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Editorials from around Pennsylvania

September 19, 2018

Editorials from around Pennsylvania:

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CLOSE EMS REIMBURSEMENT LOOPHOLE, Sept. 18

When the call for help comes in, emergency medical services organizations respond. They rush their expertise and expensive, high-tech equipment to the scene, where they assess and treat the patient in need.

In some cases, the patient does not need or declines transport to the hospital. And when that happens, nothing requires insurers to foot the bill for the care EMS service providers rendered in these so-called “no-transport” calls. EmergyCare, a regional nonprofit ambulance service serving seven counties, including Erie, has estimated about 1,330 trips end this way each year, costing the agency about $200,000 a year.

That is wrong.

It is wrong in principle — people should get paid for the work they do. But the harm is compounded when you consider the importance of emergency medical care and the ongoing financial and staffing challenges those who provide it face.

The struggles of the region’s emergency response safety net, especially the shrinking ranks of volunteer fire companies, have been well-documented. Other agencies have had to shoulder the burden and do so under a reimbursement system that makes the service increasingly infeasible.

EmergyCare executive director Bill Hagerty said inadequate reimbursements limit what the agency can pay its skilled emergency medical technicians and paramedics. At $11 to $13 dollars an hour, it is on par with service industry wages, he said. The turnover rate is high and EmergyCare is now about 20 people short. As a result, Hagerty and other administrators sometimes answer calls.

Meadville Area Ambulance now covers Cambridge Springs and Cochranton, owner Eric Henry told reporter David Bruce. The agency has not only had to cover a larger territory, but has lost a precious recruiting pool — emergency medical technicians and paramedics who got their start in volunteer fire companies, he said.

Some relief is promised in January, when Medicaid reimbursements paid for EMS services are scheduled to increase by 50 percent. But even with that healthy bump, the cost of responding to Medicaid patients’ calls will still exceed the reimbursement rate, Hagerty said.

Key bills requiring insurers to pay for EMS services delivered during no-transport calls have been passed in both the state House and Senate and now sit in committees. These reimbursements won’t solve everything, but they will help.

It is time to move this legislation forward. Insurance industry advocates have expressed openness to it. As one EMS executive told the Centre Daily Times, EMS workers spare the health care systems’ expense by sorting out who needs emergency room care. That should be worth something.

EMS workers serve on the front lines of the state’s addiction crisis. They render aid at traffic accidents and medical emergencies in our homes. Don’t let their call for help go unanswered.

__ Erie Times News

__ Online: https://bit.ly/2O1N6CV

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FARMERS FACE CHALLENGES, REMAIN CRUCIAL TO ECONOMY, LOCAL LIVING, Sept. 14

Agriculture remains Pennsylvania’s leading industry and an important financial and cultural factor here in the Laurel Highlands region.

And farming is an industry undergoing multiple changes driven by market factors and advancing technology.

But — as was noted by Tommy Nagle Jr., who runs a cattle farm near Patton, and Scott Farabaugh, who has Nicktown’s Blue Goose Farm — agriculture remains a lifestyle more than a job, even as those providing food for local residents find themselves tracking the shifting winds of science, politics and economics.

This evolving business sector faces many challenges and threats, but remains a pursuit that we must all cherish and strive to better understand.

“I make the joke that the best part of my job is I wake up and I’m at work, and the worst part of my job is I wake up and I’m at work,” Farabaugh told reporter Dave Sutor for the Sept. 2-3 report we called “Harvesting Change.”

“Obviously, you can get good and bad in all of that,” he said. ”. It’s a lifestyle. It’s not 9 to 5 and you’re done.”

A report earlier this year from the Pennsylvania Department of Agriculture and Team Pennsylvania — titled “Pennsylvania Agriculture: A Look at The Economic Impact and Future Trends” — charted agriculture’s crucial place in the statewide marketplace:

— Directly supporting 280,500 jobs.

— Providing $10.9 billion in annual earnings.

— Generating $83.8 billion in business each year.

— Accounting for whopping 18 percent of the Pennsylvania’s gross state product.

“That’s not a number that we had before,” Secretary of Agriculture Russell Redding said.

“There was a lot of speculation that it was important, but we didn’t know the number.

“And then two is, we had a chance to really look at some of the recommendations.”

The report noted the industry’s ...

— strengths, such as crop diversity, small farms and university partnerships; and ...

— weaknesses, such as an aging workforce, overwhelmed processors, difficulty in capitalizing on specific consumer demands.

The report also noted threats to farming in Pennsylvania, such as transportation and technological infrastructure and federal trade policies.

Naugle is president of the Cambria County Farm Bureau, which represents its 800 members in meetings with state and federal lawmakers.

Organizations such as 4-H continue to promote the farming way of life as healthy, meaningful and important to local communities.

In the past months, budding agriculturalists displayed produce and livestock at the Somerset and Cambria fairs through 4-H — which also links young people with skills associated with STEM (science, technology, engineering and math), which are crucial to the modern farming industry.

And agriculture now includes areas such as the making of local beers and wines, even the cultivating of wild mushrooms.

Fairs and other ag-related events also serve as a reminder of the value of the work and products generated by our farmers.

In 2012, the most recent federal Census of Agriculture showed 1,210 operations in Bedford County, 1,140 in Somerset and 551 in Cambria, Sutor reported. Farms in the three counties had a shared market value of more than $250 million.

The fate of our farms is tied directly to the future of businesses that sell seed, produce tractors and other supplies, and transport those goods to market.

We urge Congress to finalize and pass a new Farm Bill, to support struggling dairy farmers, provide insurance against crop damage, and bolster other areas of concern, from land conservation to commodities pricing. The current bill expires at the end of September.

And we urge readers to take time to reconnect with farming, to strive to build an understanding of all that goes into making sure there’s meat, milk and fresh fruits and vegetables at your local store or farmers market.

“I think as society evolves and becomes less involved with agriculture,” Nagle said, “they kind of lose the concept of what it takes to actually produce food in America.”

That lack of awareness might be the biggest threat to agriculture.

The next time you reach for the refrigerator door, pause to think about the many hard-working and dedicated individuals whose labors provided the contents of that appliance.

__ The Tribune-Democrat

__ Online: https://bit.ly/2xmVuTV

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COLLEGES NEED TO CLARIFY JUST HOW MUCH TUITION REALLY COSTS, Sept. 18

The bottom line isn’t going to change much for Elizabethtown College students. Their tuition bills will be lower, but their financial aid awards will be cut.

Essentially they’ll be paying as much as ever: a net price of about $29,000, according to the latest data from the National Center for Education Statistics.

Stating this reality is not to dismiss the value of what Elizabethtown is doing. We believe that more of this kind of transparency needs to be injected into college tuition pricing.

Figuring out the actual cost of a particular college requires honors-level mathematical skills. This makes the process of choosing colleges incredibly confusing.

On paper, a state or state-related university likely appears to be the best deal. But public universities tend to give less financial aid.

Meanwhile, private colleges, especially those with large endowments, can dispense sizable aid packages to many incoming students. (That has been the case at Elizabethtown, where 98 percent of undergraduate students currently receive some type of aid; the average award is around $25,000.)

Many colleges send financial aid award letters at the same time as acceptance letters. But not all do. So your child — and you — may be in limbo for a while, wondering if the college your child wants to attend is even a realistic possibility.

It’s kind of like a game in which nearly everyone is sure to get a prize, but you can’t start packing for that trip you’ve won until you know if it’s going to be to New Jersey or Europe.

It would be a much more straightforward process if colleges stated — as Elizabethtown intends to do — what their real price tags are.

Even when a college has an easy-to-use net price calculator — an online tool that figures out for a prospective student how much financial aid may be awarded, based on family income and assets (along with a mix of other factors) — that’s just an estimate.

And it’s hard for parents and their kids to make the life-altering — and expensive — choice of which college to attend based on guesses and estimates.

There’s another problem with the “high-tuition, high-discount” model used by so many private colleges.

Financial aid isn’t always stable over four years — not all scholarships and grants are renewable, and some are renewed only if certain criteria (including grade point average) are met.

So while the cost of freshman-year tuition may seem like a relative bargain, your aid may diminish in subsequent years. If this is going to be the case, it’s best to know it upfront — rather than to accrue debt later that you didn’t anticipate.

New America, a nonpartisan think tank in Washington, D.C., and uAspire, a nonprofit focused on college affordability, analyzed more than 11,000 financial aid award letters from colleges. Their findings? Not only was financial aid “insufficient to cover the cost of college for many students,” the award letters lacked “consistency and transparency. As a result, it is exceedingly difficult for students and families to make a financially informed college decision.”

The varying ways in which many of these letters missed the mark:

— They contained bewildering jargon and terminology (there’s a significant difference, for instance, between a subsidized and unsubsidized loan).

— They omitted complete costs that would have contextualized the financial aid being offered.

— They failed to differentiate types of aid.

— They misleadingly characterized Parent PLUS loans as awards, “making the financial aid package appear far more generous than it really was.”

— They only vaguely defined work-study.

— They offered inconsistent bottom-line calculations. “In our sample, only 40 percent calculated what students would need to pay, and those 194 institutions had 23 different ways of calculating remaining costs,” stated the analysis, which was released in June.

These nonprofits want federal policymakers to conduct “consumer testing, and then set and require award letter standards via federal mandate.”

This seems like a reasonable recommendation to us. Anything to improve transparency — as Elizabethtown is seeking to do — would help.

Because the process could not be any murkier than it is now.

Tuition and room and board aren’t the only costs of college. Textbooks are another major expense, costing an average of $1,250 last year, according to the College Board, as LNP staff writer Jennifer Kopf reported in this week’s Sunday LNP.

Kopf wrote an article for the Living section about how students can save money by buying used textbooks, seeking e-books when possible, and renting books.

These are all sound suggestions. To them, we’d add another, and it’s aimed at college professors: Think carefully about requiring specific editions of well-known tomes.

If a family has several copies of Shakespeare’s “Macbeth” at home, but you require a specific edition, make sure it’s for a good reason — and explain it on the syllabus. Otherwise, parents may suspect you’re in cahoots with a publishing company to jack up book sales.

__ LNP

__ Online: https://bit.ly/2PRXKcB

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LET CITIES TRY SAFE INJECTION SITES, Sept. 18

In response to the heroin addiction epidemic some cities have considered something referred to as a “supervised injection facility.”

Addicts would be allowed to inject heroin in their veins in a facility where clean needles would be provided and where they would be able to become known to people who might help treat their addiction. Medical professionals would be on hand, able to reverse an overdose.

It’s a drastic solution, and not likely one that would appeal to smaller cities and communities, no matter how bad the opioid addiction threat becomes.

But it is being considered in big cities, among them Philadelphia.

And rather than taking a wait-and-see approach, the U.S. Department of Justice has responded with a heavy hand.

Deputy Attorney General Rod Rosenstein last month warned that cities that create medically-supervised drug injection will face swift and aggressive legal action. As Mr. Rosenstein pointed out, possession of heroin is illegal.

In an interview with National Public Radio, Mr. Rosenstein said providing a place for people to use heroin and other illegal substances is a violation of federal law.

But more than 72,000 Americans died from overdoses last year, exceeding any one-year death total during the AIDS crisis. And safe-injection facilities have been proven to reduce harm among heroin users — though there is no evidence of a dramatic reduction.

In a safe-injection facility, the medical community has a chance to intervene with at-risk populations, such as people who are HIV positive. The American Medical Association has endorsed launching supervised injection site pilot programs.

Congress should consider legislation that would allow supervised injection sites, on a pilot basis. In the meantime, the Justice Department should work with states that want to try them.

The potential benefit outweighs the harm.

__ The Pittsburgh Post-Gazette

__ Online: https://bit.ly/2PPkLwy

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STATE’S WISE CENSUS MOVE, Sept. 16

Hardly anyone, including the federal government itself, has confidence in the constitutionally mandated decennial census that will take place in 2020.

The census’ problems are financial, political and scientific.

The Trump administration wants to include, for the first time, a question on each respondent’s citizenship status, even though the purpose of the census is to count residents where they live rather than to assess the citizenship of residents. That question will ensure that many more people will not respond the census, automatically skewing the results to harm urban areas where most non-citizens live.

Also, claiming that online responses will reduce the project’s cost, the administration significantly has reduced census funding. Its calculations do not account for the higher security that is needed for online systems, however.

Last week the Government Accountability Office reported that the census systems are behind schedule, under-staffed and over-budget, and that the online operation is highly vulnerable to cyberattacks and technical problems.

Meanwhile, the need for an accurate census cannot be overstated. It guides the distribution of billions of dollars in federal funds, and businesses rely on the data for a host of decisions.

As noted by the Pennsylvania Health Access Network, census data underlie the Federal Medical Assistance Percentage, which in turn steers allocation of money for federal health care programs — $286.1 billion in 2015. That year, Pennsylvania received $12.1 billion of that funding. According to a study by the George Washington University Institute of Public Policy, Pennsylvania would have lost $221.8 million if the 2010 census had been off by just 1 percent.

Given the high stakes and problems at the federal level, Gov. Tom Wolf is on the mark in creating the Census 2020 Complete Count Commission, which will recommend ways to ensure that the Pennsylvania count is accurate. The effort will include public education, recommendations on reaching hard-to-count communities and cooperation among local governments.

The administration deserves credit for trying to ensure that Pennsylvania will be ready for the crucial census, regardless of the degree to which the federal government is ready.

__ The Times-Tribune

__ Online: https://bit.ly/2ODzFWu

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