for what he viewed as a favorable outcome. As quoted by the Salt Lake City Tribune:

    “If the standoff with the Bundys was wrong, would the Lord have been with us?” he asked, noting no one was killed as tensions escalated. “Could those people that stood (with me) without fear and went through that spiritual experience … have done that without the Lord being there? No, they couldn’t.”

    Those remarks represent the deep commitment to the Bundy brand of faith. Abraham Bundy — Cliven’s great-grandfather — was a deeply religious man who was driven from prior homes first by flood, and then by revolution. He settled what would become Bundyville, home to a one-room schoolhouse and a scattering of homesteads in a harsh stretch of desert.

    Ultimately, the small town Abraham Bundy founded would be abandoned, after the Bundy family could not secure water and grazing rights from the federal government.

    Bundy has previously said in interviews that relocation played a significant role in shaping his family’s outlook toward the federal government.

    Those views are intertwined with Bundy’s faith. Speaking in St. George, Utah, after the standoff with the Bureau of Land Management, Bundy posed these questions to a crowd of mostly conservative Mormons, as reported by the local newspaper The Spectrum :

    “If our (U.S.) Constitution is an inspired document by our Lord Jesus Christ, then isn’t it scripture?” Bundy asked.

    “Yes,” a chorus of voices replied.

    “Isn’t it the same as the Book of Mormon and the Bible?” Bundy asked.

    “Absolutely,” the audience answered.

    A New Generation Of Mormon Extremism

    David Ammon Bundy — Cliven’s father — relocated the family to Nevada in the 1940s. Cliven named his third son, Ammon, after his father. Ammon is also a figure in the Mormon faith, described as a “great servant” in LDS scripture.

    Ammon Bundy is a self-described devout Mormon, with strong anti-federal feelings. He praises his father’s actions against the federal government, and once accused the Bureau of Land Management as using the Endangered Species Act as a type of eminent domain.

    “They have this quota that they meet,” Bundy told the Cultural Hall podcast. “What we start to see is them using the resources and selling the land for their own benefit!”

    Ammon Bundy uses much of the same language as his father, mixing Mormon religious symbolism with a disgust of the federal government.

    Speaking to Harney County residents last December, Ammon Bundy explained why he became involved in the Dwight and Steven Hammond case that sparked this takeover of federal property.

    “I got this urge that I needed write something,” Bundy said. “I asked the good Lord … I need some help. And he gave me that help. The Lord is not pleased what has happened with the Hammonds.”

    And Bundy justified their armed-intrusion this way to OPB’s Amelia Templeton:

    “The main reason we’re here is because we need a place to stand,” Bundy said. “We stand in defense, and when the time is right we will begin to defend the people of Harney County in using the land and the resources.”

    Meanwhile, Bundy has called for “fellow patriots” to join him at the armed occupation. That call itself closely represents what Captain Moroni told his fellow Nephites in LDS scripture. And it’s part of the reason why “Captain Moroni” came to Burns.

    The man identifying as Captain Moroni said he was inspired by the call, and that the inspiration was validated by God in the form of a flock of geese he saw flying.

    “I just knew it was the right thing [to come to Oregon],” Captain Moroni said. “I’m willing to die here.”

    Oregon Public Broadcasting reporter Amelia Templeton contributed to this story. This report first appeared on OPB’s website.

    The post Why the Bundy militia mixes Mormon symbolism with anti-government sentiment appeared first on PBS NewsHour.


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    After some initial silence, Republican presidential candidates began to make calls for a peaceful end to the takeover of a small wildlife refuge by anti-government protesters 30 miles outside Burns, Oregon.

    Although the armed group shares some beliefs with the Republican Party — especially the belief in limited federal government regulation — candidates largely voiced support for the issues the protesters brought forth, such as land rights, but fell short of endorsing their methods. In a statement posted to Facebook, leader of the occupation, Ammon Bundy, said he and his group planned to stay at the small complex “for as long as need be.”

    The group said they occupied the remote federal building to support two local ranchers, Dwight Hammond Jr. and his son Steven Hammond, who were convicted of arson on a broad terrorism charge in 2012. The Hammonds distanced themselves from the anti-government group, and federal officials haven’t made any major plans to engage the protesters. The White House said it remained hopeful that the “situation can be resolved peacefully and without any violence.”

    The NewsHour compiled the tweets, statements and TV appearances GOP candidates made about the occupation:

    Sen. Ted Cruz told reporters before a campaign event in Iowa that he, too, hoped for a peaceful resolution in Oregon.

    “Our prayers right now are with everyone involved with what’s happening in Oregon, especially in law enforcement,” he said. “Every one of us have a constitutional right to protest to speak our minds but we don’t have a constitutional right to use force and violence and to threaten force and violence on others. It is our hope that the protesters will stand down peaceably … There is no right to engage in violence, and it is our hope that this will be resolved peaceably,” he added.

    Rancher Cliven Bundy, the father of Ammon Bundy, said he met with Sen. Rand Paul for several minutes at a campaign stop in Mesquite, Nevada. A spokesperson for Paul said such a scheduled meeting never took place.

    Today, Paul said he was “sympathetic” to the idea that ownership of large federal lands be given back to states and the people, “but I think the best way to bring about change is through politics.”

    “That’s why I entered the electoral arena,” he said. “I don’t support any violence or suggestion of violence toward changing policy.”

    Sen. Marco Rubio told KBUR that “you gotta follow the law, you cannot be lawless.”

    “We live in a republic. There are ways to change the laws of this country and the policies,” Rubio said. “If we get frustrated with it, that is why we have elections, that is why we have people we can hold accountable.”

    Rubio goes on to say that he agreed there is too much federal control over land, especially in the Western part of the United States.

    “There are states, for example, like Nevada, that are dominated by the federal government in terms of landholding, and we should fix it,” he said. “But no one should be doing it in a way that is outside of the law. We are a nation of laws and they should be respected,” he added.

    In an interview on CNN’s “The Lead with Jake Tapper,” Ben Carson urged people to “try to look at things from both perspectives.”

    “Why, in fact, do these ranchers feel that way. Let’s hear their grievances,” he said. “I don’t condone them taking over a federal building … We have better ways of expressing our displeasure than that, but the fact of the matter is there are legitimate grievances. There’s absolutely no reason the federal government should lay claim to so much land. I believe it would be a very wise thing to get that land back in the hands of the states and then let the states deal with it in an appropriate way,” Carson said.

    Carson added that the ranchers needed to use the “regular channels” for addressing these issues.

    In an interview with CNN’s Brooke Baldwin, Rick Santorum said he didn’t like the protesters’ tactics, “but I certainly didn’t like the tactics Occupy Wall Street was using. They were taking over land — city land and government land — and occupying that for quite some period of time,” he said.

    “Well, armed or not armed, no one’s firing any shots, no one’s threatening to shoot anybody … I think patience is the appropriate way. These are folks that have legitimate grievances with the government just like, you could make the argument, that the Occupy Wall Street had legitimate grievances about, you know, income inequality.”

    New Jersey Gov. Chris Christie mirrored Cruz and Rubio’s sentiments about following the law.

    Ohio Gov. John Kasich claimed ignorance on the situation. While campaigning in Iowa Monday, he told a reporter that, “I haven’t heard about this. When did this come out?”

    The NewsHour political team will continue to update this post as additional candidates react to the ongoing situation in Oregon. And tune in to the NewsHour Monday night for further analysis of the president’s speech, including Politics Monday with NPR’s Tamara Keith and Amy Walter of the Cook Political Report.

    SUBSCRIBE: Get the analysis of Mark Shields and David Brooks delivered to your inbox every week.

    The post What do the presidential candidates think about the militia takeover in Oregon? appeared first on PBS NewsHour.


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    Inez Willis, a senior citizen, walks down the hallway with the aide of a cane to visit a neighbor at her independent living complex in Silver Spring, Maryland April 11, 2012. REUTERS/Gary Cameron   (UNITED STATES - Tags: SOCIETY HEALTH) - RTR30N4P Related words: Medicare , meds, drugs, pills

    Whether it’s coverage for end-of-life counseling or an experimental payment scheme for common surgeries, Medicare in 2016 is undergoing some of the biggest changes in its 50 years. Photo by REUTERS/Gary Cameron

    WASHINGTON — Whether it’s coverage for end-of-life counseling or an experimental payment scheme for common surgeries, Medicare in 2016 is undergoing some of the biggest changes in its 50 years.

    Grandma’s Medicare usually just paid the bills as they came in. Today, the nation’s flagship health-care program is seeking better ways to balance cost, quality and access.

    The effort could redefine the doctor-patient relationship, or it could end up a muddle of well-intentioned but unworkable government regulations. The changes have been building slowly, veiled in a fog of acronyms and bureaucratic jargon.

    So far, the 2016 change getting the most attention is that Medicare will pay clinicians to counsel patients about options for care at the end of life. The voluntary counseling would have been authorized earlier by President Barack Obama’s health care law but for the outcry fanned by former Republican vice presidential candidate Sarah Palin, who charged it would lead to “death panels.” Hastily dropped from the law, the personalized counseling has been rehabilitated through Medicare rules.

    But experts who watch Medicare as the standards-setter for the health system are looking elsewhere in the program. They’re paying attention to Medicare’s attempts to remake the way medical care is delivered to patients, by fostering teamwork among clinicians, emphasizing timely preventive services and paying close attention to patients’ transitions between hospital and home. Primary care doctors, the gatekeepers of health care, are the focus of much of Medicare’s effort.

    Patrick Conway, Medicare’s chief medical officer, says that nearly 8 million beneficiaries — about 20 percent of those in traditional Medicare — are now in “Accountable Care Organizations.” ACOs are recently introduced networks of doctors and hospitals that strive to deliver better quality care at lower cost.

    “Five years ago there was minimal incentive to coordinate care,” said Conway. “Physicians wanted to do well for their patients, but the financial incentives were completely aligned with volume.” Under the ACO model, clinical networks get part of their reimbursement for meeting quality or cost targets. The jury’s still out on their long-term impact.

    Still, a major expansion is planned for 2016, and beneficiaries for the first time will be able to pick an ACO. Currently they can opt out if they don’t like it.

    “We’re all trying to understand where is that threshold when things will flip,” said Kavita Patel, a Brookings Institution health policy expert who also practices as a primary care doctor. It could be like the switch from snail mail and interoffice memos to communicating via email, she says, but “I’m not sure we have reached critical mass.”

    Glendon Bassett, a retired chemical engineer, says he can vouch for the teamwork approach that Medicare is promoting. Earlier this year, a primary care team at SAMA Healthcare in El Dorado, Arkansas, prevented what Bassett feared would turn into an extended hospitalization. It started with a swollen leg.

    SAMA is part of Medicare’s Comprehensive Primary Care Initiative, an experiment in seven regions of the country that involves nearly 400,000 beneficiaries and a much larger number of patients with other types of insurance. The insurers pay primary care practices a monthly fee for care coordination, and the practices also have the opportunity to share in any savings to Medicare.

    The primary-care teams at SAMA consist of a doctor, a nurse practitioner, three nurses, and a care coordinator. The coordinator shepherds patients to avoid gaps in care. The nurses can be an early warning system for the doctor.

    GOT MEDICARE QUESTIONS?

    Ask Phil Here

    Bassett said he had a history of circulatory problems in his legs, but this was different. “It was scary,” he said. “Within a week’s time it turned from red to dark.”

    He thought about the emergency room, but he got in right away to see the nurse practitioner working with Dr. Gary Bevill, his longtime physician. The nurse fetched other clinicians to look at Bassett’s swollen right leg. He was immediately given antibiotics. And the doctor referred him to a cardiologist for an outpatient procedure that has since improved his circulation.

    While the medical treatment may have followed fairly standard protocols, Bassett believes the team approach prevented serious consequences.

    “If I hadn’t seen the nurse practitioner when I did, I feel like I would have been in the hospital,” he said. Bassett has since moved to Hot Springs, in another part of the state, but stays in touch.

    Medicare is weighing whether to expand the primary care model. Conway said more data is needed.

    Other notable changes coming in 2016:

    — Hip and Knee Surgery

    Joint replacements are the most common surgical procedure for Medicare beneficiaries. Starting in April, hospitals in 67 metro areas and communities will be responsible for managing the total cost of hip and knee replacements. The experiment covers a 90-day window from the initial doctor’s visit, through surgery and rehabilitation. At stake for the hospitals are potential financial rewards and penalties.

    Medicare’s goal is to improve quality while lowering cost. But hospitals worry about financial consequences and advocates for patients say there’s a potential to skimp on care.

    “What we are discovering with all this change is that trying to get to value over volume is very difficult to do,” said Herb Kuhn, who heads the Missouri Hospital Association.

    — Hospice Flexibility

    Patients choosing Medicare’s hospice benefit at the end of their lives have traditionally had to give up most curative care.

    Under Medicare’s new Care Choices model, patients with a terminal illness will be able to receive hospice services without giving up treatment. A cancer patient could continue to get chemo, for example.

    Seventy hospices will start the experiment Jan. 1, and another 70 will join in two years.

    The post Big changes coming to Medicare in 2016 appeared first on PBS NewsHour.


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    older worker

    Editor’s Note: Boston University economist Larry Kotlikoff has spent every week, for over three years, answering questions about what is likely your largest financial asset — your Social Security benefits. His Social Security original 34 “secrets” and his Social Security gotchas have prompted so many of you to write in that we feature “Ask Larry” every Monday. Find a complete list of his columns here. And keep sending us your Social Security questions.

    Kotlikoff’s state-of-the-art retirement software is available here, for free, in its “basic” version. His new book, “Get What’s Yours — the Secrets to Maxing Out Your Social Security Benefits,” (co-authored with Paul Solman and Making Sen$e Medicare columnist Phil Moeller) was published in February before the changes from the Bipartisan Budget Act of 2015 went into effect.

    Social Security expert Larry Kotlikoff has been keeping readers updated on how the budget act changes a number of Social Security rules. We’ll continue publishing updates on what this new law means for your Social Security benefits. Stay tuned.


    Jeanne: I am afraid you get thousands of emails, but I have received different answers from every person, agency and government office I spoke with regarding my retirement options. I am hoping you can shed some light on my situation.

    I was married for more than 10 years to my ex-husband. He is 69 and receives retirement benefits (approximately $2,000 per month). I have been on disability ($761 per month) since 2010 and will turn 62 in January 2016.

    My physical disabilities persist, but I am hoping to work soon. It appears that I may be jeopardizing future Social Security benefits by going back to work. Here are my questions:

    • Can I collect on my former spouse, or should I wait until full retirement age?
    • Do I have to keep Medicare if I get group coverage through work?
    • Should I only work part time?
    • How would all this be affected if I remarry?

    I raised six children and put them through college, so I no longer have any savings or property. I had prolonged health issues (not the original disability) and although those issues have been completely resolved, I’ve fallen into deep poverty and have had to use many government programs (Section 8, food stamps, Medicaid pays for Medicare and Vocational Rehab). I hate this existence and was hoping to earn enough to regain independence and improve my situation. Will I just be making things worse when I must retire?

    Any advice would be sincerely appreciated.

    Larry Kotlikoff: If your ex dies, your optimal strategy will change, but for now, my guess is that you should try to earn as much money as possible right through age 70 and start your ​benefits either at full retirement age or at 70. You missed the ability to collect a full spousal benefit at full retirement age and wait until 70 to collect your possibly higher benefit by just one month.

    If you earn enough money, you will lose all your disability benefits via the earnings test, but it will likely be worth it in terms of your lifetime income. If you go off of disability, you can simply wait until 70 to take your retirement benefit if that’s optimal. It may not be! 

    Yours is a pretty complex case. I’ve asked former Social Security technical expert Jerry Lutz for his input.

    Jerry Lutz: I assume by disability benefits Jeanne is referring to Social Security disability benefits and that the benefit amounts quoted are before any deductions for Medicare premiums.

    That said, assuming that she has not yet worked since starting disability benefits, her disability benefits will continue to be paid for at least the first 12 months in which she works, regardless of how much she earns. That includes a nine-month trial work period followed by a three-month grace period.

    If she continues to work and earn more than $1,130 per month after the first 12 months, her disability benefits will be suspended, but technical entitlement to disability will continue for at least another 33 months. This is referred to as an extended period of eligibility. During that time, her disability benefits will be reinstated if her earnings drop below $1,130 in any month. In other words, benefits would be suspended for months in which she earns more than $1,130 and paid for months in which she earns less than $1,130.

    By the end of the extended period of eligibility, she will likely be age 66 or very close to it, at which point she will convert to regular Social Security retirement benefits at the same rate as her disability benefits. From her description of her financial situation, suspending her benefits at that point in order to receive delayed retirement credits would seem to be out of the picture.

    The immediate question is when to apply for divorced spousal benefits. We know that her ex receives about $2,000 per month, but we don’t know when he started taking his benefits. If he started at 66, $2,000 is his primary insurance amount, but if he started at 62, his primary insurance amount would could be as high as $2,670. So Jeanne’s unreduced excess divorced spousal benefit could be as much as $571 or as little as $239. She should be able to find out the actual amount by contacting Social Security. Whatever the unreduced amount is, it would be permanently reduced by about 30 percent if she starts drawing her benefits at age 62. Her spousal benefits would also be subject to the earnings test until she turns 66 if she earns more than $15,720 per year. She’d have to wait until age 66 to get the full excess amount. Obviously, whatever the excess amount is, it would be paid in addition to her $761 disability benefit.

    Medicare eligibility continues for at least seven years after a person on disability returns to work, assuming that they are still considered medically disabled by the Social Security’s standards. Jeanne will be over age 65 long before that, so her Medicare eligibility will continue uninterrupted. Part A (inpatient hospital care) is free and can’t be dropped. She does have the option of dropping Part B coverage, and as long as she’s covered by a qualified employer group health plan, she will be able to re-enroll in Part B later with no waiting period or penalties.

    If she only works part time at less than $1,130 per month, there will be no interruption in her disability payments or divorced spousal benefits if she decides to start them before age 66, and her disability benefits will convert to her retirement benefits at age 66.

    If she remarries, she loses her divorced spousal benefits. She may, however, qualify for spousal benefits on her new husband’s account depending on many factors. Furthermore, since she is over age 60, remarriage will not disqualify her from drawing surviving divorced wife’s benefits on her ex’s record when he dies. If Jeanne’s ex dies before she starts receiving divorced spousal benefits, she should immediately apply for survivor benefits on his account.


    Jim — Sherwood, Ark.: My wife and I draw Social Security and are 69 and older. What I would like to know is: How will the changes in the new budget law affect us?

    Larry Kotlikoff: ​You aren’t really affected by the new law. Because you are both collecting your retirement benefit already, one of you may be able to collect an excess spousal benefit on the other’s work record. So double check if Social Security knows that you are married. To collect an excess spousal benefit, your own full retirement benefit, inclusive of any accumulated delayed retirement credits, has to be less than half of your spouse’s. If you’ve each had a decent work record, your excess spousal benefits will almost surely be zero or very small.

    What else can you do? You could suspend your benefits right now and restart them at a higher level starting at age 70. ​How much that raises your annual benefits from 70 on depends on your precise birthdates. If you just turned 69, it could be close to 8 percent each.


    Patrick — Forestville, Calif.: I turned 66 in March of this year and my wife will turn 62 in May of 2016. Her own Social Security yearly benefit, even at 62, would be more than 50 percent of mine. I am retiring at the end of 2015. My wife plans to continue working. Using your terrific Maximize My Social Security program, I’ve run many scenarios of who collects, when to collect, who suspends, etc. Assuming we both live to the program’s default of 100, it gives the same advice with each scenario, namely:

    • I file for retirement benefits in February 2019, the year I turn 70.
    • My wife files for spousal benefits in May 2020, the year she turns 66.
    • My wife files for retirement benefits in May 2024, the year she turns 70.
    • My wife files for widow(er)’s benefits in December 2049, the year she turns 95.

    So it seems that since I will turn 70 two months before my wife turns 66, it doesn’t matter if I file and suspend now or not as long as I don’t plan to actually collect until I turn 70. Right? However, considering the amended version of the budget that the House recently sneaked by us, should I file and suspend in January anyway in order to be “grandfathered” in to the current Social Security regulations as protection against any further changes? Also since the new regulation extends deeming to age 70, effectively wiping out the advice above for my wife to file for spousal benefits when she turns 66, should she do anything different in the six-month window that the recent amendment “graciously” established? Thanks for any timely advice!

    Larry Kotlikoff: We released the new version on Nov. 15, 13 days after the law was signed by the President. The suggestions the program produced before the update, which you copied in your question, are no longer valid. You need to run the new version of our software that incorporates all the new Social Security provisions. The two of you got badly hurt by the new budget and even though you could file and suspend, doing so will be of no value to your wife in terms of collecting a full spousal benefit off of your work record when she reaches full retirement age and continuing through age 70. Because your wife is five months too young, she won’t be grandfathered against the extension of deeming. And because she is five months too young, you two have lost tens of thousands of dollars in benefits over the two year period. If you both have very high maximum ages of life, the program will now simply suggest you both wait until 70 to collect your retirement benefits. You can also file for spousal benefits at that time, but it sounds like neither excess spousal benefit will be positive. You are old enough to file a restricted application for spousal benefits only. In theory, at least, your wife could file for retirement insurance benefits at 62, and you could file just for spousal benefits at the same time. Then, you could file for your retirement insurance benefits at 70.


    Deborah — Chapel Hill, N.C.: Dear Mr. Kotlikoff, I will turn 65 in 2016. I married a younger man (my real retirement plan — ha ha). He will be 59 next year. I plan to wait until I am 70 to begin collecting Social Security, but I have the lower of our two incomes. I earn $50,000 as an independent contractor, and I would like to slow down my work in the coming years, perhaps reducing my income by half. My husband earns $150,000 as a salaried engineer, and he is likely to continue earning the same or more until he retires at age 65. I am really confused about the “file and capture” possibilities and how age and income differences affect how I should apply for Social Security.

    Larry Kotlikoff: Unfortunately, my answer here is vague because I don’t have all the details. At first glance it seems that both of you will want to wait until 70 to file for your highest retirement benefits, due to your ages and the new law. The benefits of the fil​e and suspend strategy, which would, in your case, entail your husband filing just for spousal benefits at full retirement age will not apply to you. Because your husband and you both earn reasonably high salaries, it’s very unlikely that either of you could collect an excess spousal benefit in addition to your retirement benefit. So if you have a high maximum age of life, you should simply both wait until you are 70 to collect your retirement benefits. If your maximum ages of life are lower, then you’ll need to look at when to file for retirement benefits using software.


    Anonymous — Sachse, Texas: I am 65 and on Social Security Disability Insurance. I would like to know if at age 66 (full retirement age), I can suspend my Social Security until 70 and still receive my disability payments? Would it be better to simply enroll in Social Security at age 66 and then suspend until 70, while working full time if possible (that is, if I can locate a suitable job until age 70)?

    Larry Kotlikoff: Your disability benefits automatically convert to a standard retirement benefit when you reach your full retirement age, so you have no choice in the matter, and there’s no need to enroll. At that point you’ll need to decide whether you want to continue receiving your benefit or suspend it until you’re 70. If you suspend, you will stop receiving your current payments for the time being, but you’ll earn delayed retirement credits of 8 percent per year.

    Fortunately, continuing to work won’t affect your benefits in this case since after your full retirement age, the earnings test doesn’t apply.


    Rebecca — Tallahassee, Fla.: I’m 61. My husband died at 38, and we were married 11 years. He was the bread winner of the family. I have been making a bit more than $50,000 for the last five years. The work is labor intensive, and I don’t know if I will make it until 66. I do have real estate that I own and some that I’m paying on. What are my options?

    Larry Kotlikoff: ​If your widow’s benefit is less than about $1,500, you would likely lose all of it due to the earnings test. But benefits you lose due to the earnings test are restored via a bump up in the level of benefits post full retirement age. You definitely want to run yourself though software that handles the earnings test very carefully. Were you to stop working and were you to have 40 quarters of coverage to qualify for a retirement benefit on you own account, my recommendation would likely be to take your retirement benefit at 62 and flip to your widow’s benefit at full retirement age when it will start at its highest possible value. If you keep working, but start earning less and then take your retirement benefit, be aware that your retirement benefit, not your widow’s benefit, will be bumped up at full retirement age. If your widow’s benefit is larger, you’ll get it, but it won’t be bumped up in reflection of the loss of months of benefits you experience via the earnings test. So you have a complex problem. You need to understand what your total net income will be under different scenarios, including how long you work and how much you earn. But there are software programs that let you enter your future earnings and will help you answer this question.


    Vaughn — Fallbrook, Calif.: My wife and I are 63. She has a sparse work history and is unable to work. On her own work history she can receive perhaps $500 per month if she waits until age 66 to apply for Social Security retirement benefits, or she can receive about 20 percent less if she applies now. At age 66, I will be eligible for a Social Security retirement benefit of perhaps $2,600 per month, but in order to boost my benefit, I plan to earn delayed retirement credits until I turn 70. If regardless of when she starts receiving benefits she would receive a full spousal benefit of $1,300 per month when I retire, I think she would prefer to start receiving a reduced benefit now. But if receiving early benefits on her own work history now would reduce the $1,300 she would receive when I retire, I think she would prefer to wait three years and apply when she reaches age 66. If she starts receiving reduced benefits now, when I retire in 7 years would her retirement benefit be stepped up to her full spousal benefit of $1,300 per month, or would it be a reduced amount? (We understand that, with the elimination of the file and suspend loophole, she will not be able to receive a spousal benefit until I start receiving benefits at age 70.)

    Larry Kotlikoff: If your wife takes early retirement benefits, it will permanently reduce the total payment she’ll eventually receive when she also starts taking her spousal benefit, which means when you start taking your retirement benefit.

    ​However, once she reaches full retirement age, she should definitely take her retirement benefit even if you have not yet taken your retirement benefit. Once you do take your retirement benefit, she’ll get her own unreduced retirement benefit plus her excess spousal benefit, which together will become her full spousal benefit. So the answer to your question is yes. If she takes her retirement benefit early, it will reduce her total payment once she starts her spousal benefit. Apart from her taking her retirement benefit starting at full retirement age is the question of whether you should wait until 70 to collect your own retirement benefit. It depends on your maximum age of life as well as your wife’s. If you wait until 70 to collect, you will maximize her widow’s benefit should you die.


    Julie – Sultan, Wash.: I am currently 65 and will turn 66 in August of 2016. I was hoping to collect spousal benefits when I turned 66 through file and suspend on my ex-husband’s work record. He is already retired. It now appears that I will not be able to do so as I will not reach full retirement age before the 180-day limit on file and suspend. Is there any way to get around this?

    Larry Kotlikoff: I have good news for you. You don’t need to file and suspend in order to claim your divorced spousal benefit at your full retirement age. What you are referring to is filing a “restricted application” to receive your divorced spousal benefit. Filing and suspending is irrelevant in this case.

    Fortunately for you, because you were born before 1954, you are able to file for a restricted application at 66 (your full retirement age). Moreover, you can switch to your own retirement benefit at 70 if it is larger than your divorced spousal benefit at that time.


    Jodi — Dallas: I am 55 and a teacher in Texas. This is a second career, and I paid into Social Security for over 12 years. I will be able to retire as a teacher and receive my pension from the Teacher Retirement System of Texas at 62. I think I understand the windfall elimination provision and the government pension offset provision, and by my calculations, I should still be eligible for about $400 in Social Security benefits at 67 (my full retirement age), even with those terrible provisions. My husband is 69 and already retired. He has started drawing his full Social Security benefit. Our question is: Would I be able to file for Social Security under my husband’s account at age 62 and receive half of his Social Security benefit? Then, I would wait until I reached 70 to apply for my own. If I could apply for his Social Security, would it be subject to both the windfall elimination and the government pension offset provisions? What would happen to my benefit if he dies? This is a very confusing issue!

    Larry Kotlikoff: ​If you can hold off taking your pension from the Teacher Retirement System of Texas and doing so will provide a higher benefit, it may pay you to do this. You could then start your own retirement benefit starting at 62, and though it will be reduced because you are taking it early, it would not be subject to the windfall elimination provision until your Teacher Retirement System of Texas pension starts. Your husband should, I think, wait until 70 to collect his retirement benefit. If you can wait for a higher Teacher Retirement System of Texas pension, he may want to file for his retirement benefit before 70 to activate your spousal benefit with no reduction due to the government pension offset provision, because the government pension offset provision also won’t kick in until you take your Teacher Retirement System of Texas pension.

    If holding off on the Teacher Retirement System of Texas pension isn’t permitted or isn’t worth it financially, your best bet may well be to take your own retirement benefit at age 70. You may also want to consider working outside the uncovered state teachers system so that you can earn more years of covered service and potentiall, significantly raise your retirement benefit before it gets crunched by the windfall elimination provision.

    The post Can I return to work and still receive Social Security disability benefits? appeared first on PBS NewsHour.


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    According to data from the Defense Department, the sexual assault of military dependents occurs hundreds of times each year. Of the substantiated cases, most of the offenders were male, enlisted service members and the victims were overwhelmingly female. Photo of Pentagon by Wikimedia user David B. Gleason

    According to data from the Defense Department, the sexual assault of military dependents occurs hundreds of times each year. Of the substantiated cases, most of the offenders were male, enlisted service members and the victims were overwhelmingly female. Photo of Pentagon by Wikimedia user David B. Gleason

    WASHINGTON — Cpl. Aaron C. Masa befriended a fellow Marine during field training in North Carolina. But behind his buddy’s back, Masa sexually abused his 3-year-old stepdaughter and took sexually explicit photos of her and the Marine’s baby girl.

    A military judge convicted Masa last year of sexual abuse of a child and production of child pornography, according to court records and other documents detailing the case. Under the terms of a pretrial agreement, Masa pleaded guilty and received 30 years in prison.

    The sexual assault of military dependents occurs hundreds of times each year, according to data the Defense Department provided exclusively to The Associated Press. There were at least 1,584 substantiated cases between fiscal years 2010 and 2014, according to the data, which is the most current available. The abuse is committed most often by male enlisted troops, followed by family members.

    The figures offer greater insight into the sexual abuse of children committed by service members, a problem of uncertain scale due to a lack of transparency into the military’s legal proceedings. With more than 1 million military dependents, the number of cases appears statistically small. But for a profession that prides itself on honor and discipline, any episodes of abuse cast a pall.

    Those numbers fall well-short of offering a full picture.

    The ages of the offenders and victims, the locations of the incidents and the branch of service that received the report of sexual abuse were omitted. The Defense Department said in a statement that “information that could unintentionally uniquely identify victims was withheld from release to eliminate possible ‘re-victimization’ of the innocent.”

    It’s also unclear how many of the incidents resulted in legal action. The cases represent substantiated occurrences of child sexual abuse reported to the Defense Department’s Family Advocacy Program, which does not track judicial proceedings, the department said.

    An AP investigation published in November found more inmates are in military prisons for child sex crimes than for any other offense. But the military’s opaque justice system keeps the public from knowing the full extent of their crimes or how much time they spend behind bars.

    Responding to AP’s findings, three Democratic senators urged Defense Secretary Ash Carter to lift what they called the military justice system’s “cloak of secrecy” and make records from sex-crimes trials readily accessible.

    Of the 1,584 substantiated cases, enlisted service members sexually abused children in 840 of them. Most of the enlisted offenders were males. The victims were overwhelmingly female. The senators also raised another concern. Child sex-assault cases are not included in the Defense Department’s annual report to Congress on sexual assaults, which focuses primarily on adult-on-adult incidents, they said. The senators — Barbara Boxer of California, Kirsten Gillibrand of New York and Mazie Hirono of Hawaii — told Carter in a Dec. 8 letter they are concerned the department may be underestimating how many sexual assaults are occurring in the military.

    Of the 1,584 substantiated cases, enlisted service members sexually abused children in 840 of them. Family members of the victims accounted for the second largest category with 332 cases.

    Most of the enlisted offenders were males whose ranks ranged between E-4 and E-6. In the Marine Corps and Army, for example, those troops are corporals, sergeants and staff sergeants. Officers were involved in 49 of the cases. The victims were overwhelmingly female.

    Kathy Robertson, manager of the Family Advocacy Program, said in an emailed response to questions that the incident rates reflect the U.S. military’s demographics. Most of the cases involve the E-4 and E-6 ranks because they are the largest number of active-duty personnel and the largest number of parents in the military, she said.

    Duplications in the data indicate that as many as 160 additional cases of sexual abuse could have occurred during the 2010 to 2014 period, involving a child who was victimized multiple times or a repeat abuser. The figures also account just for cases involving military dependents, which are the only child victims the department tracks.

    The data on sex crimes committed by civilians is not comparable to the figures maintained by the Pentagon due to differences in demographics and the way incidents are reported.

    Making a direct comparison to national statistics “would be misleading,” Robertson said. However, a 2013 study of child maltreatment by the U.S. Health and Human Services Department suggests incidents of child sexual abuse are higher in the general population than among military families.

    In Masa’s case, military authorities first became aware of the alleged abuse in June 2014 after the 3-year-old told a neighbor that she did not like Masa because he touched her in certain places and “made it hurt,” according to the Naval Criminal Investigative Service’s investigation obtained by AP through the Freedom of Information Act.

    NCIS blacked out all the names in the report, including Masa’s. The AP identified him by the dates and events in the document that matched records from Masa’s court-martial.

    Masa, 25, admitted during questioning to at least five instances of sexually assaulting her, the NCIS report said. Investigators found nude photos of both girls on his cellphone and later discovered a pair of girl’s underwear during a search of his mother’s home in Ohio.

    The report depicted Masa as a loner with a troubled past. People interviewed by the Navy investigators described him as “oddball” who was picked on in high school in Marietta, Ohio. He graduated near the bottom of his class with a cumulative 1.782 GPA, according to his official transcript.

    Masa watched a lot of sexually explicit Japanese animation known as hentai, the NCIS report said, and he had an intense interest in “furry porn,” a genre of pornography in which animal characters with human arms and legs engage in sex.

    In 2008, Masa was arrested after threatening to bring a gun to school and shoot three other students, according to the NCIS report, which included details of the incident. Police didn’t find a gun on him, but he had a knife. He pleaded guilty to a disorderly conduct charge.

    He enlisted in the Marine Corps in June 2010, a month after graduating from high school. The arrest wasn’t serious enough to bar Masa from enlisting. A Marine Corps spokesman said he was found qualified after a thorough screening process that involved physical, mental and moral evaluations.

    Stationed at Camp Lejeune, a sprawling installation on the North Carolina coast, Masa started a friendship with the Marine sergeant and his family in 2013, according to the 286-page NCIS report. They fished together and chopped wood for the sergeant’s fire pit. Masa loaned the sergeant money to help the family through a financially difficult period and spent more and more time at their home, the report said. He babysat the girls and volunteered to give the older daughter a bath, the documents said.

    Amid the good will, suspicions surfaced. The girls’ mother suspected as early as March 2014 that the 3-year-old daughter was being molested because she complained of pain “down there,” according to portions of medical records from a hospital near Camp Lejeune that are included in the NCIS report. The girl was sleeping by the door and having nightmares, the mother said.

    Yet at the hospital, the girl was in high spirits, smiling, laughing and jumping on the bed, according to the report. She was diagnosed as having a urinary tract infection and antibiotics were prescribed. “Mom advised to follow up with law enforcement if she has concern about possible molestation,” the report said, quoting the medical records.

    But an investigation wouldn’t be launched until a few months later, after the girl talked to the neighbor. While being questioned by investigators, Masa drew a diagram of the floor plan of the sergeant’s home, using X’s and O’s to show where the abuse occurred.

    Masa is serving his sentence at the U.S. Disciplinary Barracks at Fort Leavenworth, Kansas.

    The post Pentagon data on child sex crimes in the military doesn’t show full picture appeared first on PBS NewsHour.


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    Video by YouTube user PoliticalTurkey1

    MANCHESTER, N.H. — Republican presidential hopeful Donald Trump is giving some of the most divisive proposals of his campaign a starring role in his first television ad. On the eve of its debut in the first states to cast votes in the 2016 race, billionaire developer faced questions about the footage he chose.

    With the opening 2016 primary contest four weeks away, Trump is spotlighting his plan to ban Muslims from entering the United States — temporarily and with exceptions, he says — and to build a wall along the southern border. Trump’s campaign says he plans to spend $2 million a week on the ad, set to begin airing Tuesday across Iowa and New Hampshire.

    The new ad features dark images of the San Bernardino shooters, who were Muslims, as well as body bags and explosions.

    “The politicians can pretend it’s something else. But Donald Trump calls it radical Islamic terrorism. That’s why he’s calling for a temporary shutdown of Muslims entering the United States until we can figure out what’s going on,” a narrator says.

    Video footage later in the ad shows people apparently streaming freely across a border as a narrator says Trump will “stop illegal immigrants by building a wall on our southern border that Mexico will pay for.”

    Facing questions from news outlets, the Trump campaign acknowledged in a statement on Monday that the images of border security were of Morocco, not the U.S.-Mexican border.

    “I think it’s irrelevant,” Trump said in an interview on FOX News Channel’s The O’Reilly Factor set to air Monday night, according to an early transcript. “So you can just take it any way you want, but it’s really merely a display of what a dumping ground is going to look like. And that’s what our country’s becoming very rapidly.”

    His campaign elaborated in a statement, saying the selection of footage was intentional “to demonstrate the severe impact of an open border and the very real threat Americans face if we do not immediately build a wall and stop illegal immigration.”

    The ad, posted on Trump’s website Monday, is a departure from the typical introductory campaign spot, which often features a candidate introducing himself voters or sharing her life story.

    But Trump already is well-known to voters. He was the star of the popular “The Apprentice,” his name is plastered on high-rise and hotel buildings across the country and he has dominated news coverage over the last six months.

    “We’re not the typical campaign,” Trump campaign manager Corey Lewandowski said of the ad. Instead, he said, Trump chose to focus on the issue that has been the centerpiece of his campaign: illegal immigration and its impact.

    “These are the issues that Mr. Trump has brought to the forefront of the discussion,” said Lewandowski. “He’s talked about this from the day he launched his campaign.”


    READ MORE: What does Donald Trump believe? Where the candidate stands on 10 issues

    Trump’s proposal on Muslims has been condemned by Republicans and Democrats as un-American and counterproductive, yet the hard-line approach to immigration has fueled his popularity among the overwhelmingly white GOP primary electorate.

    Republican pollster Frank Luntz, at times a Trump critic, predicted the new ad would help Trump among the slice of Republican voters who participate in early voting contests.

    “This may not be a majority position in the country,” Luntz said of the Muslim ban. “It may not even be a majority position within the Republican Party, but among those who will vote in the caucuses and the primaries it is a popular position, and he will benefit from it.”

    An ABC News/Washington Post poll conducted in December found that 6 in 10 Americans think a ban on Muslims entering the United States is the wrong thing to do. Among only Republicans, however, 6 in 10 say they would support such a policy.

    The ad represents the billionaire businessman’s first foray into television advertising after spending much of 2015 dominating polls without spending significant resources — at least compared to his rivals.

    On Monday, the campaign put almost $2 million into broadcast and cable television ads to run this week in Iowa and New Hampshire, advertising tracker Kantar Media’s CMAG shows. He had previously spent about $300,000 on radio commercials, mostly in Iowa, over three weeks in November.

    The advertising campaign comes as voters begin paying closer attention to the 2016 presidential contest following the holiday season.

    While Trump had previously said he was worried about over-saturating the airwaves, he said Monday he doesn’t “want to take any chances.”

    Peoples reported from Washington. Associated Press writer Julie Bykowicz and news survey specialist Emily Swanson contributed to this report.

    SUBSCRIBE: Get the analysis of Mark Shields and David Brooks delivered to your inbox every week.

    The post Trump’s first TV ad spotlights Muslim ban appeared first on PBS NewsHour.


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    President Woodrow Wilson addresses Congress in  December 1915 during the State of the Union address.. Photo by Universal History Archive/UIG via Getty Images

    President Woodrow Wilson addresses Congress in December 1915 during the State of the Union address.. Photo by Universal History Archive/UIG via Getty Images

    On Jan. 8, 1790, George Washington stood before a joint session of Congress to deliver the nation’s first State of the Union address. In his speech, Washington reflected on the first year of his presidency and laid out his policies for the still-new United States. In so doing, he set the tone for all future presidents to discuss pressing domestic and foreign issues of the day and promote policy ideas to combat those problems.

    At the heels of President Obama’s final State of the Union address, here’s a look at the history of the speech along with its various traditions and rituals.

  • Washington delivered his first annual address to Congress on Jan. 8, 1790 at Federal Hall in New York City. At the time, it was not yet referred to as the State of the Union.
  • President Washington began each address by saying, “Fellow-citizens of the Senate and House of Representatives…” In comparison, during last year’s State of the Union, President Barack Obama started his speech with, “Mr. Speaker, Mr. Vice President, Members of Congress, my fellow Americans…”
  • READ NEXT: The nuance you may have missed in Obama’s gun control plan

  • While John F. Kennedy coined the term “My fellow Americans,” Lyndon Johnson was the first president to add the words to his State of the Union introduction.
  • The annual address was not officially called the “State of the Union” until 1947. It was in 1942 that people began informally using that name. Before that, it was simply known as the “Annual Message,” or “Annual Address.”
  • The first State of the Union set in Washington, D.C. was delivered by President John Adams in his final annual address in 1800.
  • Only two presidents failed to deliver a single State of the Union address, but they both had a good excuse. William Henry Harrison was in office exactly one month when he died of pneumonia, and James Garfield was assassinated six months into his presidency.
  • President Bill Clinton during his last State of the Union Address before Congress.  Photo by Douglas Graham/Congressional Quarterly/Getty Images

    President Bill Clinton during his last State of the Union Address before Congress. Photo by Douglas Graham/Congressional Quarterly/Getty Images

  • From Thomas Jefferson’s presidency through William Howard Taft’s — that’s 1801-1913 — the State of the Union was delivered in written form. Woodrow Wilson brought back the tradition of delivering a speech in his first term. The State of the Union has been delivered in written form 130 times and as a speech 93 times.
  • The last president to only submit a written State of the Union was Jimmy Carter in 1981, four days before Ronald Reagan was sworn into office.
  • The shortest State of the Union was delivered by Washington, with only 1,089 words total. The longest written State of the Union had 33,667 words — that was Jimmy Carter in 1981. The longest speech was 9,190 words, delivered by Bill Clinton in 1995.
  • The first opposition response to the president’s address was given by Senate Minority Leader Everett Dirksen and then-House Minority Leader Gerald Ford in 1966. Ford, George H. W. Bush and Clinton all gave opposition responses before becoming president.
  • The modern day State of the Union is traditionally scheduled for January, but that trend did not start until Franklin Delano Roosevelt. Before FDR, most presidents delivered their annual address in December; a handful opted for November or October.
  • The first radio broadcast of the address aired in 1923 by Calvin Coolidge. The first television broadcast was of Harry Truman’s speech in 1947. And the first live webcast of the speech was in 2002 by George W. Bush.
  • Since the ‘80s, a designated survivor has been selected for the State of the Union. This is a member of the president’s cabinet who does not attend the event, in case a disaster or attack kills the president and everyone in the line of succession. The first designated survivor was Reagan’s Housing and Urban Development secretary, Samuel Pierce. The two cabinet positions most often selected to serve as designated survivor are the secretary of the Agriculture Department and the secretary of the Interior Department; both positions have been selected six times each. The only person to serve in the role more than once was George W. Bush’s Commerce secretary, Donald Evans.
  • President Barack Obama delivers his State of the Union speech on Capitol Hill on January 28, 2014 in Washington, DC. Photo by Larry Downing-Pool/Getty Images

    President Barack Obama delivers his State of the Union speech on Capitol Hill on January 28, 2014 in Washington, DC. Photo by Larry Downing-Pool/Getty Images

  • In the 2011 speech, members of Congress broke with tradition and sat with lawmakers of the opposite party after Senator Mark Udall of Colorado called for a show of unity in response to the shooting of Rep. Gabby Giffords and others in Arizona.
  • Presidents Reagan, George H. W. Bush, Clinton, George W. Bush, and President Obama all delivered non-State of the Union addresses to Congress in February of their first year as president. Tomorrow’s speech will be Obama’s seventh and final State of the Union address.
  • The post Who coined ‘my fellow Americans’ and other State of the Union trivia appeared first on PBS NewsHour.


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    It appears more likely than ever that American prosecutors will eventually get their hands on drug lord Joaquin "El Chapo" Guzman. Photo by Daniel Cardenas/Anadolu Agency/Getty Images

    It appears more likely than ever that American prosecutors will eventually get their hands on drug lord Joaquin “El Chapo” Guzman. Photo by Daniel Cardenas/Anadolu Agency/Getty Images

    WASHINGTON — With Mexican authorities saying they’re committed to extraditing Joaquin “El Chapo” Guzman to the United States, it appears more likely than ever that American prosecutors will eventually get their hands on the drug lord.

    But it’s not clear exactly how long that process will take, nor which of the offices that have already brought charges against Guzman would get to go first with their cases.

    READ MORE: Sean Penn met secretly with drug lord ‘El Chapo’ Guzman

    A look at how Guzman could be extradited.

    WHAT HAPPENS NOW?

    Mexican authorities say they’ve formally notified Guzman, whose capture Friday came six months after he broke out of a Mexican prison, that arrest warrants from the U.S. are being processed.

    That’s the start of the process, though the head of extradition for the Mexican attorney general’s office told local media that it will probably take at least a year to extradite Guzman. And Guzman’s attorney said that the defense already has filed six motions to challenge extradition requests.

    The speed of the extradition process is almost entirely up to the Mexican government, said David Weinstein, a former federal prosecutor who oversaw the narcotics division at the U.S. attorney’s office in Miami.

    “It can go as slow or as fast as they want it to go,” Weinstein said.

    WHERE IS HE WANTED?

    About a half-dozen U.S. attorneys’ offices throughout the country — among them in Chicago, San Diego, New York City, New Hampshire, Miami and Texas — have secured indictments against Guzman in his absence over the years.

    In the Eastern District of New York, for example, a 49-page grand jury indictment accuses Guzman of running a cartel that imported “multi-ton quantities of heroin, methamphetamine and marijuana into the United States” and of employing hit men who carried out murders, kidnapping, tortures and other acts of violence.

    Meanwhile, prosecutors in the Western District of Texas accuse Guzman and a series of associates of bringing cocaine and marijuana into the state through vast open desert, across bridges and via other trafficking routes, and then arranging for the proceeds to be smuggled back into Mexico.

    WHERE WILL HE BE PROSECUTED?

    No announcement has yet been made, and a Justice Department official said Monday that no decision had been reached on where Guzman would be sent once Mexico actually extradites him. The Justice Department has a designated Office of International Affairs that deals with extradition matters and securing the return of fugitives.

    Regardless of where he ends up, it’s safe to expect jockeying among the different offices.

    Prosecutors in San Diego, for instance, can point to their experience in going after the Arellano Felix cartel. That group’s former leader, Benjamin Arellano Felix, was extradited from Mexico in 2011 and was sentenced to 25 years in federal prison in 2012.

    In Chicago, Guzman has been dubbed “Public Enemy No. 1,” and prosecutors there say the city is a major hub for Guzman’s Sinaloa drug cartel.

    Besides its own experience in narcotics cases, the Eastern District of New York in Brooklyn counts among its alumni some of the highest-ranking Justice Department officials in Washington, including Attorney General Loretta Lynch and Leslie Caldwell, chief of the department’s criminal division.

    There’s often politicking involved in these decisions, and deference is sometimes paid to the office that filed its case first, said Marcos Jimenez, a former U.S. attorney in Miami who oversaw drug cases involving extradited defendants.

    But, he said, “the overwhelmingly most important factor is which office has the best case against him and the most likelihood of conviction. I would think that they would put those things together and pick the office that has both the best case and the best team of prosecutors available.”

    The post Even if Mexico extradites ‘El Chapo,’ where will he be prosecuted? appeared first on PBS NewsHour.


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    Photo by Kris Livingston/Flickr

    Larry Kotlikoff answers your Social Security questions. Photo by Kris Livingston/Flickr

    Editor’s Note: Boston University economist Larry Kotlikoff has spent every week, for over three years, answering questions about what is likely your largest financial asset — your Social Security benefits. His Social Security original 34 “secrets” and his Social Security gotchas have prompted so many of you to write in that we feature “Ask Larry” every Monday. Find a complete list of his columns here. And keep sending us your Social Security questions.

    GOT SOCIAL SECURITY QUESTIONS?

    Pose Your Questions to Larry Here

    Kotlikoff’s state-of-the-art retirement software is available here, for free, in its “basic” version. His new book, “Get What’s Yours — the Secrets to Maxing Out Your Social Security Benefits,” (co-authored with Paul Solman and Making Sen$e Medicare columnist Phil Moeller) was published in February before the changes from the Bipartisan Budget Act of 2015 went into effect.

    Social Security expert Larry Kotlikoff has been keeping readers updated on how the budget act changes a number of Social Security rules. We’ll continue publishing updates on what this new law means for your Social Security benefits. Stay tuned.


    John and Karen: We went to Social Security on Dec. 21 with the full intention of simply confirming that I would be receiving 50 percent of John’s Social Security the month I turn 66. We were informed by the person with whom we met that that can’t happen until three months before my 66th birthday, so we prepared to end our meeting at that point, noting that we’d come back in February 2017 to accomplish that task.

    At that point, we learned that the person with whom we were meeting, Hannah, was a Social Security Disability Insurance specialist. (The person we met with at our previous meeting, who admitted to us that she was an Supplemental Security Income specialist and knew little about Social Security Disability Insurance had arranged her to meet with us.)

    Hannah informed us that she had studied our son Karl’s information and proceeded to cheerfully offer to resubmit Karl’s Social Security Disability Insurance application in an attempt to roll back its start date to before he turned 22. She claimed that this was possible because he was born with a genetic syndrome, rendering him, in effect, disabled at birth. She claimed that all she needed was 1) documentation from a medical professional that he has a genetic syndrome; 2) a certified copy of our guardianship; and 3) monthly payroll sheets for Karl from March 2013 to the present.

    We were stunned.

    She reported that Karl had undergone six of the required 16 “pay trial” reviews and that the most recent one was done in March 2013. She claimed that, at each trial, he was below the magic number of $780 per month.

    It was her turn to be stunned when we told her to do nothing quite yet, requesting that we have some time to review our decision and seek counsel with our financial planner. She truly couldn’t understand our hesitation. We asked her many different ways if the resubmission could affect Karl’s Social Security Disability Insurance in any way. She claimed that it would not. She said that it would either be approved or not and that if the latter were the case, he would simply continue receiving the same benefits. She agreed strongly with us that Medicaid should never be an option for Karl and that the benefits of Social Security Disability Insurance far outweighed Supplemental Security Income (he can have assets and Medicare).

    She claimed that rolling back the date to before he turned 22 would make it possible for him be classified as a “disabled child.” Karl would be able to immediately collect the additional money, which would bring him to 50 percent of John’s Social Security (from about $700 to $1,050), and at the time of John’s demise, it would bring him to a monthly Social Security Disability Insurance amount of 75 percent of John’s Social Security, which would be a monthly amount of $1,500 for the rest of Karl’s life.

    John began to gather the payroll information. He freaked a bit when he discovered that, during the period of time from March 2013 to present, there were two months when Karl earned more than the magic number of $1,090. (Yes, we are confused about the two different magic numbers — $780 and $1,090). My big concern is that any action we take will make it possible for the Social Security person to see that Karl earned over $1,090 two different months in 2015, as a result of a combination of three pay periods in a month and profit sharing, although one month he was over roughly $100. Will this cause huge problems? Most months he is well below and well under $12,000 per year.

    Our financial planner’s big area of concern is John bumping into his Social Security maximum with Karen going on John’s Social Security when she turns 66 and Karl being on it.

    Lastly, does Hannah at Social Security seem to be correct on this stuff? We don’t really understand what the trial periods and the $780 per month has to do with the whole deal, but I can tell you that Karl has earned less than $780 per month about half of the months between March 2013 and the present times.

    Larry Kotlikoff: I’ve asked former Social Security technical expert Jerry Lutz to weigh in.

    Jerry Lutz: It’s much easier to answer questions when you have all of the facts. Unfortunately, that’s not the case here.

    I’m guessing John is currently entitled with a primary insurance amount of around $2,000. If he has a disabled child, I would certainly think they’d want him to apply for disabled child’s benefits. If he qualifies, it’s essentially a lifetime benefit.

    The $780 figure is the trial work month amount for 2015 and is basically irrelevant. If Karl is approved for childhood disability benefits, then the Social Security Administration will start tracking trial work months, but that’s still irrelevant, unless he subsequently starts earning more than the substantial gainful activity limit. If Karl is already receiving Disability Insurance Benefits based on his own earnings, the Social Security Administration would be tracking his trial work months for that, but he would continue to be entitled as long as his average monthly earnings remain below the substantial gainful activity limit.

    The $1,090 number is the monthly substantial gainful activity figure for 2015, and the fact that Karl was over that amount in two months due to getting three paychecks in one month and profit sharing in another month will not disqualify him. As we’ve discussed, earnings are averaged for substantial gainful activity purposes, usually on a calendar year basis, and since Karl earned less than $12,000 in 2015, his average monthly earnings were well below the $1,090 figure. I assume that’s true of 2013 and 2014 as well, but we don’t have that information. I’m also assuming that Karl turned 22 in 2013, since that’s the first point in time that the Social Security Administration is requesting proof of his earnings.

    It’s true that Karl’s childhood disability benefits entitlement could cause Karen to receive a lower benefit due to the family maximum, but the family would receive more in total. Also, if and when Karen becomes eligible for retirement benefits on her own account, Karl will likely qualify for childhood disability benefits on her account as well, at which point, Karen’s and John’s family maximums can be combined, and everyone will likely get their full benefits. Furthermore, one of the questions on the Social Security Administration application for retirement benefits is whether or not you have any disabled children. I’m sure they wouldn’t prosecute you for failing to disclose that you have a disabled child, but it’s not really proper to answer ‘no’ if you do in fact have a disabled child.

    Obviously, all of this is difficult to explain to someone even when you have all of the facts. It certainly sounds like the Social Security Administration workers are on the right track in this case, and I would encourage this family to follow their advice. If Karl doesn’t file now, it could keep him from ever qualifying for childhood disability benefits, which would probably be around $1,500 per month (plus future cost-of-living-adjustments) when John dies. If, for example, Karl starts earning more than the substantial gainful activity level in the future, it would then be too late to apply for childhood disability benefits. On the other hand, if entitlement is already established and he subsequently earns more than the substantial gainful activity level, he can still qualify to have his benefits reinstated if and when his earnings drop below substantial gainful activity level.

    The bottom line: It sounds like a no brainer that Karl should apply ASAP, even if it causes Karen to at least temporarily receive a lower spousal benefit.

    John: So we went to Social Security yesterday and all seemed to go smoothly. It took a long time, including a trip to the county offices for a certified birth certificate for Karl. The Social Security lady appears to have changed his date of disability to birth and not when we applied him for benefits, which as I recall would officially allow him to collect on me. Hopefully, there will be nothing but good news now!


    Michael: I bought and read your book and follow your articles (they are great, thank you very much). I have a few questions about filing for Social Security benefits under the new law. I have not seen them addressed nor has the Social Security Administration been able to answer them (I called a few times).

    I am turning 66 now, and my wife is turning 63. My benefit is $2,400 a month at 66, and my wife’s is only $500. In order to not waste her benefit, I would like her to retire now and get a reduced benefit of $400, and I would file a restricted application to get $250 a month spousal benefit. Can I then also suspend my own benefit in April (the last date to be grandfathered in), so that she could file a restricted application for a spousal benefit (and get the excess of half of mine, or $1,200,) when she turns age 66? Assuming that I can, would my suspension cut off the $250 spousal benefit that I would already be receiving?

    Larry Kotlikoff: I believe you can do what you suggest, but I don’t think it is necessarily 100 percent optimal. If your wife files for her retirement benefit now (before you file and suspend for your retirement benefit), she will get a permanently reduced retirement benefit plus an unreduced excess spousal benefit when she files for her spousal benefit at 66. Her total benefit will then be somewhat lower than if she simply to waited till 66 to file for her spousal benefit.

    On the other hand, you can collect a full spousal benefit on her work record up until the point that you file and suspend, which you need to do by April 29 (in order for your wife to file for a spousal benefit at 66) while you are only 69 and still waiting until 70 to restart your retirement benefit.

    Why do I say “up until the point?” When you file and suspend, your full spousal benefit will revert to an excess spousal benefit, which will be zero in your case.

    I don’t think your strategy is necessarily optimal. However, it all depends on your maximum ages of life.


    Linda: I purchased your ESPlanner program. I am confused by the articles I have read and your notice regarding the new changes with Social Security “file and suspend” rules. Please review our brief scenario below and comment:

    1. I filed for my Social Security benefits when I turned 66 (in January 2015).
    2. My husband turned 65 in December 2015.
    3. Following the ESPlanner program, we decided to have my husband file and suspend when he turns 66 in December 2016 and file for spousal benefits (half of my Social Security benefits). He will file for his own Social Security benefits when he turns 70.

    Will this plan be possible given the new changes in Social Security? Please let me know.

    Larry Kotlikoff: DO NOT have your husband file and suspend. Have him file for just his spousal benefit when he reaches 66. You two were grandfathered in, but having him file and suspend will truly screw you. If your husband did file and suspend when he turns 66, he would get his excess spousal, not his full spousal benefit, and his excess spousal benefit would likely be zero.

    The post What you should know about Social Security childhood disability benefits appeared first on PBS NewsHour.


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    Dr. Robert Schwartz of the University of Miami/Jackson Memorial Medical Center meets with a patient as President Barack Obama speaks before signing the health care reform bill. Joe Raedle/Getty Images

    Medicare is expanding a major experiment that strives to keep seniors healthier by coordinating basic medical care to prevent common problems that often lead to hospitalization, the agency said on Monday. Photo by Joe Raedle/Getty Images

    WASHINGTON — Medicare is expanding a major experiment that strives to keep seniors healthier by coordinating basic medical care to prevent common problems that often lead to hospitalization, the agency said on Monday.

    Officials announced 121 new “accountable care organizations,” networks of doctors and hospitals that collaborate to better serve patients with chronic medical conditions. A limited number will be able to directly recruit patients.

    “We do view this as beneficiaries voting with their feet,” said Patrick Conway, Medicare’s chief medical officer. Talking things over with their doctor is the best way for beneficiaries to decide on joining one of the accountable care groups. They can also call Medicare at 1-800-633-4227 to find out if there is a so-called ACO in their community.

    ACOs work to improve quality and lower costs. Part of their payment from Medicare is based on how well they meet those goals. It can be as simple as making sure patients receive regular follow-up visits and stay on their medications. Eliminating duplicative tests is another route to savings.

    Monday’s announcement means 8.9 million beneficiaries will now be getting their care through ACOs. That’s close to 1 in 4 seniors with traditional Medicare. The total number of ACOs will increase to 477 across the country.

    Twenty-one new ACOs will be allowed to recruit patients, and Conway said they’re already starting out with 650,000 beneficiaries.

    The ACO’s come in a variety of designs, according to the level of financial risk the groups themselves take on. Conway said organizations that take more responsibility for the bottom line often do better on quality, because they have a greater incentive to keep patients healthy.

    Traditionally Medicare paid the bills as they came in from hospitals and doctors. But under President Barack Obama’s health care law, the program is trying to shift to rewarding quality over sheer volume of services. With Medicare’s long-term financial future in jeopardy, much is at stake.

    The new approach tries to remake the way medical care is delivered to patients, by fostering teamwork among clinicians, emphasizing timely preventive services and paying close attention to patients’ transitions between hospital and home. The jury is still out on its lasting impact.

    The post Medicare expands major experiment to coordinate medical care appeared first on PBS NewsHour.


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