Second Court Strikes Down Obamacare Subsidies In Federal Exchanges

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SARAH HURTUBISE
Reporter

Another federal court has struck down an IRS rule that gives Obamacare subsidies to customers in federally-run exchanges.

The United States District Court in Oklahoma ruled Tuesday in Pruitt v. Burwell that the IRS rule extending health insurance tax credits to Obamacare exchange customers in states that chose not to build their own exchange is illegal.

The Obama administration’s rule is “arbitrary, capricious, an abuse of discretion or other not in accordance with law,” according to federal district Judge Ronald White.

The question comes down to the repeated instruction in the text of the Affordable Care Act that advanced premium tax credits are to go only to customers of exchanges “established by the state.” The plaintiff in this case, Oklahoma attorney general Scott Pruitt, argues that Congress’ text says customers in Oklahoma, which doesn’t run its own exchange, aren’t eligible for the subsidies.

The decision follows two highly-charged appeals court cases. The Washington, D.C. Circuit Court ruled in Halbig v. Burwell that Obamacare’s tax credits are only applicable to the several state-run exchanges; but hours later, the Fourth Circuit Court ruled that the IRS was within its rights to make the adjustments in its extension of the subsidies. (RELATED: Federal Court Takes Down Obamacare)

But at the Department of Justice’s request, the D.C. Circuit Court agreed to re-hear its case with a full court — which has been packed with three new judges appointed by President Obama since Senate majority leader Harry Reid deployed his nuclear option to avoid Republican opposition last fall.

With liberal judges outnumbering conservatives now by eight to five, it’s likely that the court will take back its initial ruling and approve the subsidies, taking the pressure off the Supreme Court to hear the case.

But Pruitt’s victory in Oklahoma paves the way for another court split in the future. The Department of Justice will presumably appeal the district court’s decision to a United States appeals court, and if the Obama administration loses again, the Supreme Court will once again be presented with a split decision by two equal courts below it. That may prompt the justices to take the decision into their own hands.

UK jets launch first attacks against ISIS in Iraq

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Tornado bombers from Britain’s Royal Air Force (RAF) have carried out their first attacks against the Islamic State in Iraq, according to the Ministry of Defense (MoD).

“This action is part of the international coalition’s operations to support the democratic Iraqi government,” the MoD said in a statement.

“In the course of an armed reconnaissance mission from RAF Akrotiri, two Tornados were tasked to assist Kurdish troops in north-west Iraq who were under attack from Isil (Isis) terrorists,” the statement continued.

Two Tornado GR4 aircraft were used, which are now based at RAF Akrotiri in Cyprus. The Tornado is an all-weather day and night fighter bomber, which has been in use by the RAF since the 1980s and is now becoming a little long in the tooth.

According to the statement, the patrol identified a heavy weapon position belonging to the Islamic State (ISIS/ISIL), which was attacking Kurdish forces in the area.

The planes used a Paveway IV guided bomb and a Brimstone anti-armor missile to take out the position, as well as an armed pick-up truck.

Until now, RAF Tornados have been limited to flying reconnaissance missions over Iraq, and only began armed patrols after the UK parliament agreed to authorize military action against ISIS on Friday.

UK Defense Secretary Michael Fallon has said that RAF planes could be engaged in bombing ISIS for years to come.

Although there is widespread skepticism of the effectiveness of airstrikes, Prime Minister David Cameron has insisted that they are crucial in the future destruction of the hardline Islamist group, adding that the most important tools in the fight against the Islamic State are better armed Kurdish Peshmerga fighters and better trained Iraqi troops.

Ebola Virus Symptoms and Prevention Tips

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Sep 30, 2014 By Brandon De Hoyos

With the confirmation of the first U.S. patient to test positive for the Ebola virus, concern about symptoms and how to prevent infection is likely to be at the forefront of people’s minds.
Tom Frieden, director of the Centers for Disease Control, said in August that the risk of an outbreak in the U.S. is considered very low, as patients become contagious only when symptoms are shown and that American hospitals are well equipped to isolate cases to control the spread of the virus.

The early signs and symptoms of the Ebola virus include:
Fever
Severe headache
Joint and muscle aches
Chills
Weakness
Symptoms may become increasingly severe over time, the Mayo Clinic said, with additional symptoms present, including:
Nausea and vomiting
Diarrhea (may be bloody)
Red eyes
Raised rash
Chest pain and cough
Stomach pain
Severe weight loss
Bleeding, usually from the eyes, and bruising (people near death may bleed from other orifices, such as ears, nose and rectum)
Internal bleeding
There is no vaccine for the Ebola virus as of this time, but scientists and researchers are working on a variety of drugs that could one day combat the Ebola virus.
The best means of prevention are similar to those you would practice to prevent the common cold or the flu, and it starts at your bathroom sink. Thoroughly washing your hands, and practicing good hygiene with soap and water, is a good first step to preventing infection.
An alcohol-based hand rub containing at least 60 percent alcohol is an alternative when soap and water isn’t available.
Other Ebola virus prevention tips including:
Avoiding travel to areas with known outbreaks
Refraining from eating bush meat from developing nations, especially those where Ebola virus has been found
Avoid contact with infected people, including their body fluids and tissues.
Wear protective clothing, including gloves, masks, gowns and eye shields if you are a health care worker.
Dispose of needles and sterilize other instruments regularly to prevent infection.
Do not touch or handle the bodies of people who have died of the Ebola virus.
Remember, people with Ebola virus are most contagious in the later states of the disease, as symptoms become evident, the Mayo Clinic said.

WILL CDC ACTIVATE EMERGENCY MEASURES AFTER EBOLA CONFIRMED IN US?

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Provisions would allow for quarantine of “well persons” who “do not show symptoms” of virus

by PAUL JOSEPH WATSON | SEPTEMBER 30, 2014

Confirmation that the first case of Ebola has arrived in the United States will prompt questions as to whether the CDC will enact emergency procedures that could see even healthy Americans detained against their will.

The Centers for Disease Control confirmed today that an Ebola victim was admitted to the Texas Health Presbyterian Hospital in Dallas. Reference to the patient’s “recent travel history” suggests that the victim arrived from one of the African countries hit by the virus.

The patient has been held in “strict isolation” and the hospital is “complying with all recommendations from the Centers for Disease Control and the Texas Department of Health to ensure the safety of other patients and medical staff,” according to WFAA.

In an understandable effort to prevent hysteria, the CDC has been reticent to release too many details about its preparations for a potential Ebola outbreak inside the United States, although plans currently on the record allow for the quarantine of “well persons” as well as those who “do not show symptoms” of the virus.

The official CDC website details ‘Specific Laws and Regulations Governing the Control of Communicable Diseases’, under which even healthy citizens who show no symptoms of Ebola whatsoever would be forcibly quarantined at the behest of medical authorities.

“Quarantine is used to separate and restrict the movement of well persons who may have been exposed to a communicable disease to see if they become ill. These people may have been exposed to a disease and do not know it, or they may have the disease but do not show symptoms,” states the CDC (emphasis mine).

Last month, former FDA official Scott Gottlieb, M.D. wrote in Forbes that the CDC will invoke powers to “hold a healthy person against his will” in the event of an Ebola outbreak, warning that the feds may assume “too much jurisdiction to detain people involuntarily,” leading to “spooky scenarios where people could be detained for long periods, merely on a suspicion they might have been exposed to some pathogen. And forced to submit to certain medical interventions to gain their freedom.”

An executive order signed by President Obama at the end of July also allows for the “apprehension, detention, or conditional release of individuals to prevent the introduction, transmission, or spread of suspected communicable diseases.”

As we reported earlier today, the CDC has also instructed funeral homes to prepare for Ebola victims, telling workers not to embalm corpses or carry out autopsies.

Airports Have No Way to Screen for Ebola

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BY PATRICK TUCKER, DEFENSE ONE

(Sergey Uryadnikov/Shutterstock)
August 1, 2014 The Nigerian government announced Thursday that it had started screening passengers at international airports for signs of Ebola after a passenger showed up in Lagos suffering from the illness, which kills up to 90 percent of the people infected with it. Treatment options are extremely limited. Nigerian airport authorities will be checking passengers who just arrived from Sierra Leone, currently under a state of emergency, and they’ll be looking for fever, since an elevated temperature is considered a sign of Ebola. If the passenger is presenting with higher than normal temperatures, screeners would subject the passenger to a blood test.

Ebola is moving into more countries across Africa, but not as quickly as is alarm. South Africa announced Thursday that it was in the process of outfitting airports with thermal scanners to detect feverish passengers. In many ways, it’s a repeat of 2009, when airports around the world brought in thermal scanners to look for passengers who were presenting with fever and suspected bird flu.

Ebola has arrived in the United States in the form of a victim who is here for treatment under careful observation. The CDC confirmed that at least one Ebola victim is headed out of Africa to the United States to be treated in Atlanta. The patient will be flown in a special N173PA jet. “The plane will be arriving at Dobbins Airbase in Georgia, and from there the patients will be transported on to whatever the medical facility they’re going to be treated in. But that’s the limit of our involvement,” Pentagon spokesman Rear Adm. John Kirby said Friday. Authorities didn’t disclose the patient’s name but researchers know of at least one American doctor, Kent Brantly, of Fort Worth, Texas, who was working to staunch the outbreak in Liberia and who picked up the illness.

HOW THE EXPERTS FIND AND STOP EBOLA
The CDC attempts to hunt down the deadly virus using “contact tracing” methods. (Centers for Disease Control and Prevention)
“All I am aware of, in terms of U.S.military involvement, is that we have a couple of Army researchers down in Africa, in Liberia, right now who have been for some time working on this particular virus,” Kirby said.

The good news is that neither the White House nor the epidemiologists that spoke to Defense One expects Ebola to have nearly as deadly an effect in the U.S.as it is having in Africa, where more than 729 people have already died.

The bad news is that thermal screenings of the international flying population at airports are not likely to yield much by way of improved safety.

Here’s why: Fever can be a sign of a lot of different illnesses, not just Ebola. And thermal scanning proved to be a poor method of catching bird-flu carriers in 2009. So presenting with an elevated temperature at an airport checkpoint does not indicate clearly enough that the fevered person is carrying the deadly virus. More importantly, the incubation period for Ebola is two days. As many as 20 days can pass before symptoms show up. That means that an individual could be carrying the virus for two weeks or longer and not even know it, much less have it show up via thermal scan. So what good are these scanners?

“I think that thermal screeners help people feel safe,” Dr. Noreen Hynes, with the Johns Hopkins Bloomberg School of Public Health, told Defense One.

The second method that the Nigerian government is using to detect the presence of Ebola in—possibly—feverish passengers is a blood test. The presence of antibodies in the blood is a much more conclusive sign of the deadly virus. Unfortunately, subjecting hundreds or possibly thousands of passengers to a blood test for Ebola would be practically impossible in a major airport without slowing international air travel to a crawl. The current method for performing one of these tests, also called a polymerase chain-reaction test, can take eight hours or longer, requires results to be sent to a lab, and is prohibitively expensive in many cases.

Experts agreed that a test able to reveal the presence of Ebola on location at an airport checkpoint—and do so in a relatively short amount of time—would greatly improve authorities’ ability to stop the virus from crossing international borders. One person working on that is Douglass Simpson, CEO of Corgenix, which in June received a $3 million National Institue of Health grant to develop a point-of-care test for Ebola. Airport screeners would use it to spot the virus in a feverish passenger in just 10 minutes. “Our job is to as quickly as possible advance those tests and make them available in those zones,” Simpson said.

It’s exactly the sort of thing that could provide much more conclusive evidence of a passenger with Ebola. But it won’t be in the hands of airport screeners for years. “We’re several years from getting it completed,” says Simpson, who hopes that Corgenix will have a rapid test for Ebola by 2016.

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What do we have to protect us today? The same thing we have to protect us from dangerous terrorist masterminds: background screening.

Because the population of people who have this illness is relatively small and we have some idea of the areas that have been exposed, Ebola is an example of a threat that could be better managed at airports by picking out those people who were most likely to have encountered the disease based on where they had been.

“The nature of Ebola makes it similar to, but also different than traditional aviation threats. Aviation security protects against the flight on hand, while screening for Ebola has a longer footprint to display and protect,” Sheldon H. Jacobson, a professor of computer science at the University of Illinois, told Defense One.

It’s a subject that he knows a lot about. In 2012, his paper Addressing Passenger Risk Uncertainty for Aviation Security Screening effectively showed that too much random screening at airports was making TSA and border agents less effective at their jobs. The guards were scanning, patting, and focusing on people who posed no real threat, effectively desensitizing them to people who may have had more intent and capacity to commit harm. “A natural tendency, when limited information is available about from where the next threat will come, is to overestimate the overall risk in the system” Jacobson said in a statement around the time of the paper’s release. “This actually makes the system less secure by over-allocating security resources to those in the system that are low on the risk scale relative to others in the system.”

Pre-screening passengers for Ebola on the basis of where the passenger has been and the likelihood of coming into contact with the disease is probably a more effective means to catch it than is trying to take the temperature of thousands of people with a camera, according to Jacobson. “Prescreening would be prudent, and reasonable, based on the information available. Public-health personnel would need to develop appropriate criteria that yield good results and also limit false positives. In essence, prescreening, if done appropriately, can work in any type of screening mechanism,” he wrote to Defense One in an email.

Ebola is passed through fluids such as blood and so health care workers treating infected populations, and doing so in less than ideal settings like clinics in Sierra Leone, are the most vulnerable. Hynes says that’s one reason the typical American is at much less risk.

(Of course, in most cinematic depictions of a zombie outbreak, zombieism is also passed via fluids, and, as in the case of Ebola, carriers are ambulatory for long periods of time. Published modeling has shown that a zombie outbreak would spread across a major city like Logos in a period of four days. But zombiesim, as depicted fictionally, is also accompanied by psychotic cannibalism, which serves as an accelerant to spread. Ebola is accompanied by malaise, which has the opposite effect.)

Hynes acknowledges that while the U.S. won’t become like Sierra Leone, more people will be getting the illness in the months ahead. “Right now the trajectory is still in the upward mode,” she said.

The issue of Ebola slipping into the United States is part of the broader, hotter discussion on border control, which entails everything from keeping potential terrorists out of the country to detecting nuclear weapons, to housing, processing and caring for the some 57,000 immigrant children who have crossed into the country illegally since Oct. 1. These are all fundamentally different challenges. Some pose mortal threats, others do not. But from a political perspective they share the border in common. That can lead to politicians who want to treat every incursion over the border with equal alarm, as Rep Michelle Bachman, R-Minn, effectively did the other day, claiming the country’s southern border was an open invitation “not only people with potentially terrorist activities, but also very dangerous weapons are going to cross our border in addition to very dangerous drugs, and also life-threatening diseases, potentially including Ebola and other diseases like that.”

On Thursday, a subcommittee of the House Committee on Science, Space, and Technology tackled the issue in a special hearing on the technology needed to secure America’s border. The hearing did not touch on Ebola, but the panelists were largely in agreement on one key point: The Homeland Security Department has no effective means for evaluating the deployment of border technology.

While point-of-care tests for Ebola won’t be deployable for at least two years, biometric facial-recognition technology and other security screening technologies are far more advanced, but they have yet to be fully implemented. “The technologies are good and mature. I think one of the areas where DHS struggles is tooth to tail. Where do you have people to back up and integrate with technology to make the best effective use of it. DHS acquisition processes are maturing … but are not perfect,” Jack Riley, the director of the RAND National Defense Research Institute, testified.

“We worked on an evaluation for a technology for biometric identification at airports. The technology was quit ready. It was off the shelf. It was effective. The problem was it couldn’t be integrated into the human systems,” testified Joseph D. Eyerman, the director for research and management at the Institute for Homeland Security Solutions at Duke University, meaning that human airport screeners couldn’t use the data from the facial-recognition systems, for a variety of reasons.

How to make sure screening technology is implemented at airports and other checkpoint is no simple matter, but it could become one. Riley suggested that border czar could help make sure that the technology to catch nuclear weapons, and perhaps Ebola, isn’t misspent screening immigrant children who are very unlikely to be harboring either. “We need a single point of accountability on the border so that we can begin to understand some of these large tradeoffs,” Riley toldDefense One.

When asked by committee Chairman Lamar Smith, R-Texas, how they would rate the Homeland Security Department’s use of border technology, the witnesses answered uniformly: incomplete.

Despite centuries of progress, in many ways our ability to catch disease at a border hasn’t changed much since 1374 when the Black Death was laying waste to populations of Europe. It was at this time that the doge of Venice put in place a protocol to attempt to arrest the disease in port. He created three so-called guardians of health. They were health screeners and their job was to board ships in port and inspect crew for inflamed lymph nodes. If symptoms were found, or suspected aboard the crew, the guardian would order the ship away from port for a period of 40 days.

Not enough has changed. The current Ebola outbreak is unlikely to claim the lives of hundreds of Americans, and will likely run its course before summer of next year. The question of how to catch diseases at the border is not going to go away. But because of our innate tendency to “overestimate the overall risk in the system,” we will be inclined to treat every incursion over the border as an equal threat. The next time a major outbreak hits, technology to detect it will be more advanced. Our ability to implement that technology may not be.

EBOLA HITS DALLAS

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CDC Confirms Patient In Dallas Has The Ebola Virus

DALLAS (CBSDFW.COM) – Officials with the Centers for Disease Control have confirmed that a person in Dallas definitely has the Ebola virus. Tuesday’s official determination makes the Dallas patient the first diagnosed Ebola case in the United States.
Officials with the Centers for Disease Control and Prevention are holding a press conference at 4:30 p.m.
It was late on the evening of September 29 that CBS 11 News learned a patient at Texas Health Presbyterian Hospital in Dallas was feared to have been exposed to the Ebola virus.
Health officials said given the information that the unnamed patient had been in the West Africa area where the Ebola virus exists and the type of symptoms they were exhibiting, testing was being performed.
After the information was related to the CDC the health institute sent a team to North Texas just in case the patient was infected with Ebola. Members of that team, including CDC Director Thomas Frieden, M.D., M.P.H, will be a part of the 4:30 p.m. press conference. The press conference will be streamed live here on CBSDFW.COM.
Monday night Texas Health Presbyterian Hospital in Dallas released the following statement:
“Texas Health Presbyterian Hospital Dallas has admitted a patient into strict isolation to be evaluated for potential Ebola Virus Disease (EVD) based on the patient’s symptoms and recent travel history. The hospital is following all Centers for Disease Control and Texas Department of Heath recommendations to ensure the safety of patients, hospital staff, volunteers, physicians and visitors. The CDC anticipates preliminary results tomorrow (Wednesday).”
Of course, since the patient was already in “strict isolation” officials at Presbyterian Hospital said that will continue.
On Monday night CBS 11 spoke with Dallas County Health and Human Services director Zachary Thompson, who stressed that there were certain procedures that would need to be followed if tests for the patient come back positive. “We [health professionals] all had been planning to look at what our next steps are if there is a confirmed case,” Thompson said. “Again, we have to do the public health follow up to see what contacts, where this individual has gone since they arrived here in Dallas. There are a number of things that have to be looked at.”
Before it was confirmed the patient definitely had the virus, Thompson spoke about the possibility of other North Texans being infected by the patient. “The key point is, if there’s been no transmission, blood, secretion, any type of bodily fluids by the infected person to someone else, then that [infection] risk is low to none.”
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The Ebola virus has killed more than 3,000 people across West Africa and infected several Americans who have traveled to the region, including Fort Worth doctor Kent Brantly, who contracted the disease while doing missionary work in Liberia. Earlier this month Dr. Brantly donated a unit of blood to help treat an American aid worker being cared for in Nebraska. While the medical procedure hasn’t been proven, doctors were experimenting to see if antibodies in Kent Brantly’s blood could help strengthen the immune system of the patient. There’s no word on if that approach will be taken with the patient in Dallas.
In all, four infected patients have returned to the United States in specially outfitted planes — three were treated in Atlanta and the fourth, who Dr. Brantly donated blood to, in Omaha. An American physician who was exposed to the virus, but not infected, was flown to Maryland over the weekend.