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Heist in South America is ‘robbery of the century’

Authorities are calling a heist in South America the “robbery of the century” after dozens of gunmen stormed a private security firm in Paraguay, CNN reported.

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More than 50 people carrying large caliber weapons detonated explosives and set vehicles on fire as they stole millions of dollars and sparked a violent police chase into Brazil, CNN reported. One police officer was killed and another was injured, along with three bystanders.

The group escaped with money from several vaults inside Prosegur, a private security firm in Ciudad del Este, police said.

Police initially said the vaults could store up to $40 million, but neither authorities nor the firm confirmed the amount of money that was stolen.

Ciudad del Este is Paraguay's second-largest city, located along the border with Brazil and Argentina.

Authorities believe the robbers were members of Primer Comando de la Capital, one of the largest criminal organizations in Brazil.

The robbers were able to cross the border into Brazil, CNN reported. A small group was intercepted by Brazilian police about 50 miles from Ciudad del Este, officials said.

Three suspects were killed and four were arrested during the confrontation, a spokesman with Paraguay's Interior Ministry said in a news release.

Reluctant Patients, Hispanic Men Pose A Costly Challenge To The Health System

BALTIMORE — Peter Uribe left Chile at 21 with his wife and 2-year-old daughter, landing in Baltimore and finding steady work in construction. His social life revolved around futbol, playing “six or seven nights a week in soccer tournaments,” he said.

A couple of years after his arrival, he broke his foot during a game and afraid of the cost, didn’t seek medical care.

“Some of my family warned me that if I went to the hospital and couldn’t pay the bill, I’d get a bad credit record,” said Uribe, 41, who made about $300 a week and had no health insurance. “I wanted to buy a car or a house someday.” Instead, he hobbled through workdays and stayed off the field for three years; the residual pain is sometimes disabling, even two decades later.

For reasons both economic and cultural, Hispanic men are loath to interact with the health system. Women across all races are more likely to seek care than men. But the gender gap in the Hispanic community is especially troubling to health care providers. Studies show that Latino men are much less likely than Latinas to get treatment.

That is true even though Hispanic men are more likely than non-Hispanic whites to be obese, have diabetes or have high blood pressure. Those who drink tend to do so heavily, contributing to the group’s higher rates of alcoholic cirrhosis and deaths from chronic liver disease. Many take risky jobs such as construction workers and laborers, and are more likely to die from on-the-job injuries than other workers, government data show.

Hispanics’ share of the population is expected to widen from nearly a fifth now to a quarter by 2045. As that number grows, researchers worry that the nation could face costly consequences as long-ignored conditions lead to serious illness and disability.

“It could literally break the health care system,” said José Arévalo, board chairman of Latino Physicians of California, which represents Hispanic doctors and others who treat Latinos.

And now, some medical professionals fear the effects of President Donald Trump’s crackdown on illegal immigrants.

“When the community faces this kind of stress, I worry that people will do unhealthy things, like abuse alcohol, to deal with it,” said Kathleen Page, co-director of Centro SOL, a health center at Johns Hopkins Bayview Medical Center, and founder of the city’s Latino HIV Outreach Program. “That means they may not work as much,” she added. “They’ll have less money, which means they’re less likely to seek care.”

Welcomed by Baltimore officials, immigrants have driven the city’s Hispanic population, tripling it to 30,000 since 2000.

Here, as elsewhere, evidence suggests that for many Hispanic men, seeking health care is an extraordinary event. Hospital data show they are more likely than Hispanic women, white women and white men to go to the emergency room as their primary source of treatment — a sign that they wait until they’ve no choice but to get help.

Some care providers say medical institutions haven’t done enough to keep Hispanic men healthy, or to persuade them to get regular exams.

“There’s been an ongoing need for institutions to become more culturally attuned and aware of bias,” said Elena Rios, president of the National Hispanic Medical Association, which represents the nation’s 50,000 Latino physicians.

There are some significant differences in health risk and illness rates among Hispanic subgroups — Puerto Ricans are more likely to be smokers, for example. Compared with Hispanics born in the U.S., those born elsewhere have much lower rates of cancer, heart disease and high blood pressure. Overall, Hispanics live longer than whites.

But these advantages may be dissipating as Latinos become Americanized and adopt unhealthy habits such as smoking and diets high in fatty, processed foods.

“I tell people we live longer and suffer,” said Jane Delgado, a clinical psychologist and Cuban-American who serves as president of the National Alliance for Hispanic Health.

Researchers who investigate gaps in cancer testing have found that all ethnic groups and genders have seen a decrease in late-stage colon cancer diagnoses and deaths in recent years — except Hispanic men, who get screened at the lowest rates of any race or ethnic group.

Often, health problems arise after immigrants come up against an insurance barrier. A few years after Jose Cedillo came to Baltimore from Honduras, the 41-year-old cook noticed his legs were often numb or painful. Worried about finances, he eschewed treatment and continued to work, before finally going to a clinic where he was diagnosed with diabetes.

In the seven years since, his health has so deteriorated he can’t work, is frequently homeless and spends long stints in the hospital. As an immigrant who came to the U.S. illegally, he is not eligible for government-paid insurance or disability payments. And he can’t afford medicine. Instead, he said, “I’ll drink alcohol to numb the pain.”

[caption id="attachment_723487" align="aligncenter" width="770"] Jose Cedillo, a 41-year-old former restaurant worker from Honduras struggles to get health care for his diabetes. His immigration status compounds his issues and often finds himself without a job and homeless on the streets of Baltimore. (Doug Kapustin for KHN)[/caption]

Part of the problem is that Spanish speakers are underrepresented among medical professionals. After arriving here, Uribe’s family members frequently brought along an English-speaking nephew or niece when they could afford to see doctors. Otherwise, “we’d travel a long ways to find a doctor who spoke Spanish,” he said.

Hospitals frequently lack cultural understanding and bilingual staffing, administrators admit. Though Latinos make up nearly 20 percent of the population, only 5 percent of physicians and 7 percent of registered nurses are Hispanic. That gap has widened as more Hispanics have come to this country during the past three decades, according to a UCLA study released in 2015.

“Too often, people don’t understand what you’re saying, they don’t know what you’re going to charge them, what dietary restrictions you might place upon them,” said James Page, vice president for diversity at Johns Hopkins Medicine. “It creates a trust issue for Hispanics. We’ve got to get better at serving them.”

That is particularly true in mental health. Only 1 percent of psychologists in the U.S. are Hispanic, meaning that Spanish-speaking men who do seek therapy will probably struggle to find it.

In Baltimore, there is only one Spanish-language support group for men who suffer from anxiety and depression, local psychologists and Latino advocates say. The city employs one Spanish-speaking substance abuse counselor. A small handful of bilingual social workers citywide offer reduced-rate counseling sessions, and only three psychiatrists offer therapy sessions conducted in Spanish.

For Peter Uribe, the key to maintaining his family’s health is getting help paying for care. His wife and brother both suffer from epileptic seizures, and his brother’s despondency caused Uribe to become depressed, he said. In 2015, he obtained insurance for his family through a charity program. With the help of now-affordable medicines, his wife’s seizures waned, and he sought help for chronic depression. Since he now speaks English, finding counseling help is easier.

In January, after intervention from a Latino advocacy group, the charity renewed the Uribes’ policy for two years. Peter Uribe calls it a godsend:

“I honestly have no idea what we’d do without it.”

Michael Anft is a Baltimore-based journalist and writer whose work regularly appears in AARP: The Magazine, The Chronicle of Higher Education and other publications. Daniel Trielli, a data journalist at Capital News Service at the Philip Merrill College of Journalism, contributed to this report.

The Annie E. Casey Foundation supports KHN’s coverage of health disparities in east Baltimore.

CHIP Offers Families With Seriously Ill Kids More Financial Protection Than ACA Plans

Kids with chronic conditions are especially vulnerable to health insurance changes, relying as they often do on specialists and medications that may not be covered if they switch plans. A new study finds that these transitions can leave kids and their families financially vulnerable as well.

The research, which examines the spending impact of shifting chronically-ill kids from the Children’s Health Insurance Program (CHIP) to policies offered on the health law’s marketplaces, found that their families’ out-of-pocket costs would likely rise, in some cases dramatically, following a change to marketplace coverage.

The study comes at a time when health insurance issues are on the front burner in Congress. Republican lawmakers are pushing for fundamental changes to the marketplaces and to the Medicaid program. At the same time, Congress must soon decide whether to extend CHIP when its funding ends in September.

Together the state-federal Medicaid and CHIP programs insure nearly 46 million low-income children in the United States. CHIP covers kids whose family income is low but too high to qualify for Medicaid. The eligibility levels  vary by state. Half of states set the upper income eligibility limit at 255 percent of the federal poverty level or higher — about $52,000 for a family of three.

Both programs provide comprehensive coverage for children with little or no out-of-pocket cost to families.

Since passage of the Affordable Care Act in 2010, some policy analysts have advocated moving children who are enrolled in CHIP into marketplace plans and dismantling the CHIP program. But earlier evaluations found, as did this study, that CHIP coverage was better and cheaper than marketplace coverage, said Joan Alker, executive director of the Georgetown Center for Children and Families.

CHIP is much smaller than Medicaid, with more than 8 million children enrolled, roughly 2 million of whom have one of six chronic health conditions, including asthma, attention deficit hyperactivity disorder, diabetes, epilepsy, mood disorders and developmental disorders such as autism, according to the study, which was published in the April issue of Health Affairs.

Using data compiled from state CHIP programs and marketplace plans for 2016 and health care use data from the federal Medical Expenditure Panel Surveys from 2008 to 2013, researchers simulated the annual out-of-pocket costs for children with these six chronic conditions if they were enrolled in CHIP versus one of the plans sold on the marketplaces operated by the federal government.

The spending differences were stark. For every chronic condition and at every income level, cost sharing was higher for children enrolled in marketplace plans than for those in CHIP.

Take the case of asthma, the most common condition that researchers modeled. For a child with asthma whose family income was between 100 and 150 percent of the federal poverty level, or about $20,000 to $30,000 for a family of three, annual out-of-pocket spending on deductibles and copays would be $284 in a marketplace plan, compared with $27 in CHIP — a difference of $257. At higher incomes, the out-of-pocket spending differences were greater. Families with incomes between 251 and 400 percent of the federal poverty level, or about $51,000 to $81,000 for a family of three, would pay $1,227 out-of-pocket annually if they were enrolled in a marketplace plan but just $84 in the CHIP program — a difference of $1,143.

“The lowest income families were relatively well protected by cost-sharing reductions” in marketplace plans, said Amy Davidoff, a senior research scientist in the Department of Health Policy and Management at the Yale School of Public Health, who is one of the study’s co-authors. Those cost-sharing subsidies, which reduce a plan’s deductible, copayments and coinsurance, are available to marketplace customers with incomes up to 250 percent of the federal poverty level — about $51,000 for three people. These subsidies are the subject of a lawsuit, however, and their fate is unclear.

As family income rises, however, the gap between the out-of-pocket costs for the two different types of coverage increases and becomes quite substantial, Davidoff said. “For these families, it would be huge barrier,” she said.

About 97 percent of children on CHIP belong to families with incomes below 250 percent of the poverty level.

The deductible — the amount that people have to pay on their own before insurance covers most services — was a significant factor in the cost differences. The average deductible in marketplace plans for families with incomes between 251 and 400 percent of poverty was $3,126. None of the CHIP programs for families at that income level had deductibles, the study found.

Noting that CHIP has a history of strong bipartisan support, Alker said she is hopeful that it will be extended. “I think it would be very hard for Congress to let CHIP expire,” she said, “and put those children into the marketplace, when according to their leaders it’s about to fold.”

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

HHS, States Move To Help Insurers Defray Costs Of Sickest Patients

As congressional Republicans’ efforts to repeal and replace the Affordable Care Act remain in limbo, the Trump administration and some states are taking steps to help insurers cover the cost of their sickest patients, a move that industry analysts say is critical to keeping premiums affordable for plans sold on the law’s online marketplaces in 2018.

This fix is a well-known insurance industry practice called reinsurance. Claims above a certain amount would be paid by the government, reducing insurers’ financial exposure and allowing them to set lower premiums.

Two states — Alaska and Minnesota — that have seen double-digit increases in ACA plan premiums this year have already moved to implement reinsurance policies, and Oklahoma is making plans to seek federal approval to set up a program. The Idaho legislature also recently passed a health care reinsurance law, and Maine is considering taking similar action.

The Trump administration has told other states they should consider doing the same. On March 13, Health and Human Services Secretary Tom Price sent a letter to all 50 governors soliciting proposals for reinsurance and other options to help cover the costs of consumers with expensive medical conditions.

Long an advocate for more state control of health insurance, Price said the administration is “seeking to empower states with new opportunities that will strengthen their health insurance markets.”

“This is one practical way the administration and states can work together to reduce premiums,” said Matthew Fiedler, a health policy specialist at the Brookings Institution. “While it’s the insurers who get the [support] directly, reductions in insurers’ claims costs ultimately translate into lower premiums for consumers.”

The focus on reinsurance comes as insurers must tell state and federal regulators no later than June 21 whether they will participate in the ACA’s marketplaces in 2018, and what plans they will offer at what price. This issue is separate from other highly publicized efforts underway to preserve federal payments to insurers to cover the costs of deductibles and copayments for low-income enrollees.

The federal law offered the security of a reinsurance program to insurers during its first three years. It helped reduce premiums among insurers by 10 percent in 2014, the last year the impact was analyzed, according to the Congressional Budget Office.

But the ACA reinsurance program ended this year. That helped drive premiums up by an average 22 percent across the country, raising concerns about the stability of the state-based marketplaces — also called exchanges — that provide insurance for people who don’t get it through work or public programs such as Medicare or Medicaid.

Now officials from both political parties are eyeing another part of the health law to help reprise and finance reinsurance programs.

In his letter, Price encouraged states to consider a special provision — known as a Section 1332 waiver — that went into effect this year and opens an avenue for them to pursue exemptions from ACA rules as long as the state plan maintains equivalent or better coverage levels for residents and doesn’t raise federal spending.

The Trump administration is betting that some states can set up reinsurance programs with federal funding. Federal spending on the program would be kept in check because the move will reduce government spending on tax credits that the law gives some low-income exchange customers to help defray the cost of premiums.

Need To ‘Stabilize Things Fast’ 

Consider deep-red Oklahoma. State officials have always held the ACA at arm’s length, leaving the insurance marketplace’s management and details to federal officials. But after rate increases averaging 76 percent this year — second only to Arizona — state officials set up a task force to explore how to put a brake on insurance premiums. The group last month published a multifaceted, 60-page plan for a waiver request. State officials say they will submit the plan to HHS later this year. Among the proposed first steps: reinsurance.

“We are in critical condition,” said Buffy Heater, chief strategy officer at the Oklahoma Health Care Authority. “Reinsurance is a way to stabilize things fast and attract additional insurers and more enrollees.”

Enrollment in the Oklahoma marketplace plan grew just 1 percent in 2017, to 146,300, after fairly robust growth in 2014 and 2015. Still, only about 30 percent of eligible Oklahomans are enrolled, and the number of uninsured in the state grew by 20,000 people in 2017.

Blue Cross Blue Shield of Oklahoma, the only carrier now selling on the state’s insurance marketplace, concurs with Heater’s assessment. The company declined through a spokesman to address state officials’ concern that the insurer was poised to exit the market in 2018. But Kurt Kossen, senior vice president at the Illinois-based Health Care Service Corp., which owns the Oklahoma Blues plan, said in a statement: “We agree reinsurance and well-designed high-risk pools help lower premiums and encourage greater competition.”

The two main health insurance lobbying groups in Washington — America’s Health Insurance Plans and the Blue Cross Blue Shield Association — also support efforts to offer reinsurance.

“We are very much in favor of using reinsurance to help insurers pay for the most expensive claims and to stabilize the marketplaces,” said Kristine Grow, senior vice president for communications at America’s Health Insurance Plans.  

Alaska And Minnesota Spurred To Act

Building on its state-funded reinsurance program for 2017, Alaska has asked the federal government to set aside $51.6 million for a reinsurance pool there for 2018. Lori Wing-Heier, director of the state’s division of insurance, said the state’s $55 million fund this year enabled Premera Blue Cross Blue Shield, the sole insurer left on the exchange, to reduce an expected premium increase of 40 percent to just 7.3 percent.  But the state said it cannot keep up the effort alone and needs federal funding.

In Minnesota, where premiums for marketplace plans spiked by around 50 percent this year, the Legislature enacted a law this month that establishes a $271 million reinsurance pool for that state’s troubled ACA marketplace for 2018 and 2019. The funds are contingent on getting the same waiver from the federal government that Alaska seeks and that Oklahoma plans to pursue.

Consumer complaints about the price hikes for 2017 pushed Minnesota to set up a $326 million fund to bail out insurers and help consumers who didn’t qualify for federal premium subsidies. That state-based reinsurance fund reduced premiums by about 25 percent, said Eileen Smith, a spokeswoman for the Minnesota Council of Health Plans. The state’s Department of Commerce has estimated that the 2018 reinsurance fund will reduce premiums by about 20 percent.

About 4 percent of Minnesotans — 235,000 people — get coverage in that state’s individual marketplace.

Back in Washington, D.C., some lawmakers have newfound fervor for insurance market stability and tools such as reinsurance. In their proposed bill to repeal and replace portions of the ACA, House Republicans included a 10-year, $100 billion fund to offset the burden of high-cost patients.

States would be allowed to establish reinsurance pools or set up separate high-risk insurance pools for patients with expensive medical conditions.

And even as the fate of the legislation to repeal the ACA remains uncertain, a group of Republicans in the House of Representatives this month sought to sweeten the pot with an additional $15 billion fund over nine years to help reimburse insurers for high-cost patients with certain preexisting conditions, such as cancer.

Democrats and health policy analysts immediately criticized this latest proposal.

“It’s not enough money to make a serious dent,” said Tim Jost, a professor of health law at Virginia’s Washington and Lee University and an expert on the health law. While the concept is sound, he said that the proposal is flawed because the House Republicans’ bill creates the need for it with “the other damaging changes it makes to the market.”

Jost, other policy analysts and consumer advocates also take issue with Republican proposals that appear to create equivalency between reinsurance and separate high-risk pools for people with preexisting conditions and high claims. In most states that have tried them, said Lynn Quincy, a health insurance specialist and senior policy analyst at Consumer Union, high-risk pools have failed to offer affordable coverage to people who need care the most.

“Reinsurance is the much preferred option,” Quincy said. “It doesn’t segregate sick people into a separate pool, and reinsurance has proved far more efficient and effective over the years.”

President Trump’s Hollywood star vandalized again

For the second time in less than six months, President Donald Trump’s Hollywood Walk of Fame star has been vandalized, the New York Daily News reported.

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In October, a 52-year-old man destroyed the star with a pickax and sledgehammer. This time, the Hollywood star was defaced with a black marker and an obscene phrase, according to a photograph acquired by TMZ.

The star was replaced after James Lambert Otis destroyed it last fall, one week before the presidential election, the Daily News reported. At the time, Otis said he planned to auction the star to raise money for the women who accused Trump of sexual assault.

Otis was sentenced to three years of probation and 20 days of road maintenance work in February after pleading no contest to vandalism, the Daily News reported. He was also ordered to pay $3,700 to the Hollywood Historic Trust and $700 to the Hollywood Chamber of Commerce.

The Los Angeles Police Department did not return a request for comment about the recent explicit message left on Trump’s sign, the Daily News reported.

Ludacris’ rap of ‘Llama Llama Red Pajama’ is classic

It’s a bedtime story full of fun llama drama, thanks to hip-hop artist Ludacris.

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The singer took the Anna Dewdney’s classic “Llama Llama Red Pajama to a new level when he rapped the book’s text on Power 106’s “The Cruz Show,” the Huffington Post reported.

Ludacris, a father of four, provided a jaunty, bubbly, free-form version of the bedtime story. It’s part of a recurring segment on the “The Cruz Show,” a hip-hop program. The host gives a rapper a copy of the book to read over a beat. 

Other artists who have rapped the text include DesiignerJeezy and Migos.

Penelope Cruz gets Julia Roberts to lip-sync iconic song

Julia Roberts relived a scene from her iconic 1997 movie “My Best Friend’s Wedding” thanks to some prodding by actress Penelope Cruz, ETonline reported. 

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At Wednesday’s Lancome's Stars & Wonders gala in Monaco, California, one of the bands covered Dionne Warwick’s 1967 song “I Say a Little Prayer.” 

Cruz captured the moment on Instagram, then led a lip-sync singalong, which included Roberts, ETOnline reported.

The song was a part of a memorable scene in “My Best Friend's Wedding” as Rupert Everett's character convinces everyone in a restaurant — including Roberts, Cameron Diaz and Dermot Mulroney — to sing along with him.

Florida man steals woman’s panties, leaves them on porch with note

A Florida man allegedly stole woman’s underwear from her bedroom and left her other pairs on her property along with handwritten notes, deputies said. 

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Isitro Lee Sanches, 58, of Panama City, was identified as the alleged panty thief after the woman’s boyfriend caught Sanches inside their home, the Bay County Sheriff’s Office wrote on its Facebook page

It started in January 2017 when the woman found underwear in her car and on her porch railing with notes that “expressed a desire to see the victim wearing the underwear,” according to the sheriff’s office. 

Sanches was arrested on April 13 and charged with stalking and burglary. 

Report: N. Korea conducts large-scale artillery drills on anniversary

North Korea conducted large-scale artillery exercises on Tuesday to coincide with the 85th anniversary of its army’s foundation, South Korea's Yonhap News Agency reported.

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Citing an unidentified South Korean government source, Yonhap reported that there were signs North Korea's military was carrying out large-scale, live-fire drills in areas around the east coast city of Wonsan.

South Korea's defense ministry could not immediately confirm the report, according to Reuters.

North Korea warned that the United States will have to choose between political and military surrender, according to the Yonhap report.

"If the U.S. and warmongers run amok with a reckless preemptive strike, we will stage the most brutal punishment of a preemptive attack in the sky and land as well as at sea and from underwater without any warning or prior notice," according to Rodong Sinmun, spokesman of the ruling Workers' Party of Korea.

Civil War cannonballs to be removed from Pittsburgh site

Dozens of Civil War-era cannonballs unearthed at a Pittsburgh construction site will be removed starting Tuesday.

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Ordnance Holdings Inc. and Milhaus Ventures have been hired to remove the cannonballs found near the former site of the Allegheny Arsenal. The arsenal supplied the Union Army, and an explosion there in September 1862 killed 78 people, many of them female employees.

Franjo Constructions unearthed the cannonballs — believed to be 35 to 43 of them — during excavation for a planned apartment complex.

The public will not be allowed to watch their removal for safety reasons.

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