The border city of Yuma, Arizona is on the ‘brink of collapse’ as a flood of migrants have overloaded hospitals and food banks.

According to officials, some 5 million migrants have crossed into the US since President Biden took office in January 2021.

As a result, Yuma County’s Border Patrol has seen a rise in migrant crossings of 171%. According to County Supervisor Jonathan Lines, the county will ‘crumble’ if it can’t support the flow of migrants. Lines says that the situation will only get worse, according to the Fox News.

In a statement to Fox News, Lines said that “Policies need to be changed when you see an unprecedented amount of people coming across the border that even supersedes what we saw under any of the other presidents for the past 30 years,” adding that the surge in crossings is “ridiculous.”

“They’re coming because they said that Biden told them to come, that we have an open border.”

According to fifth-generation Yuma resident and farmer, Hank Auza, “The problem that we’re foreseeing right now is there’s a couple of big waves coming,” adding “Yuma can’t support that. It will overwhelm the system here.“

El Paso, Texas, another border town, declared a state of emergency as thousands of migrants camped in the streets during below-freezing temperatures in December. Many migrant shelters were over capacity, leading the city to use the local airport for temporary refuge. 

Lines, Auza and another Yuma farmer, Alex Muller, had shared concerns, starting with the fear around food security, since agricultural production makes up a large part of the town’s economy. 

“Our fields are monitored and audited and tested for different pathogens,” Muller, said. “You can’t have people walking through the field.” 

Auza said Yuma’s fields, which produce 93% of the nation’s leafy greens in the winter months, have faced a fair amount of migrant traffic, risking damage to their crops due to foodborne illness concerns. He also said many residents can’t get into the city’s only hospital.  -Fox News

“People have had a hard time getting into the hospital because the hospital has been so full of” migrants, said Auza.

Authored by Matt Stoller via BIG (emphasis ours),

The movie The Big Short is about the housing crisis and its collapse, along with all the fraudulent activity up and down the financial system that abetted it. It is as much a cultural story as it is one about finance, a film about what banking corruption does to human beings and the law itself. In it, there’s a famous scene where fund investors betting on a housing collapse are trying to learn about the Florida housing market, and are interviewing some frat-boy type Florida real estate agents. The agents keep discussing their self-serving and illegal behavior, like falsifying paperwork or selling to people who knowingly can’t pay back loans. At a certain point, the main character asks his colleagues, ‘why are they confessing?’ to which the others respond, “they’re not confessing, they’re bragging.”

The point of this scene is to show that people in the industry during the housing bubble weren’t just breaking the law, but saw the law itself as irrelevant. Enforcement was so weak that those in finance and real estate would just openly brag about all the crime they were doing.

It was a true story. And it continues to be a true story in most white collar areas.

Late last year, the CEO of Equifax Mark Begor presented at a Goldman Sachs conference for investors, and openly told the investors how much market power his firm has in the business of selling income verification services to creditors. “We have meaningful pricing power,” he said, because “only Equifax has that income and employment data.” Equifax aggressively raises prices on the Work Number product line annually, and has, according to Begor, “already got our January 1, 2023 price increases in the market.” Long term, he says, “we have an ability to grow price well in excess of GDP.” This is fairly shocking stuff from a CEO, who should know better than to confess to monopolization. Only, it seems as if Begor wasn’t confessing, he was bragging.

Here’s the audio.

Still, why wouldn’t Begor brag to investors? Equifax’s controversial behavior is near-legendary. The firm is an important credit bureau, and credit data is exactly what we wouldn’t want to fall into the hands of hackers, who could then easily use it to engage in identity theft, en masse. But in 2017, Equifax had a massive scandal, one of the biggest data breaches in history, when it accidentally exposed the personal data of 147 million people. The Federal Trade Commission fined the company more than $575 million, and the CEO, CIO, and chief security officer were all forced out.

Yet the firm didn’t suffer any long-term reputation damage. And in all the hoopla around the scandal, there really wasn’t a lot of discussion about why that is, and how Equifax actually makes money. So looking at Begor’s braggadocio around the firm’s market power is useful. The product Begor told investors about at the Goldman Sachs confab is called The Work Number, which is a business line that bundles data about the incomes of hundreds of millions of people and sells it to interested parties, like lenders, landlords, employers, and government agencies. Payroll and data is by some estimates a $10 billion market, and now brings in a majority of the firm’s domestic revenue.

Equifax used to be a firm, which, along with Experian and TransUnion, focused on keeps tabs on all of us and whether we pay our debts. But over the last four years, it has transformed itself into a sort of tax information agency, which sells information about our salary and income to third parties. It’s a better business than just credit data, because while three firms have information about whether you pay back your credit card company, only Equifax has complete information about where you work. And a monopoly, as Begor bragged, is better than an oligopoly.

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The Work Number

First let’s start with why this business exists. Sharing information about where you work and what you make is something we all need to do on occasion. If a bank or auto dealer wants to lend someone money to buy a home or car, they need a verification that the person works where he says he works and makes the income he says he makes. Sometimes a potential employer or landlord needs to check work history, or a public agency needs to ensure someone qualifies for government assistance, or they have to update immigration status.

How do third parties verify this information? Employers don’t like it when their HR departments are getting constant requests from lenders about their employees and what they make. And getting this information from the IRS is illegal (or least has been since progressives in the 1920s temporarily had tax returns made public.) So for decades, employers have been sending data on this to brokers, who sell the records to interested parties. Today, the biggest and in some ways only meaningful broker in this space is Equifax. If you are trying to find out someone’s work history and income, it’s pretty likely Equifax has it, and it’s unlikely anyone else does. (Experian is the second player in the market, but they just started their product line in 2021, and as I’ll explain, they are far behind.) And we’re not just talking about the data the IRS has, we’re talking about data on pay for every payroll cycle, your overtime amount, the start and end date for your job, your title, your health care provider, whether you have dental insurance, and if you’ve ever filed an unemployment claim.

There are network effects in this business; the more data Equifax gets from employers, the more likely it is to be the place lenders and government agencies seek to do income verification. In addition, having lots of data about workers also allows Equifax to build services for firms, such as managing unemployment compensation. When a firm lays off a worker, that worker is supposed to have rights to unemployment compensation, which the firm has to pay for. But if that employee was fired for cause, or quit, then that worker isn’t entitled to unemployment payments, and the firm is off the hook. There are lots of grey areas here, it’s a quasi-legal setup between the state, the business, and the employee. Managing this process, along with appeals, is also something Equifax does, as it’s a natural extension of its data business.

Because of this extensive warehouse of data and set of services, firms and agencies then integrate themselves into the Work Number. So one could argue this business has natural barriers to entry. But the story here isn’t just one of scale efficiencies. The Work Number is a legacy business, started decades ago. With the internet, however, there’s no technical reason for a centralized repository of employment and verification data, or at least not the way it’s set up today. It’s quite possible to set up a system allowing any verifier to ask the individual for his or her records. But that would cut against Equifax’s business model, which involves not only taking your data without you knowing about it and selling it, but also, crucially, preventing any other third party from innovating to build a more privacy-safe version of the same service.

Indeed, the story here is monopolization. Fifteen years ago, Equifax had already run into the Federal Trade commission, not for privacy violations, but for antitrust violations. Only, because its income verification business was a sideshow to its main credit reporting revenue line, people didn’t really notice. Today, however, Equifax is now a monopoly income verifier with a side credit information business.

The original Work Number product came from a company called TALX Corporation, which was founded in the 1970s and that Equifax bought in 2007. From 2002-2005, TALX had bought up seven rivals, consolidating the verification of income and employment business. Immediately after this acquisition spree, TALX raised prices and forced customers to move from buying annually to signing long-term multi-year contracts. Additionally, TALX had non-competes and non-solicitation agreements with its employees, which further locked up the market.

In 2008, the Bush administration FTC sued Equifax over acquisitions and unfair methods of competition. It was a creative complaint, with the Chair of the commission – Bill Kovacic – looking skeptically at a series of small acquisitions, instead of one big one. But the FTC didn’t seek to undo any of the mergers. Instead, it signed a consent decree forcing TALX, now Equifax, to let customers out of long-term contracts and employees out of non-compete agreements. These consent decree obligations ended in 2017. Ultimately, this FTC action, because it didn’t require a break-up, didn’t restore competition in the market, allowing Equifax to fortify its monopoly. Equifax’s TALX subsidiary was even caught for violating of the Fair Credit Reporting Act just two years later. And the company is still a merger machine, purchasing small and large firms nearly every year. For instance, just in 2021, it made $3 billion in acquisitions, buying HIREtech and i2Verify.

After the consent decree ended, the exclusive arrangements came back. ADP, Intuit, Paycor, PrismHR, Rippling, and many other providers of outsourced payroll services have deals with Equifax to turn over or sell records. So do large companies. In 2017, Joel Winston at Fast Company reported that “75% of the Fortune 500 companies, 85% of the federal government workforce, entire state governments and agencies, courts, colleges, and thousands of small businesses nationwide” handed over data. Facebook, Amazon, Oracle, Google, Wal-Mart, Twitter, AT&T, Harvard Law School, and the Commonwealth of Pennsylvania do too. The number of entities handing over this data has only gone up since then.

And Equifax pays many of these entities for their employee data, turning human resources into a revenue generator. Of course, the employees don’t know their own data is being sold by their employer, and even small businesses who use payroll services like ADP don’t realize their data is being sold. (Small businesses can opt-out, but they have to tell their payroll provider.)

The net effect of these arrangements is that smaller players in the market, such as ExperianVerify, Truework, Thomas & Company, and Certree, simply cannot get the data that Equifax has. They are boxed out. If you are doing income verification, and you put someone’s Social Security number into Equifax, you have a 50-70% chance of getting a successful conversion. For other brokers, it’s much lower. There isn’t so much a market for employer/income verification information, there’s a market for information about each specific person. To a lender, it doesn’t matter if a rival to Equifax has information on 30% of the country, it matters if that rival has information on the individual to whom they are considering loaning money. If they don’t, you have to use Equifax.

On the other side, Equifax has also erected barriers to entry. If you are a frequent buyer of income and employment data, Equifax sometimes offers a loyalty discount if you move all your business to the Work Number. One background check provider, SwiftCheck, explained Equifax offered that “if our organization performs The Work Number Verification on every employment verification, a discount is offered.” This is a classic loyalty discount, what looks like an unlawful mechanism to exclude competitors.

So that’s how Equifax establishes its market power, by blocking rivals from getting data and by locking in customers of that data. And we can see this market power at work in the pricing, as their CEO noted in December. Equifax has been raising prices substantially for years. How much? Well like an airline or any firm with market power, Equifax doesn’t just have one price. It can engage in price discrimination depending on the willingness to pay. But the price hikes that are public, are extreme. In 2017, the price for a record was $20, in 2020 it was $41.95. Today, it lists its price as $54.95 for a record of where you currently work, and potentially up to $200 for records with more historical information. And it’ll keep going up.

The Real Cost: Equifax as Private Government

Consumers pay for this cost in ways they don’t see. When you get a loan or rent an apartment, the lender or landlord has to pay Equifax’s toll, and will include that extra cost in the price of your loan or rent. But more than just higher prices, Equifax’s database is powerful. The Work Number can, according to the government, help determine “an applicant’s social service eligibility” or “inform child support collections and enforcement.”

There are often errors, and getting your own data from Equifax can be difficult if not maddening. Just read this thread of frustrated consumers trying to do so, and often encountering mistakes in the process. And as we know, Equifax is prone to hacking. People don’t know that their employment data is being sold to Equifax, and they tend to be upset when they find out. Google workers were outraged about it, which is ironic. It’s also prone to abuse; Apple told the Work Number that every worker who left was automatically given the title “associate,” regardless of whether they were a top engineer. According to one former Apple worker, this error “delayed the hiring process at a prospective employer by nearly a week, during which time the company rescinded the offer.” I don’t tend to focus on privacy, but though Equifax claims there are controls on who can buy this information, security researcher Brian Krebs noted in 2017, that it’s easy for pretty much anyone to learn your salary. These flaws are all quality harms, standard for any monopolist who isn’t subject to competition.

The Work Number is so important that Equifax is engaged in the work that should be reserved to a government. Generally speaking, people would get really upset if the IRS shared our tax information for a fee. Effectively, Equifax is doing that, because for most people, employment and income is our tax information. But since it’s a private monopoly, the anti-government types don’t notice or care. At the height of the Great Recession in 2010, Equifax’s TALX division was processing 30% of the unemployment claims in the country. Though originally intended to automate the process, what Equifax ended up doing was automating the refusal to pay out unemployment claims. It systemically denied applications regardless of merit so its clients – employers – would have to pay less in unemployment taxes. And this goal is on the firm’s investment documents, which uses the anodyne wording of “reduce the cost of unemployment claims through effective claims representation” to describe the service it provides to employers who give it data.

It’s perhaps no exaggeration to note that Equifax is a quasi-governmental agency, a monopoly provider of evidence that you work, where you work, and what you make. If there’s an error, or if someone lies about you, too bad. If Equifax itself is paid to harm you, too bad. If a government agency gets the wrong data and denies you assistance or screws up your immigration status, that’s on you, well, you have limited to no rights in this situation. In some ways, you might have more to fear from Equifax than the IRS.

It Need Not Be This Way

As is always the case, most things created by people can be unmade by people. And so too with Equifax. I learned about the Work Number from a contact on Wall Street who pays attention to monopolies. He told me the Work Number is one of the purest examples of market power he’s seen, which of course, the CEO of Equifax helpfully confirmed in public. I’ve also talked to a number of people in the industry trying to compete in the payroll data space. Two firms – Certree and Argyle – recently sent letters to the Federal Trade Commission asking for an investigation into this market, pointing at the abuse of consumers by Equifax (and to a lesser extent Experian).

The strategies for each small rival are different, but both give the consumer control over who can access their data, instead of building a giant centralized repository controlled by a monopolist. Certree gives each employee a ‘personal vault’ where his or her data resides. While they verify that the data came from an employer, only the employee can give permission for a third party to look at what’s inside – even Certree can’t see it. Certree is paid when a lender or third party successfully verifies an employment or income record.

Argyle has a totally different model. It isn’t even a data broker, but a ‘data transfer agent.’ It lets third parties ask consumers about their income and employment information by sending them a link, and then gets consumers to give them their passwords for their employment information. Argyle doesn’t keep any data on hand, but is controversial because it engages in screen-scraping of your employer’s website, which can be a security risk. And yet it is weird to think it’s problematic for employees to take their own data from their employer, but fine for employers to sell that data to Equifax.

Both Certree and Argyle charge much less than Equifax for their service.

Regardless, the overall point is that having a centralized data broker that has a quasi-monopoly over income and verification data, and sits largely unregulated, is ridiculous. Breaking up Equifax’s monopoly wouldn’t be that hard, at least conceptually. Many of the practices that it engages in today are things the FTC banned in its old consent decree with the firm. And it’s obvious that Equifax is immune to competitive forces. Despite the price hikes and devastating and routine news stories about hacks, errors and problems, as well as public polling showing increasing concerns over privacy, Equifax marches on, unbothered and unchastened. That’s the classic monopoly position, a recognition that there is no alternative.

Beyond the monopoly problem, however, why not have a system where individuals control their own data? Prior to the internet this would have been impossible, but today it’s quite doable. Giving individual control over their data would probably require both antitrust law and an aggressive reading of the Consumer Financial Protection Bureau’s authority over Credit Reporting Agencies, or a new Congressional statute for ownership and control of employment data.

Regardless, I’d like to thank Equifax CEO Mark Begor for bragging last month about his firm’s market power. Without that, I never would have taken the time to learn why Equifax can act as a private IRS, put out a middle finger to each one of us, and collect our money regardless.

* * *

Thanks for reading! Your tips make this newsletter what it is, so please send me tips on weird monopolies, stories I’ve missed, or other thoughts. And if you liked this issue of BIG, you can sign up here for more issues, a newsletter on how to restore fair commerce, innovation and democracy. And consider becoming a paying subscriber to support this work, or if you are a paying subscriber, giving a gift subscription to a friend, colleague, or family member.

cheers,

Matt Stoller

The housing industry is up in arms over new tenant protections that the Biden administration administration is preparing to roll out as soon as this month, Politico reports.

The protections, which come as rents around the country are falling, could include promoting grace periods for late rents, as well as giving renters who are facing eviction the right to legal counsel, according to advocates.

According to Jerry Howard, CEO of the National Association of Home Builders, the industry is bracing for “some pretty intense regulation.”

“They need to be very cautious about what they’re doing,” he added, having attended a November White House meeting on tenant protections. “There’s a real chance of creating a problem that doesn’t exist.”

With a possible recession looming, the Biden administration will be looking for ways to provide relief to cash-strapped Americans suffering from a higher cost of living. Since the U.S. House is now under Republican control, the kind of sweeping economic legislation enacted during the last two years is off the table.

Democratic lawmakers including Sen. Elizabeth Warren (D-Mass.), are leaning on the administration to go big by curbing rent increases at millions of units in properties with government-backed mortgages – a long-shot move the White House is not seriously weighing, according to a person with knowledge of the discussions. -Politico

The National Apartment Association and 10 other industry groups are lobbying the White House to resist pressure to enact new federal requirements on top of existing laws – insisting in a December letter that doing so would “further exacerbate affordability challenges.”

“People can’t afford to live,” said Rep Jamaal Bowman (D-NY). “We want to push the president as far as possible to lighten the burden of rent on everyday people.”

Democrats are pushing the Biden administration to enact restrictions on rent hikes and punish landlords who they say are price gouging.

“[N]ot just principles, not just guidelines, but what can the president do through executive action to lighten the burden on people and put more money in their pockets,” Bowman told Politico in an interview.

The White House, meanwhile, appears to be in agreement – though it has yet to comment on specifics.

“We are exploring a broad set of administrative actions that further our commitment to ensuring a fair and affordable market for renters across the nation,” according to spokesperson Robyn Patterson. “We look forward to continuing to work with lawmakers to strengthen tenant protections and improve rental affordability.”

While rent is still driving up overall inflation — thanks in part to a data lag in the official inflation gauge — the national median rent has fallen for four straight months, according to the latest data from Apartment List. New lease demand plummeted in the second half of 2022, when the net demand for apartments fell into negative territory for the first time since 2009, according to an analysis by RealPage Market Analytics. -Politrico

“Complicating this process isn’t good at any time in the market cycle,” said Greg Brown, senior VP of government affairs at the National Apartment Association. “But we’re in the fourth straight month of rent declines. I think things are adjusting again, so it does raise the question, are they responding to a situation of three to four months ago, not what is currently happening or will be happening in the near future?“

By Mariah Muhammad and Laura Dyrda of Becker’s Hospital Review

Rural hospitals and healthcare facilities face amplified financial challenges amid persisting workforce shortages, rising costs and leveling reimbursement. Reserves are dwindling and without urgent action, hundreds of facilities face closure. 

But it’s not too late. Mobile health, partnerships, new payment methods and government support can make a big difference to rural hospitals across the U.S. Becker’s asked 33 healthcare executives to share their best ideas to save rural healthcare, and here they are. The executives featured in this article are all speaking at the Becker’s Healthcare CEO+CFO Roundtable on Nov. 13-16, 2023 in Chicago.

Question: What is your best idea to save rural healthcare?

President and CEO

Johnese Spisso. President of UCLA Health, CEO of UCLA Hospital System and Associate Vice Chancellor of UCLA Health Sciences: While some progress has been made in improving access to primary care in rural areas, access to specialty care remains a challenge. One of the opportunities to increase access is through the use of telemedicine and video visits with highly trained specialists who are available at academic medical centers and other large health systems. One of the ways we have expanded access at UCLA Health is through telemedicine. Additionally, through operating an interfacility transfer center, we serve as a resource to rural hospitals in our region, which rely on us to accept transfers of complex patients that have needs that exceed the level of care that can be provided in the rural facilities.

David Lubarsky, MD. CEO and Vice Chancellor of Human Health Sciences at UC Davis Health (Sacramento, Calif.): Around one in five Americans live in rural areas, but only 5 percent of physicians practice in these same areas. UC Davis has made it a priority to help close this gap in rural healthcare by incentivizing medical school graduates to practice in rural communities. We have built a number of clinical and education partnerships to both increase providers in these communities and bring in, via virtual technologies, advanced and specialty practices from regional academic medical centers.

We need new models of place-based medical provider recruitment, education and training to include far greater numbers of individuals from rural communities, as they are much more likely to ultimately practice in these communities. Our COMPADRE program is an example of a cross-state effort funded by American Medical Association, UC Davis and Oregon Health & Science University to partner with dozens of graduate medical education programs and tribal communities in Southern Oregon and Northern California to address this crisis.

Bill Gassen. President and CEO of Sanford Health (Sioux Falls, S.D.): Protecting rural health care starts with reimagining how we deliver care for the 1.5 million patients we have the privilege of serving at Sanford Health, two-thirds of whom live in rural communities. Sanford’s landmark $350 million virtual care initiative aims to expand access to convenient, high-quality care regardless of zip code, improve the patient experience, advance innovation through new research and attract and train a new generation of clinicians.   

The past few years have tested our nation’s health systems as never before. Sanford Health is committed to seeking new ways to provide more affordable, accessible and equitable care, which is why we’re excited about our proposed merger with Fairview Health Services. Together, we will strengthen care for our patients, offer expanded career growth opportunities for our employees and serve as a destination for top clinical talent. By combining our respective strengths and expertise in rural and urban health care, we will expand access to high-quality care for more people across our region, drive innovative care solutions, invest in the well-being and quality of life of our communities and ensure we can continue to deliver world-class care for all those who place their trust in us long into the future

Donna Lynne. CEO of Denver Health (Colo.): My best ideas for rural healthcare are partnering with urban hospitals, particularly safety nets, and using telehealth with those hospitals that are truly partners. Lastly, another good idea is to use some form of “gainsharing” when patients are transferred.

Brian Peters. CEO of Michigan Health Hospital Association (Okemos): I am a big believer in technology as a game-changer for the future of healthcare delivery. In particular, it can serve as a force multiplier in the realm of healthcare staffing. When combined with the significant traction gained by telehealth since the start of the pandemic, this means that technology — if thoughtfully deployed — can help to stabilize the rural health infrastructure. One imperative: we need regulatory and reimbursement policies that incentivize and support this concept.

Jeff Thompson, MD. CEO Emeritus at Gundersen Health System (La Crosse, Wis.): Although more rapidly changing the payment system away from fee-for-service will help, the best hope and most progress is to change the behavior of the large systems and universities to view rural areas not as referral pipelines but as citizens and providers that need real population healthcare partners.

Not closing, but re-focusing the work of rural providers and rural hospitals that have already been shifting to outpatient work [will help]. Systems can connect the EHR , provide quality and HR systems improvements, focus on cancer screening and mental health services as well as those other needed procedures that can be done well locally like cataracts, mammograms, and colonoscopies. Those systems that are truly partners will most likely improve referrals, but the connection is built on the value of improving health.

Robert Corona. CEO of SUNY Upstate Medical University (Syracuse, N.Y.): It will be solved by technological and process innovations. We serve one-third of the geography of New York State, so rural healthcare is key for us. We have a rural medicine training program for physicians and they need special tools. Rural healthcare is best served through use of advanced computing and communications technology, autonomous machines like drones and robots for supply logistics and other operations.

We now have established an autonomous machines division and a mobile medical unit. We have a hospital at home program and an influenza-like illness program that both use body-worn sensors on remotely located patients for vital signs and other parameters. This is all part of the distribution of healthcare services beyond bricks and mortar healthcare facilities.

Mark McPherson. President and CEO of Trinity Health At Home (Livonia, Mich.): Enact legislation to pay for telehealth in a home health nursing environment. During the pandemic, telehealth was shown to be highly effective as a way to provide care. It’s reimbursable for physicians, but not for nursing care. Reimbursing telehealth in-home care would allow home care agencies to leverage already scarce nursing resources across an unlimited geography, mitigating many of the logistical issues of providing home care in a rural environment.

Charles A. Powell, MD. CEO of Mount Sinai-National Jewish Health Respiratory Institute; Medical Director of Mount Sinai Hospital Respiratory Care Services (New York City): In the respiratory disease space, a key point of emphasis on providing access to specialty services in remote or rural regions. We are able to address potential gaps in access by leveraging technology to connect rural clinics and to connect with patients at home. For example, multidisciplinary tumor boards and multidisciplinary interstitial lung disease management programs can provide access to clinicians in practice locations that are distant from the tertiary facility hosting the discussion. We have deployed remote patient monitoring solutions to patients and home sleep study patients by direct shipping that allow us to connect with COPD patients across the continuum of care and to diagnose patients with symptoms of obstructive sleep apnea.

Helen Johnson. CEO of Sparrow Eaton Hospital (Charlotte, Mich.): The expansion of broadband internet services has helped level the playing field for rural communities. While not yet complete, in those areas where access to high-speed internet is available, those communities are leveraging this basic utility for healthcare, education and economic development.

Donald Lloyd, II. President and CEO of St. Claire Healthcare (Morehead, Ky.): In my view, we cannot perpetuate a stable rural health infrastructure until we address three significant issues critical to achieve rural health sustainability. First, we must develop and attract a rural-centric pipeline of talent to meet our clinical and workforce needs. Second, we must realize that it is not economically possible to sustain a full service acute care hospital in every rural community. Such a realization takes great political courage but also clinical creativity to meet the community’s needs. Third, CMS and state Medicaid agencies must establish payment methodologies that sustain institutions in low volume and safety-net environments

Mark Gridley. President and CEO of FHN Memorial Hospital (Freeport, Ill.): My thought is a deep focus by federal and state legislators that are truly seeking to understand the barriers to healthcare in rural communities. Many of these barriers are driven by inadequate reimbursement methodologies for noncritical access providers, which creates difficulty in staffing and, ultimately, in providing access to care that is sustainable, consistent and close to small communities. This would include innovative technological program funding in addition to stabilizing declining reimbursement amidst increasing costs.

Michael Canady, MD. CEO of Holzer Health System (Gallipolis, Ohio): The solution to saving rural healthcare lies in solving the payer mix issue. Rural HCOs have such a high percentage of Medicare/Medicaid/self-pay that it is becoming a challenging revenue issue. Closely related to this is the 20 percent initial denial rate across the board. Fix these two problems and rural healthcare can survive.

Thomas Siemers. CEO of Wilbarger General Hospital (Vernon, Texas): Collaboration and diversification are the key strategies for future success. We should look for ways we can collaborate with other organizations and providers to expand and diversify our services. Rural hospitals will have to try new strategies, start new services, adapt to the changing needs of patients. The key is to keep our patients local so they don’t have to travel for care. Rural hospitals will have to share revenue and/or pay for the services provided by other organizations/providers. But it’s worth it. We’ve got to grow.

Jeremiah Hodshire. President and CEO of Hillsdale (Mich.) Hospital Administration: Ultimately, rural healthcare suffers from the reality that we are often paid less than what it costs us to provide patient care. No other business or industry would be expected to survive under those conditions, and rural hospitals shouldn’t have to scramble to find other revenue sources like grants, cash-only services, etc., in order to be financially sustainable. Achieving health equity for rural Americans requires us to sustain rural hospitals so we can continue innovating, investing in technology, pioneering access to care initiatives and more. Payment reform is not just the best way to save rural healthcare long-term — it is the ONLY way.

Kenneth Rose. President and CEO of Texas Health Hospital Mansfield: The plight of rural healthcare in our country is one that will not be solved by hospitals and healthcare systems alone. Rural communities would be benefited by the collaboration of community services offered by other not-for-profit organizations along with hospitals. The issues in rural communities many times are more than just acute care related and have other social/societal components, which calls for more than the expertise of community hospitals. An issue as large as this brings the old saying to mind: many hands make light work.

Christopher Bjornberg, CEO of Mayers Memorial Healthcare District (Fall River Mills, Calif.): The best way to save rural healthcare is to treat it as rural healthcare. Urban health is not the same as rural health but it is mostly treated the same way. Currently, Medicare is the only payer that has a program specific for rural health that takes a critical access hospital designation while Medicaid and commercial payers like Blue Cross, UnitedHealthcare and the like generally do not. Coupled with the poor reimbursement rates, are the rising administrative costs for providing healthcare. According to an article from CNN in February 2022, “Administrative costs alone make up more than a quarter of U.S. healthcare spending.” If we want to save rural healthcare we have to change the reimbursement across all payers not just one and then ease the administrative burdens that go along with that. Just like it shouldn’t be difficult for people to obtain good quality healthcare, it should not be difficult to get paid to provide good quality healthcare.

CFO and Strategic Leaders

Marty Hutson. CFO of St. Mary’s Health Care System (Bayside, N.Y.): The first step to ‘save’ rural healthcare is to accept that the one-size-fits-none model of Medicare does not work. Rural hospitals face more difficulty in recruiting and retaining staff. Given your location, access to goods and services is also more expensive. CAH based on bed size is not effective when some facilities are too big to be considered critical access but remain just as remote and important as those with that designation.

Nate Shinagawa. COO of UCI Health (Orange County, Calif.): One of America’s strengths, compared to anywhere in the world, is our recognition that immigrants add value to the culture and success of our country. Nowhere is this more evident than in healthcare, where 25 percent of all physicians are international medical graduates. Many of these physicians came to America through the H1-B visa program, a critical pathway that’s provided talented physicians to underserved areas, including much of rural America.

For example, in places like North Dakota, H1-B applicants represent almost 5 percent of all physicians. We can turn around the healthcare access problem in rural America with progressive immigration policies. Expand H1-B visas, fast-track the green card process for physicians and nurses, expand the J-1 visa waiver program and make it easier to attain state licensures. In a year, we’d see the impact of these changes to the great benefit of rural America.

Cristen Page, MD. Executive Dean of the UNC School of Medicine (Chapel Hill, N.C.): We should address this issue with humility. Our neighbors living in rural areas need to be listened to and supported as they know best what is needed in their communities. I have dedicated much of my career to rural workforce development and creating sustainable programs that introduce future providers to the impacts that they can make and the joys that they can find in rural service. We need more providers in rural service – not just physicians, but nurses, APPs, and others. We need to support the expansion of rural residency and other training programs and to continue building strong networks so that success stories and knowledge can be shared. And we need to leverage technology to support our rural providers as well as new models of care to better serve our rural patients.

Arianne Dowdell, JD. Vice President and Chief Diversity, Equity, and Inclusion Officer of Houston Methodist (Texas): Equitable access to healthcare may not just mean a brick-and-mortar location but also working closely with community partners to support people with chronic health conditions through prevention, education and access. Looking at data to learn more about the communities we serve or those we have the potential to serve and knowing more about incidence rates of certain diseases is helpful when meeting the healthcare needs of patients, particularly those in rural communities.

At Houston Methodist, we often talk about meeting people where they are and that includes supporting people with varying education levels, limited knowledge about their own healthcare, or those who have little to no access to technology. We learned a lot during the pandemic about how we can support people who may fall into these areas of their healthcare journey, and we’re continuing to use those lessons learned to create quality healthcare experiences for people despite where they live.

Nick Stefanizzi. CEO of Northwell Direct (New Hyde Park, N.Y.): ‘Saving’ rural healthcare will be predicated on solving for the unique challenges experienced by these populations – primarily, addressing access and social determinants of health, which in the context of rural health, are synergistic strategies.

To start, given that the National Rural Health Association has described that of the more than 7,200 federally designated health professional shortage areas, 3 out of 5 are in rural regions, access is a clear structural barrier. The fix here can’t just be brick and mortar facilities and providers. Rather, solving for this will require a combination of in-person and virtual treatment modalities to expand the pool of providers available for critical services. It will also require an investment in digital tools and resources that enable individuals to better engage and manage their own health. All must be highly integrated and easy to navigate if we expect widespread adoption and utilization.

Further, a population health approach to addressing the social determinants of health and the underlying factors that can adversely influence the health of populations living in rural communities will similarly help to address root causes. An individual’s zip code often has more impact on health than any other factor, and in order to raise the health of rural populations, the focus needs to expand beyond traditional medical care. Through innovative and proactive interventions, we can enable health professionals and individuals to better engage and manage chronic and other conditions that exacerbate the challenges associated with the lack of access to local care providers.

Taken together, addressing access and social determinants will go a long way in solving the rural healthcare crisis.

Kerry Mackey. Vice President of Hospital Operations, Women and Children’s Services at NYU Langone Health (New York City): Telemedicine/telehealth services can be utilized to expand access to care in rural areas. We learned this from COVID-19 when we had to extend healthcare outside the hospital’s doors/walls. Also, implementing a home hospital service can complement telehealth/telemedicine by bringing that day-to-day nursing care to the applicable patient’s home. In addition, utilizing data and outcomes to negotiate reimbursement rates for Medicare services is how we can overcome the challenge around service or provider restrictions.

Scott Polenz, CPA, MBA, FACHE. Vice President of Physician and Advanced Practice Clinician Relations of Marshfield Clinic Health System (Wis.): Saving rural healthcare is about as ambitious an undertaking as you can aspire to because of the complex, interwoven challenges that must be addressed. Fixing rural health care requires fixing our national health care system and a societal-level shift with regard to how we view health and health care. On a national level, we have to commit to the systemic changes required to truly move to a value-based system. On a more rural-specific level, we need massive investments to upgrade our overall public health infrastructure. Rural communities lag behind metropolitan counterparts in areas like access to transportation, availability of internet, distance from sites of care, access to healthy food and many other community-based resources. This basic infrastructure is fundamental to accessing quality health care, and it is going to take systemic, sustained investment to equip rural health care with the tools we need.

Chad Dilley. COO of IU Health Saxony (Fishers, Ind.): IU Health is proud to serve many rural Indiana communities in places like Tipton, Bedford and Frankfort. There are really two inherent challenges: the geography of small populations spread over large areas, and provider recruitment to live and work away from urban centers and the specialty and subspecialty support that affords. We are continuing to lean into virtual care, virtual consults and telehealth to make care more accessible for patients close to home (or at home), and support our teams with the expertise and collaboration they need to provide excellent care in rural settings.

Kira Carter-Robertson. Senior Vice President of Regional Hospitals at Sparrow Health System (Lansing, Mich.): I would love to say there is a magic bullet to save rural healthcare, but I don’t think the answer is one-size-fits-all. While rural hospitals may face similar pressures, rural communities are not all the same. In the short-term, rural healthcare providers will have to continue blocking, tackling, and juggling service needs with volume, managing staffing and provider challenges, assessing the right operation models, and exploring partnerships and mergers. Finances are the key driver behind closures and financial challenges for rural hospitals, so the long-term answer is a drastic payment overhaul. In the meantime, the secret sauce for rural healthcare is more complex and several levers will need to be pulled both regulatory and operationally to sustain the future of rural healthcare.

Rashid Syed. Managing Partner of North Houston Surgical Hospitals: In my opinion, the best approach towards improving rural healthcare is to segregate the patient care services from one large hospital system to nimbler healthcare facilities, making it more approachable and personable for both, the patients and the providers, by creating urgent care centers, surgery centers, specialty microhospitals for mild to moderate complexity elective and nonelective treatments and keeping larger hospitals for higher complexity, longer complicated treatments. It’s about taking healthcare to the patients rather than patients in need seeking healthcare.

Clinical Leaders

Andy Anderson, MD. Chief Medical and Quality Officer of RWJBarnabas Health (West Orange, N.J.): Rural healthcare is essential to address the health and healthcare needs of patients and families who live in rural communities. My best idea to save rural healthcare is to provide robust virtual access (through telemedicine and remote patient monitoring devices) to triage and address acute care needs, to better manage chronic conditions, and to provide access to the best specialists to diagnose and treat complex medical conditions.

William Morice, MD, PhD. President of Mayo Clinic Laboratories and Chair of the Department of Laboratory Medicine & Pathology at Mayo Clinic (Rochester, Minn.): From my perspective, to save rural healthcare, one must tackle one of the greatest challenges facing rural hospitals and healthcare providers, which is maintaining sufficient patient volumes in their facilities while also developing next-generation tools and capabilities. These tools and capabilities, such as at-home testing and digital diagnostics, will allow them to reach their patients in their homes spread across large areas. So, my idea is to invest in rural healthcare’s ability to interact with patients remotely while also designing practice and social service models that bring them into facilities for care when needed. Done correctly, this will enable rural healthcare to sustain and grow their services while also increasing their reach and convenience for patients.

Phil Schaefer. Senior Vice President, Ambulatory Services and Chief Care Network Development Officer of Southern Illinois Healthcare (Carbondale): For rural hospitals to survive, the economics of reimbursement must change along with the hospitals’ approach to their cost structures. With almost all major payers having record profits last year and with declining utilization and reimbursement, the current model of paying hospitals is not sustainable. Given this, it’s imperative for rural hospitals to reevaluate their service portfolio and bend their cost curve downward.

Steve Lipshultz, MD. Goodyear Professor and Chair, Department of Pediatrics of University at Buffalo Jacobs School of Medicine and Biomedical Sciences (Buffalo, N.Y.); Pediatric Chief-of-Service of Kaleida Health (Buffalo, N.Y.); President of UBMD Pediatrics (Buffalo, N.Y.): Improving rural healthcare finances is one of several key elements to sustaining rural healthcare and coming closer to a single standard of US healthcare. Below I list 14 areas where opportunities exist and are needed. Utilizing technology such as:

1. Telehealth;

2. EMRs;

3. 3. ub-and-spoke health system networking and infrastructures to allow most care in the local community but having the backup;

4. Ongoing physician and other healthcare provider and staff training;

5. Recruitment;

6. Retention, addressing;

7. Workforce shortages with pipeline programs and others;

8. QA/QI oversight and feedback as drivers of decisions based on the quality of care in rural places;

9. Enhanced rural public health;

10. Focused patient management on unique needs in rural settings;

11. Other necessary infrastructures to increase both revenues from payments and reimbursements and other efficiencies and outcomes are key;

12. The transition to value-based care will be very sensitive for rural healthcare with reduced reserves and with unique needs and solutions.;

13. Having a national agenda to reduce disparities by states for funders of rural healthcare around the U.S. will help level the playing field. The differences in reimbursements and uncompensated care for the same services around the U.S. widely vary based on local rules and regulations and (both state and federal) often cause essential services in rural communities to no longer be sustained.; and

14. Adequate payments and better payment systems are needed with a level playing field.

Anuj Vohra, DO. Chairman and Medical Director of the Department of Emergency Medicine of Charlotte Hungerford Hospital (Torrington, Conn.): My best idea to save rural healthcare is advancing access to care by means of telemedicine, home visits and increasing preventative care.

Charles Emerman, MD. Chair, Emergency Medicine and Medical Director, Service Line of MetroHealth Medical Center (Cleveland, Ohio): Smaller rural hospitals would do well to form more robust clinical programs that leverage the resources of the larger urban hospitals. For example, we have trauma surgeons who take calls at two smaller rural hospitals. The local surgeons are happy not to take overnight ED calls. The trauma surgeons operate locally when appropriate and then transfer the more complex patients. It works out well for the patients, the local medical staff, and both systems.

Andy Anderson, MD. Chief Medical and Quality Officer of RWJBarnabas Health Medical Group (West Orange, N.J.): Rural healthcare is essential to address the health and healthcare needs of patients and families who live in rural communities. My best idea to save rural healthcare is to provide robust virtual access (through telemedicine and remote patient monitoring devices) to triage and address acute care needs, manage chronic conditions better, and provide access to the best specialists to diagnose and treat complex medical conditions.

Nisha Mehta, MD. Founder of Physician Side Gigs: Maintaining the quality of care in rural areas will become increasingly challenging as healthcare personnel shortages continue to amplify. Employers will need to place a real focus on retention and recruitment of clinicians, and systemically, threats to compensation by CMS and other payers need to be addressed. Medicare cuts are short sighted and will only exacerbate existing issues with access to care.

Tesla, Inc. plans to report fourth-quarter results after the market close on Wednesday. Investors seek updates on the 2023 demand outlook after the EV company slashed prices on its cars worldwide. 

The automaker realized it’s not only EV game in the ‘carbon-free’ town, as US, Europe, and Japanese car companies are ramping up EV production. Tesla slashed Model 3 and Model Y prices by up 20% in hopes of stoking demand as the entire EV market becomes saturated but also slows.

WSJ spoke with Stanly Tran, a 32yo California psychotherapist, who was on the waiting list to purchase a Ford Mustang Mach-E electric SUV but quickly canceled his reservation and bought a Model Y after hearing about the price cut. 

“‘There’s no way,'” Tran said when he heard about the price cut, adding the Model Y offered more range and a competitive price to the Mach-E. 

Tesla’s move to squeeze competitors by sacrificing some of its strong operating-profit margins is a desperate attempt to increase sales but also roiled the secondary market for used Teslas. 

Meanwhile, dealers who sell Teslas from their used-car inventory say valuations on some models fell by several thousand dollars following this month’s price cut. In the first 17 days of January, prices of 2020 model year or newer used Teslas were down about 25% from their peak in June of last year, about double the rate of the industrywide drop during that same period, according to Edmunds. –WSJ

One example of the price cut was the Model Y, now priced at $53,000, down from about $66,000. And if buyers qualify for the federal tax credit, they can loop off another $7,500. 

Bank of America analyst John Murphy said, unlike Tesla, traditional automakers have very thin profit margins or lose money on their EV lineups. He said such a move to reduce prices could spark a price war.  

“These price cuts are likely to make the business even more difficult, just as they are attempting to ramp production of EV offerings,” Murphy said.

The lingering question is if the Elon Musk-led carmaker stoked demand. WSJ has some data on that:

The number of car shoppers researching Tesla surged following the early January price cut, research site Edmunds said. The Model Y was the second-most-researched vehicle on Edmunds’ website for the week ended Jan. 15, up from 70th the week prior. The Model 3 moved up 36 spots.

Soon after the price cut, applications for financing of Tesla vehicles tripled at Tenet, a New York startup firm that provides financing to EV buyers. The influx of customers has remained elevated, Tenet Chief Executive Alex Liegl said.

One consequence of the price cut is that it might spark an EV price war with Detroit. Then there’s the issue of angry car dealers and owners who saw their Teslas drop in price overnight. Such a move is a sign of desperation by Tesla. 

Authored by Zachary Stieber via The Epoch Times (emphasis ours),

U.S. health officials who spread inflated COVID-19 child death data in public meetings apologized to the source of the false data but not to the public, newly obtained emails show.

Drs. Katherine Fleming-Dutra and Sara Oliver, with the U.S. Centers for Disease Control and Prevention (CDC), offered the false data in 2022 while U.S. officials weighed granting emergency authorization to COVID-19 vaccines for children as young as 6 months.

The study they cited for the data was published ahead of peer review by a group comprised primarily of British authors. The study was corrected after the public meetings.

Emails obtained by The Epoch Times showed that Fleming-Dutra and Oliver were alerted that they had spread misinformation. Neither the officials nor the CDC have informed the public of the false information. Newly obtained emails showed the officials apologized to Seth Flaxman, one of the study’s authors, and even offered to see whether the study could be published in the CDC’s quasi-journal.

“I feel … that we owe you an apology,” Oliver wrote to Flaxman on June 27, about 10 days after she and Fleming-Dutra falsely said there had been at least 1,433 deaths primarily attributed to COVID-19 in America among those 19 and younger. “We draw the attention of a variety of individuals with the ACIP meetings, and apologize that you got caught in it this time.”

“I am also sorry that you got pulled into the attention around the VRBPAC and ACIP meetings,” Fleming-Dutra added. She had presented the data to the Vaccines and Related Biological Products Advisory Committee, which advises the U.S. Food and Drug Administration, and the Advisory Committee on Immunization Practices, which advises the CDC.

Fleming-Dutra, Oliver, and Flaxman did not respond to requests for comment.

Inflated Death Toll

Using data from the CDC, Flaxman and his co-authors claimed that there were at least 1,433 deaths primarily attributed to COVID-19 among those aged 0 to 19 in the United States. The actual number was 1,088, the authors acknowledged in the corrected version of the study.

Fleming-Dutra presented the false data as rankings to VRBPAC on June 14, 2022 and ACIP three days later. It’s not clear why the CDC didn’t examine its own database rather than relying on a preprint study.

Oliver also cited the study while speaking during the ACIP meeting.

The data had an impact. It showed “that this is not a minor illness in children,” Dr. Katherine Poehling, one of the ACIP members, said at the time.

Dr. Rochelle Walensky, the CDC’s director, later appeared to cite the inflated death toll and ACIP still cites the preprint, though it was later updated with the correct data.

Flaxman updated the study after receiving an email from Kelley Krohnert, a Georgia resident who has become a fact-checker of suspect COVID-19-related claims.

Krohnert’s concerns also made their way to Fleming-Dutra and Oliver, but the CDC officials have never publicly acknowledged promoting misinformation.

‘We Had an Error’

Flaxman acknowledged in emails to Krohnert, and in a June 27 message to Fleming-Dutra and Oliver, that he did not fully understand how the CDC’s death database works.

“Thanks for your work, and your great presentations to VRBPAC and ACIP. You cited our preprint. We’ve just updated it (see attached; it should appear on medrxiv in the next day). While none of the substantive conclusions change, we had an error which you may have seen was picked up very prominently by a blogger,” Flaxman wrote. “I am writing first to say sorry–I really regret that this happened. It was my mistake in misunderstanding the [death certificate] data, and not realizing about CDC Wonder’s provisional database.”

Flaxman also asked for feedback on the updated study and whether the officials could help with submitting the paper to the Morbidity and Mortality Weekly Report (MMWR), a quasi-journal the CDC publishes that only includes articles (pdf) vetted and shaped by top CDC officials to align with the agency’s policies.

“We’ve never tried to publish there, so I don’t know the process or how often they consider manuscripts from non-CDC authors,” Flaxman said. “If you do think this would be a possible route, perhaps one or both of you would want to help us revise the manuscript and join as an author?”

Oliver wrote back first, saying that she wanted to apologize to Flaxman and that “we will absolutely review and provide feedback,” as well as context.

“We are more than happy to do that without formally being co-authors. That way you can avoid formal CDC clearance,” Oliver wrote.

Fleming-Dutra then chimed in with her apology, adding, “I am glad to hear that you and your team are continuing to do this important work.” She recommended Flaxman and his team review studies published in the MMWR to get a sense of the format of the digest. A large portion of her email was redacted under an exemption to the Freedom of Information Act for “inter-agency or intra-agency records.” The Epoch Times has appealed that and other redactions.

Flaxman then notified the CDC officials that the corrected study had been made public. Fleming-Dutra replied, but the email was redacted.

“Thanks, very useful feedback. Small update: we’re hoping to submit to JAMA Pediatrics in the next week or so, and [redacted],” Flaxman answered. He indicated that the CDC had provided feedback and questioned on how to cite it in the submission.

Read more here…

A new study released this week by the D.C.-based Center for Strategic and International Studies (CSIS) has concluded that America’s defense industry is “not adequately prepared” for “a protracted conventional war” with an enemy with a large military like China.

The findings were the result of a war games simulation which also relied heavily on observations and statistics being gained from the Ukraine-Russia war, and Washington’s ongoing military support role to Kiev.

Information from the Ukraine war led CSIS to find that the US would rapidly deplete its munitions, particularly long-range, precision-guided ones – in merely less than a week of a hot war with China in the Taiwan Strait.

“The main problem is that the U.S. defense industrial base — including the munitions industrial base — is not currently equipped to support a protracted conventional war,” the study emphasized.

“The bottom line is the defense industrial base, in my judgment, is not prepared for the security environment that now exists,” CSIS’s Seth Jones concluded in a statement to The Wall Street Journal.

As the study’s main author, Jones posed the question: “How do you effectively deter if you don’t have sufficient stockpiles of the kinds of munitions you’re going to need for a China-Taiwan Strait kind of scenario?” According to more from the study:

“As the war in Ukraine illustrates, a war between major powers is likely to be a protracted, industrial-style conflict that needs a robust defense industry able to produce enough munitions and other weapons systems for a protracted war if deterrence fails…”

“Given the lead time for industrial production, it would likely be too late for the defense industry to ramp up production if a war were to occur without major changes.”

The report additionally pointed out that the slow-moving nature of US bureaucracy and oversight is also a fundamental aspect to the problem:

The study also said that the U.S.’s foreign military sales (FMS) take too long because they need to be initiated by the Department of State and then executed by the Department of Defense and ultimately approved by Congress. Foreign sales have benefits, including supporting the U.S. defense industry, strengthening ally relations and preventing the sale of adversary systems to other countries, the study said.

“The U.S. FMS system is not optimal for today’s competitive environment — an environment where such countries as China are building significant military capabilities and increasingly looking to sell them overseas,” the study stated.

It does seem the Pentagon is taking note, and is aware that events in Ukraine have exposed US defense shortcomings, as the Biden administration chooses to get more and more involved. The New York Times reported Tuesday that the US plans to boost production of artillery ammunition by 500% over the next two years.

Whereas the US Army previously produced 14,400 155mm shells a month, the new plans could see those numbers hit over 90,000 each month.

Authored by Julie Kelly via AmGreatness.com,

A New Jersey man will be sentenced on Friday for his participation in the events of January 6, 2021. Julian Khater, 33, faces up to eight years in prison for allegedly using pepper spray against three police officers, including the late Brian Sicknick, that afternoon.

Khater and his friend, George Tanios, were arrested in March 2021 in connection with the alleged assault. After spending more than 18 months in a fetid D.C. jail under pretrial detention orders – Judge Thomas Hogan repeatedly denied attempts by his family to post bail – Khater pleaded guilty to assaulting police officers with a dangerous weapon.

(Tanios rejected numerous plea offers on the same charges; prosecutors finally dropped the assault counts, and he pleaded guilty to two misdemeanors.)

The Justice Department’s case was flimsy from the start, which I explained shortly after the pair’s arrest. Khater and Tanios are nothing more than human props to sustain arguably the biggest falsehood related to January 6—that Capitol Police Officer Brian Sicknick was killed in the line of duty. Even though a coroner concluded Sicknick died of two strokes caused by a blood clot near his brain, his death is still shamefully exploited by everyone from Joe Biden to congressional Democrats and even Sicknick’s own loved ones.

Capitol police announced Sicknick’s passing on January 7, 2021, with claims he was “injured while physically engaging with protesters.” Donald Trump and his supporters were immediately branded as cop killers.

The story, however, kept changing. First, the New York Times reported Sicknick had been bludgeoned to death by a fire extinguisher. After the paper retracted that story in February 2021, the media, no doubt prompted by the Justice Department, suggested Sicknick died of an allergic reaction to chemical spray.

In an attempt to salvage the credibility of its first bogus account, the Times published another lengthy report in March 2021 with cherry-picked clips and screenshots designed to reenact the assault.

“New videos obtained by The New York Times show publicly for the first time how the U.S. Capitol Police officer who died after facing off with rioters on Jan. 6 was attacked with chemical spray.” 

But body camera footage from a D.C. Metropolitan police officer on duty that day raises serious doubts about the government’s claims and the Times’ face-saving story about what happened to Sicknick.

In fact, the video shows how police, not protesters, gassed their fellow officers with chemical spray. Stricken officers, including Sicknick, appear to seek aid and shelter from the toxic gas, causing the collapse of a security line on the west side of the building.

This six-minute clip from Officer Daniel Thau’s body camera shows the accidental discharge of a 40-millimeter canister of a chemical irritant around 2:25 p.m. on January 6. Thau ordered Officer Richard Khoury to aim a launcher with the canister at protesters assembled on scaffolding erected for Biden’s inauguration.

“Fire it up in the air,” Thau instructed Khoury. “Just fucking shoot.”

But Khoury misfired. “What the fuck?” he asked.

A large cloud of chemical powder fell short of the scaffolding and instead enveloped a crowd of officers standing on the northern end of the west side of the Capitol. Officers coughed and gasped for air; some were bent over in pain. 

The gas cloud quickly traveled southward to where Sicknick was stationed, propelled by a brisk 18-mile-per-hour wind out of the north in Washington on January 6.

Prosecutors claim Khater sprayed Sicknick at around 2:23 p.m., but the evidence, just like everything in the January 6 saga, is dubious at best. Darren Beattie at Revolver News carefully disassembled both the Times’ reporting and the government’s evidence.

“[From] the moment Khater raises a spray canister onward, there is not a single moment in which Khater appears in the same video frame as Officer Sicknick,” Beattie wrote in March 2021. 

That’s because, according to a separate choppy video released by the government in April 2021, Sicknick left that area and headed north—presumably walking straight into the drifting chemical cloud produced by Khoury’s launcher.

Sicknick is then photographed bent over near inaugural scaffolding, the same area where officers quickly advanced up a set of stairs to seek fresh air on the upper west terrace after Khoury’s misfire.

It just happened to be the exact location where Sicknick is also seen on surveillance video recovering from the effects of chemical spray and rinsing his eyes with bottled water about two minutes after Khoury’s misfire.

The Times’ March 2021 also suggested Khater’s “attack” on law enforcement caused many officers to abandon the secure perimeter.

“The attack on Officer Sicknick and his colleagues comes at a key moment. Within five minutes, the police line collapses, officers retreat into the Capitol and rioters gain control over the west side of the building.”

Except that’s not accurate.

Testimony by a top Capitol Police official this month confirmed it was the misfire by Officer Khoury that led to the collapse of the police line, which at the time was successfully keeping the crowd away from the building:

Defense Attorney Bradford Geyer: As we play this, if you can try to pay attention to the smoke, whether it’s just smoke or whether it’s [tear] gas, and the reactions of the officers. Okay?

Mendoza: OK.

(Video played.)

Geyer: Does it seem to you there’s some kind of retreat by the officers along the line in this video?

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Mendoza: Yes.

Geyer: So could this be a reason why right around this time you had to confront protestors coming into the crypt and coming into that first floor, because there was a strategic retreat, the lines gave way, and the crowd just walked forward with provocateurs.

Mendoza: I can’t say why that specific crowd was where they were at the time they were there.

Mendoza also confirmed that police used “a lot of munitions that day.” Thau’s full video shows his arrival at the west side of the Capitol shortly after 1:00 p.m., more than an hour before the building was breached on the other side. Officers are seen coughing and rubbing their eyes after being hit with tear gas deployed by law enforcement.

At around 1:50 p.m., Thau ordered another officer to “drop one in there” against the nonviolent crowd.

He then warned his colleagues to protect themselves.

“Wind, wind!” he shouted, referring to high wind conditions.

As Thau tended to the injured, one officer screamed at him: “Stop doing the goddamn pepper spray!”

Even giving the government the benefit of the doubt—that Khater attacked Sicknick a minute or so before Khoury’s misfire—it’s clear the individuals responsible for discharging copious amounts of dangerous chemicals into the air on January 6 were police officers. (Khater is seen on open source video at 2:14 p.m. complaining that “they just sprayed me,” referring to police. And body camera footage from the D.C. Metro police officers who recorded the alleged attack remains under protective seal.)

The notion that a palm-sized container of pepper spray could disable three officers standing several feet away is simply not believable. Officer Caroline Edwards, one of the three officers Khater is accused of attacking, told the January 6 select committee that the spray she encountered was much stronger than what she endured during training. “I remember it hurting a lot more, which is saying something because the academy’s—our pepper spray is—well, it’s actually Sabre Red. It’s no joke. It literally feels like someone punched—just punched like two holes in your eye sockets. This felt like—it was just pain unimaginable.”

That wasn’t produced by anything allegedly sprayed by Trump supporters. Potent gas that caused dozens of officers to struggle to breathe, see, or stand—some reportedly vomited—was used needlessly by law enforcement itself against a crowd obeying police commands and respecting barriers at the time.

How many of the 140 or so officers reportedly injured on January 6 were hurt by the actions of their own colleagues?

Of course, these facts have surfaced too late to save Julian Khater, who will face the vengeful wrath of federal prosecutors and an octogenarian judge, all of whom consider January 6 an act of domestic terror. The New York Times will again escape accountability for publishing another flawed story about what happened to Brian Sicknick.

And the false narrative about Sicknick’s death will remain intact and leveraged for political purposes, evidence be damned—a recurring theme when it comes to anything about the events of January 6.

*  *  *

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Two weeks after the state of Texas filed a lawsuit to stop the Biden administration from ignoring a federal immigration law that prevents illegal immigrants from residing in the US if they’re likely to rely on taxpayer-funded programs, a group of 20 Republican-led states, spearheaded once again by Texas AG Ken Paxton – have sued the administration again.

This time, the 20 states and America First Legal, have claimed in the suit that the Department of Homeland Security effectively created a visa program without congressional approval by “announcing that it will permit up to 360,000 aliens annually from Cuba, Haiti, Nicaragua, and Venezuela to be ‘paroled’ into the United States for two years or longer and with eligibility for employment authorization.”

The lawsuit claims that DHS exceeded congressional limits on parole authority – and that the agency can only issue parole on a case-by-case basis. Moreover, the agency did not have the authority to authorize the program, and ignored the mandatory notice-and-comment rulemaking requirement detailed in the Administrative Procedure Act, Just the News reports.

Since President Joe Biden took office, more than 4 million illegal migrants have entered the United States, with a record 2.4 million doing so in fiscal year 2022 alone. The crisis shows no sign of abating, with roughly 216,000 migrants crossing the border in December 2022, an 11% increase over the November totals.

That surge was largely driven by an influx of Cuban and Nicaraguan migrants, which the Biden administration took to indicate that its parole program for Venezuelans was succeeding, given the decline of migrants from that country. Migrants from Cuba, Nicaragua and Haiti would benefit from the expanded parole process. -JTN

When the program was originally announced, President Biden claimed that the aim was to limit the number of uninvited arrivals on the southern border because migrants would be encouraged to obtain pre-approval for entry while still in their home country.

“We anticipate this action is going to substantially reduce the number of people attempting to cross our southwest border without going through a legal process,” said Biden.

Read the complaint below:

GOP state lawsuit on humani… by Adam Shaw

Authored by Tom Ozimek via The Epoch Times (emphasis ours),

Former socialite and convicted sex trafficker Ghislaine Maxwell told Britain’s Talk TV in a jailhouse interview that she believes her former associate and disgraced financier Jeffrey Epstein was murdered.

Epstein, who was facing multiple charges of sex trafficking of minors, was found dead in his cell at the Metropolitan Correctional Center (MCC) in New York City in August 2019.

His death was officially ruled as a suicide by hanging, but there has been widespread speculation about the cause. For instance, a forensic pathologist hired by Epstein’s brother said multiple fractures found in his neck were “very unusual in suicidal hangings” and more consistent with strangulation.

Maxwell, who is currently serving a 20-year sentence in a Florida prison for helping Epstein sexually abuse girls, told Talk TV that she believes Epstein’s death was no suicide.

“I believe that he was murdered,” Maxwell said in the Talk TV interview. “I was shocked. Then I wondered how it had happened because as far as I was concerned, he was going to … I was sure he was going to appeal.”

Many people have united in skepticism that Epstein could have taken his own life a mere month after being arrested on sex trafficking charges.

In particular, a number of people have pointed to Epstein’s connections to powerful individuals, some of whom may have been implicated in illicit activities with him and would have wanted to keep him quiet.

Maxwell said earlier that one of her fellow inmates was offered money to murder her and schemed to “strangle her in her sleep,” according to court papers filed last year by her lawyers ahead of her sentencing.

“This incident reflects the brutal reality that there are numerous prison inmates who would not hesitate to kill Ms. Maxwell—whether for money, fame, or simple ‘street cred,’” the lawyers wrote in the filing, suggesting someone may have wanted Maxwell dead badly enough to pay for it.

Maxwell was sentenced on June 28, 2022, to 20 years in prison for conspiring with Epstein to sexually abuse minors.

She is serving time at Florida’s low-security FCI Tallahassee prison.

Questions Unanswered

Questions have swirled about the circumstances surrounding Epstein’s death since he was found dead on Aug. 10, 2019, in his cell with a bedsheet around his neck.

Epstein’s death sparked outrage that such a high-profile prisoner could have gone unmonitored at a facility where such infamous inmates like Mexican drug lord Joaquin “El Chapo” Guzman and Wall Street swindler Bernie Madoff came and went without incident.

Epstein had been placed on suicide watch about a month before his death after he was found on his cell floor on July 23 with bruises on his neck. He was later taken off suicide watch and placed in a high-security housing unit where he was less closely monitored but still supposed to be checked on every half hour.

Two jail guards who were supposed to monitor Epstein were accused by prosecutors of falling asleep and surfing the internet that night rather than checking on him every 30 minutes.

The pair, Tova Noel and Michael Thomas, would later admit they “willfully and knowingly” falsified records to make it seem they were following the correct check-in protocols with regard to Epstein.

In January 2022, the criminal case against Noel and Thomas was dropped after they complied with the six-month deferred prosecution agreements they agreed to earlier, which included 100 hours of community service and cooperating with a Justice Department (DOJ) probe into Epstein’s death.

Medical Examiner: ‘The Cause Is Hanging’

Chief Medical Examiner Dr. Barbara Sampson ruled Epstein’s death a suicide by hanging. She said she made the determination “after careful review of all investigative information, including complete autopsy findings.”

Not long after Sampson ruled Epstein’s death a suicide, Epstein’s brother hired forensic pathologist Dr. Michael Baden, who was in the room for Epstein’s autopsy, to review the evidence.

Baden, who was New York City’s chief medical examiner in the 1970s, said at the time that the evidence suggested Epstein may have been murdered. He said that Epstein’s injuries were more consistent with those found in homicide victims and that he hadn’t seen the type of neck bone injuries that Epstein had in any suicides that he had investigated. Baden added, however, that his observations were not conclusive.

Some experts have said that, while uncommon, injuries to the hyoid bone that Epstein had do sometimes occur in suicidal hangings, more so in older people. Epstein was 66 at the time of his death.

After Baden issued his opinion, Sampson responded by saying that no conclusions should be drawn from a single piece of evidence or unusual injury.

“I stand firmly behind our determination of the cause and manner of death for Mr. Epstein,” she said in October 2019. “The cause is hanging, the manner is suicide.”

‘Serious Irregularities’

Then-Attorney General William Barr said at the time that there were “serious irregularities” at the Manhattan jail where Epstein died, vowing that the DOJ’s inspector general would “get to the bottom of what happened” and that there “will be accountability.” That investigation continues and no report has been released yet.

Following Barr’s remarks, then-House Judiciary Committee Chairman Rep. Jerry Nadler (D-N.Y.) and then-ranking member Rep. Doug Collins (R-Ga.) sent a letter to the Bureau of Prisons asking 23 questions about Epstein’s death. In the letter, they cited deficiencies in inmate protocol and requested information about the Bureau of Prisons’ suicide prevention policies, resources, and staffing.

A subsequent report (pdf) prepared by the Bureau of Prisons National Suicide Prevention Coordinator, Psychology Services Branch, Central Office, put forward a timeline of events and circumstances leading up to Epstein’s death.

The report stated that a facilities assistant described Epstein as “distraught, sad, and a little confused” when he arrived at the correctional facility on July 6, 2019.

The assistant was cited in the report as saying that, even though Epstein said he felt fine, she wasn’t convinced and wrote that he seemed “dazed and withdrawn” and advised in an email that someone from Psychology should talk to him to “just be on the safe side and prevent any suicidal thoughts.”

Following a court proceeding on July 8, Epstein denied having any suicidal thoughts but due to risk factors was put on psychological observation, a protocol that is less restrictive than suicide watch. The report says he was taken off psychological observation several days later.

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