A wearable solution which helps to identify certain health risks early on thereby enabling people to maintain their independence for longer, has been certified as an official medical device after conforming to EU standards.

Developed by HAS Technology with support from Edinburgh Napier University and Scotlands Digital Health and Care Institute (DHI), ARMED empowers users with access to data allowing for better self-management, whilst healthcare professionals can be quickly alerted to potential issues.

Combining predictive analytics with wearable technology and health and social care data, ARMED can identify risks, such as a fall, by using this information to create a risk profile. As a certified medical device, in accordance with the Medical Device Directive (MDD), ARMED can now be used in clinical settings.

The ARMED clinical evaluation stated that a proactive approach to falls is considered crucial and significant reductions in falls have been observed in trials when a risk of falling is identified, and the risk is managed. It also highlighted that evaluations to date have identified clinical trends in patient groups including dehydration, weight loss, restlessness nocturnally, muscle wasting and reduced grip strength, all of which can be monitored by ARMED.

Brian Brown, director of ARMED at HAS Technology, said: We are delighted that ARMED has received certification as a medical device. Technology has a huge role to play moving forward and with so much evidence to support the benefits of early detection, this places ARMED in a much more credible position, especially within NHS spheres, to help make a real difference.

This process can usually take up to nine months but, with the herculean effort of my colleagues, we reduced that timescale by several months. I would like to take the time to thank them all for their hard work and dedication to getting this done.

Dr Kes Khaliq, clinical director of DigiTEC Innovation, who supported the team through the process and signed off on the 52-page clinical evaluation report, added: I am pleased to have helped support the ARMED team during this process, receiving this end result. ARMED has been shown to have a huge impact for users, identifying potential issues at an early stage - up to 32 days in advance - thereby looking after the patient and also relieving pressure on already strained services. It is great that its benefits have been officially recognised.

See the article here:
Risk assessment wearable officially classed as medical device - Med-Tech Innovation

This afternoon we received the news that our sweet Sophie in Hamburg had been snatched away by influenza, snatched away in the midst of glowing health, from a full and active life as a competent mother and loving wife, all in four or five days, as though she had never existed.

It is a distant voice that echoes our reality. It brings us face to face with our vulnerability and the terrifying possibility of losing loved ones. These are the words that Sigmund Freud wrote to Pastor Oskar Pfister in a letter dated 27 January 1920 to tell him that the so-called Spanish flu had snatched his daughter away from him.

Sophie was Freud's fifth daughter and probably his favourite. She softened her father's autocratic character and as she grew up, she evoked feelings of admiration in him, according to his biographers.

At the age of 20, Sophie Freud married Max Halberstadt, a photographer from Hamburg. Nevertheless, despite the distance, she always maintained an intense correspondence with her father, who kept up with his daughter's joys and sorrows.

Sophie had two boys, but a third seemingly unwanted pregnancy weakened her and paved the way for the virus that was sweeping across Europe to take hold of her. She died on 25 January 1920, at the age of 26.

Her death was a severe blow to the father of psychoanalysis, who came to recognise that although he had mentally prepared himself for the death of his sons, who had all been drafted for the Great War, he was not prepared for his daughter to be snatched away.

Losing a loved one is always painful, but losing them suddenly is even more so because, as Seneca said centuries before: what is quite unlooked for is more crushing in its effect, and unexpectedness adds to the weight of a disaster.

The unexpected is exactly what is dealing us the greatest blow in this crisis. What has left us with nothing to hold onto. With no cardinal directions to guide us. Many people have seen their relatives get sick quickly and leave them in a matter of hours.

These unexpected deaths make everything seem like a nightmare. We live through them with a sense of unreality that clears up at times, when the pain breaks through. Sudden losses make it difficult for us to accept that the person is no longer with us. They make it even more difficult for us, if such a thing were possible.

Although we had been worried about her for a couple of days, we had nevertheless been hopeful; it is so difficult to judge from a distance. And that distance had to remain distance; we were not able to travel immediately, as we had intended, after the first alarming news; because there were no trains, not even for an emergency. The clear brutality of our time is weighing heavily upon us. Tomorrow she will be cremated.

Freuds words are a very distant mirror, but they perfectly reflect the pain of many people who saw their loved ones disappear behind the doors of an intensive care unit or an ambulance on its way to the hospital and who were not given the chance to hug them or hold their hand again during their final moments.

Not having a chance to say goodbye causes great anguish that in the long term can lead to feelings of guilt. We start blaming ourselves for what happened in an attempt to make sense of a sudden death that we find difficult to accept and understand, while the world around us becomes increasingly confusing, chaotic and alienating.

This is why Freuds story is also the story of those who have had to accept something that until recently had been unthinkable: that someone could die without their loved ones by their side to accompany them on their final journey. That their funeral would be brief, silent and deserted. With only three people to fill the emotional vacuum and 10 minutes to say goodbye to an entire life.

The fact is that coronavirus, just like the Spanish flu, can take away not only our loved ones but also something as essential as saying goodbye and supportive hugs, which we may receive too late or which will not be strong enough to break through the screens from behind which we try to send them.

We must not forget that the funeral ritual fulfills very important psychological functions. It helps us become aware of our loss so that we can start the mourning process. It also gives us the chance to receive the love and support of others to confirm that, although we have lost someone, we still have others by our side. And lastly, it fills that deep-seated need to know that the body of the person we love has been treated and sent off with dignity. When both the person and the farewell ritual are taken away from us, we experience a double loss. Double the pain. And double the anger.

Story continues

Sigmund Freud and his daughter Anna Freud pictured in 1920. (Wikipedia)

At first, Freud was devastated. He wrote to the husband of his deceased daughter that it was a senseless and brutal stroke of fate," stating that they could only bow their heads under the blow like the poor, helpless creatures we are, mere playthings for the higher powers.

His words give a glimpse of that initial period of mourning when we resist accepting the loss and feel immense anger because something extremely valuable that we would have always liked to have with us has been taken away from us. Freud, too, wavered between the need to accept a painful reality and the desire to reject it, precisely because it was too painful.

He took refuge in his work. His work was his salvation and he acknowledged: I do as much work as I can, and I am grateful for the distraction [...] as for mourning, that will no doubt come later."

Freud, who had always been very attached to his routines, found in them a comfort and a way to escape the pain that gripped him, even if only for a few hours a day. Finding comforting routines to keep our minds occupied will help us cope with loss and give our unconscious time to process what has happened.

It is no coincidence that it was during this period that Freud published the book that would mark a turning point in his theory: Beyond the Pleasure Principle. It is likely that he took advantage of the chaos that surrounded him to reflect on the human essence, later manifesting it in his work.

The deaths from the Great War, the rampage of the Spanish flu in Vienna, and even the death of his own daughter must have left a very strong impression that led him to restructure the model of the psyche that he had proposed and to which he had made every effort to include Thanatos, or the death instinct. Some critics have said that this book was his most confusing work, albeit his most intimate.

In a way, writing about death seems to become a way of regaining control after the disrupting experience of death, of reassuring continuity in the face of discontinuity, of mastering the absence, suggested Elisabeth Bronfen. Freud found a way to channel those losses, the chaos and suffering of the world around him. And that helped him move forward.

Little by little, in time, acceptance also came. Nine years later, Freud sent a letter to Ludwig Binswanger in which he wrote: "My daughter who died would have been thirty-six today [...] We know that the acute sorrow we feel after such a loss will run its course, but also that we will remain inconsolable, and will never find a substitute. No matter what may come to take its place, even should it fill that place completely, it yet remains something else. And that is how it should be. It is the only way of perpetuating a love that we do not want to abandon.

Freud always wore a tiny locket with a photo of his daughter inside it, and he looked at it every so often. Nothing could take her place. He knew it and so do we. We know that the arrival of another person will never take the place of the one who has left us. And thats the way it should be.

But we should also be aware that mourning will be softened and transformed into nostalgia. With the passage of time, whenever we remember the person who is no longer there, their memory will no longer evoke pain but instead a bittersweet feeling that can even be comforting for us.

Freuds story drives home the fact that no matter how great the pain we feel today, acceptance and consolation will come in the end, with the reassurance of knowing that, although a loved one may have been taken from us, nothing can take away the moments we have shared together. And that is what we must hold onto.

More:
When Freud lost his daughter to the Spanish flu: a story that connects the past to coronavirus - Yahoo Sports

Once upon a time, Nigeria discovered oil. Soon enough, it became our main source of livelihood, the foundation upon which our national budget rests, and the one commodity that provides most of our forex inflows. To be able to extract value from this oil, we created refineries all of which are government-owned and managed. Sadly, the rest of the story includes heavy bouts of politicking, lots of bloodshed, corruption, explosions, and billions of Naira in losses. Oil might have been one of Nigerias biggest blessings, but it also undoubtedly doubles as its biggest curse.

On Monday, the Nigerian National Petroleum Company (NNPC) released its audited financial statements for 2018, noting that its refineries recorded losses of N154 billion. As embarrassing and disappointing as it sounds, it is not as surprising. The nations 3refineries located in Port Harcourt, Warri, & Kaduna, reported combined losses of N154 billion. Kaduna Refining and Petrochemical Company (KRPC) incurred a loss of N64.5 billion, Port Harcourt Refining Company (PHRC) recorded a loss of N45.6 billion, while Warri Refining and Petrochemical Company (WRPC) recorded a loss of N44.4 billion. The losses also arent new as all refineries performed better than the preceding year 2017. The only thing more confounding than the billions in losses is the convenience with which Kaduna refinery conveniently recorded zero revenue for 2018.

Many issues feed into the wreckage that has become Nigerias refineriesand most of these issues date as far back as decades prior tonowwith the last of the nationsrefineries built40 years ago. For a recap, heres an overview of some of the problems that have led us this far.

As far back as the 1970s, Nigeria, Norway, and Malaysia set up national oil companies for the exploration, production, and refining of oil. So when Norway came up with Statoil (now Equinor) and Malaysia, Petronas, Nigeria created NNPC. Today, while Malaysia and Norway boast of having the biggest state-owned oil and gas companies in the world, NNPC has a long list of excuses and mind-boggling losses to show for it. While PH and Warri and in oil-producing states, Kaduna does not produce any oil. For the sake of balance and to have a national spread, some of the crudes are moved to Kaduna via pipeline. Hold that thought.

(READ MORE:NNPC GMD gives reasons for shutdown of refineries, to get private managers)

The capacity of all three refineries is also insignificant, compared to the required consumption of the nation. Hence, most of our oil is still imported because we cannot produce enough. This rate of importation is over80%of our consumption.The existing refineriesalsooperatesignificantlybelowcapacity.Sometime last year, the refineries operated as lowas 5.55 percent capacity.Toincreasecapacity,the country carriesout turnaround maintenanceperiodicallyandnot only does it cost an arm and a leg, it takes months but barely anything ever changes. Production stays low and cost stays high.Even if we turn all 3 around successfully, wehave shown that we areincapable of increasingtheir capacity. Essentially, Nigerians will stillneed to import.Other factors contributing to the losses arespillages, explosions, and theft.

Yet in the midst of this, salaries and employee benefits are huge.KRPC, WRPC, and PHRC reported 13.8 billion, 13.8 billion, and 9.2 billion in employee wages and salaries, excluding directors remuneration, staff pension and other benefits. Given the inefficiency of the operations of the refineries, theonly thingthat could have been doneasides creating better refineries is to have an overhaul of the entire thing and shut down the refineries. But thats a different problem.

The first thing youll learn about oil in Nigeria is that everybody wants it. All of our refineries were built in the Military regime as far back as that. Given the failure of the refineries, the first attempt to sell them off was made by former president Olusegun Obasanjo. When Umaru Yar Adua became president, he reversed it citing that the process lacked transparency. The fears of the unions in the oil and gas sector was also palpable as they saw the sale of the refineries as a ploy by the government to award the deal to its cronies. In November 2012, former President Goodluck Jonathan also recommended that the refineries be sold as a result of inadequate finance and under-performance, but they still remained. It didnt take long before more issues emerged.

With developments going on in non-oil producing northern parts of the world like the States capital and barely any developments in the south, Niger Delta Militants sprung up and swore to wreak havoc on the entire nation. Also worthy of note is that today, President Buhari still remains the minister of petroleum.

(READ MORE:260 Nigerians set to be evacuated from India FG)

One of the most confounding things is the fuel subsidy saga.With the costof import landed costhigh, the government had thought it a great idea to subsidizefuelfor the average Nigerian.Forget the question of whether we should be paying subsidies or not, how much in subsidies is the government really paying?Subsidies are based onthe volume of petroleumconsumed,butone unconfirmed information is how the subsidy is being calculated.Eventoday, NNPC and PPRA cannot agree on the volume of petrolbeing consumed daily in Nigeria.

IfDPR saysNigeria isconsumingaround38millionlitres in a day and NNPCsuggests thatthe countrys daily petrol consumptionis around50 60million litres, it means thereare significantdiscrepancies. As it is, no one knows how much subsidies Nigeria is actually paying every day and where the money is going to if were not actually consumingasmuch.

Of the series of challenges therefiningspaceis plaguedwithfromtheft of petroleum products,topoor maintenance andaseriesofoperational challenges, corruption ranks tops and it isnt news.Corruption in the downstream sectorwasalsoexposed during the subsidy probe. It revealed thatsome of the companies that took money for subsidydid not even importrefined productsat all. With marketers preferring toimport,our refineriesstay dormant. The funds used in Turn Around maintenance (TAM) annuallyalsodoes notalsocontribute to any meaningfuland could also be another avenue for exploiting the industry.

While Nigerians sit and watch the decay in the system fester, one billionaire is on course to provide an alternativethat both the government and the private sector are basing all their hopes and dreams.AlikoDangotes650,000 barrels a day refinery which is set to beoneof theworldslargest,is due to start operations inless thana years time.Even as we hope that the refinery brings somesanityto the modus operandi andreverse the decades-oldrot in the system, it too isnt bereft of flaws.Yet, it is the only foreseeable hope we have to put an end to the joke that is our refining system and commence the process of recovery.

See the original post:
Analysis: NNPC and its refining losses - Nairametrics

The coronavirus pandemic and the economic fallout that has come with it boosted health insurance enrollment counselor Mark Van Arnams workload. But he wants to be even busier.

The loss of employment for 21 million Americans is a double blow for many because it also means the loss of insurance, said Van Arnam, director of the North Carolina Navigator Consortium, a group of organizations that offer free help to state residents enrolling in insurance.

Calls to the consortium have increased sharply, but he believes many more people are going without insurance and could use his help. He suspects these newly unemployed people dont realize they have options. Years of budget cuts by the federal government have hampered outreach from nonprofit groups like the consortium, so many consumers dont understand that policies are available to help them regain or maintain health coverage.

Large numbers of folks arent getting the message, said Van Arnam.

Some newly unemployed people are taking advantage of special enrollment periods to sign up for plans offered on the Affordable Care Acts insurance marketplaces, while others find they qualify for Medicaid. Some might have the option to stay on their former employers plan, even while bearing the full cost themselves.

But the clock is ticking for some of these options.

A Special Enrollment Period For You

The ACA is a critical backstop for many of the newly unemployed.

Under the federal health law, people who experience certain life events such as moving, getting married, having a baby or, in this case, losing your job and job-based coverage qualify for a special enrollment period. They can sign up for new coverage without waiting for the open enrollment period, which generally occurs near the end of each calendar year.

Applicants must submit certain documents to prove they qualify for special enrollment, such as proof of prior job-based coverage. The Obama administration in 2016 began random checks of these documents and the Trump administration stepped up that scrutiny in response to insurers concerns that some people were gaming the system with special enrollments, waiting to sign up until they were sick, thus driving up health spending. The claim was controversial, with little evidence presented on how prevalent a problem it was.

Because of COVID-19, some navigators report, these requirements have been loosened. Specifically, the Trump administration appears to have cut back on preapproval documentation checks perhaps a nod to the difficulty of obtaining the necessary paperwork from employers since so many offices are operating remotely.

Even in good times, employees almost always need help from their HR department to identify what they needed to provide, said Deepak Madala, program manager for Enroll Virginia, a nonprofit that helps people sign up.

The administration has, reportedly, stayed vigilant in its document requirements regarding the immigration status of applicants. Undocumented immigrants are not eligible to enroll in ACA plans, Medicare, Medicaid or the Childrens Health Insurance Program.

Time Is Of The Essence

Its important to remember, too, that the clock is ticking. In general, people have 60 days after they lose their job-based insurance to use that as a reason to qualify under an ACA special enrollment period.

Those in the first tranche of layoffs would need to act quickly to get into the marketplace, said Tara Straw, a senior policy analyst with the Center on Budget and Policy Priorities.

Its also important to watch the calendar if you live in a state that runs its own marketplace and opened it for a special enrollment period because of the coronavirus outbreak. Some windows of opportunity have now closed, but in Maryland and Vermont, the deadline is June 15. Special enrollment in California is scheduled to remain open until at least June 30 and in the District of Columbia until Sept. 15.

There is no national tally of how many people have signed up for ACA coverage since January, as the federal marketplace does not release statistics. However, some states do. In California, the largest market, more than 125,000 have enrolled, more than two times the typical special enrollment rate. Smaller numbers are seen in other states.

Finally, an option few may be aware of: People who otherwise qualified for a special enrollment say, by losing job-based insurance but failed to sign up within the 60-day window because they were affected by the COVID-19 emergency perhaps they were sick or were caring for someone who was ill might qualify for additional time, according to the federal governments website, healthcare.gov. This is similar to what the government has done in cases of natural disasters, such as hurricanes.

If seeking this special enrollment, applicants may need to ask for a supervisor when calling healthcare.gov, said Straw, as front-line staff may not be as well versed in the exception.

Other Avenues

The best bet for some applicants is Medicaid, said Straw.

Thats because this joint federal-state health program doesnt require a special enrollment period. Applicants can seek to enroll at any time during the year and eligibility is based on income and other qualifying factors.

Generally, Medicaid and the Childrens Health Insurance Program cover families with children, pregnant women, older adults and people with disabilities. Income eligibility varies by state. Maximum income levels vary and can be restrictive in some states, but applicants should know that the additional $600 weekly in unemployment benefits Congress approved in the CARES Act does not count toward that total (although it does for ACA plans).

Another complication: Fourteen states have not expanded their Medicaid programs under the ACA, and another, Nebraska, has enacted, but not implemented, an expansion. In those states, some people, especially adults below the poverty line with no dependent children, might not be eligible for Medicaid coverage at all. This creates a catch-22: They dont earn enough to get them over the poverty line, but they dont qualify for a subsidized ACA plan, either. These people are caught in what is called the coverage gap.

Still some good news some adults in that gap might be lifted out of it by the additional $600-a-week payment for unemployment.

The vast majority of people we see are getting coverage and reach 100% of the federal poverty level with unemployment benefits and year-to-date income, said Van Arnam in North Carolina, one of the states that have not expanded Medicaid. They are usually able to get an ACA plan with a zero or low premium, which is a big weight off their shoulders.

Staying on a former employers plan, through a law commonly known as COBRA, is also an option for some. The deadline to enroll in this has been extended until 60 days after the national COVID emergency ends, although people who wait to enroll are still liable for past premiums dating back to when they lost their coverage.

And those could be substantial. In COBRA, employees must pay the full cost of the premium although some employers are sharing that cost during the pandemic and Congress may consider a full or partial subsidy in upcoming legislation.

2020 Kaiser Health News

Visit Kaiser Health News at http://www.khn.org

Distributed by Tribune Content Agency, LLC.

PHOTO (for help with images, contact 312-222-4194):

Read more:
If you've lost your health plan in the COVID crisis, you've got options - yoursun.com

The coronavirus pandemic and the economic fallout that has come with it boosted health insurance enrollment counselor Mark Van Arnams workload. But he wants to be even busier.

The loss of employment for 21 million Americans is a double blow for many because it also means the loss of insurance, said Van Arnam, director of the North Carolina Navigator Consortium, a group of organizations that offer free help to state residents enrolling in insurance.

Calls to the consortium have increased sharply, but he believes many more people are going without insurance and could use his help. He suspects these newly unemployed people dont realize they have options. Years of budget cuts by the federal government have hampered outreach from nonprofit groups like the consortium, so many consumers dont understand that policies are available to help them regain or maintain health coverage.

Large numbers of folks arent getting the message, said Van Arnam.

[khn_slabs slabs=799584 view=inline /]

Some newly unemployed people are taking advantage of special enrollment periods to sign up for plans offered on the Affordable Care Acts insurance marketplaces, while others find they qualify for Medicaid. Some might have the option to stay on their former employers plan, even while bearing the full cost themselves.

But the clock is ticking for some of these options.

A Special Enrollment Period For You

The ACA is a critical backstop for many of the newly unemployed.

Under the federal health law, people who experience certain life events such as moving, getting married, having a baby or, in this case, losing your job and job-based coverage qualify for a special enrollment period. They can sign up for new coverage without waiting for the open enrollment period, which generally occurs near the end of each calendar year.

Applicants must submit certain documents to prove they qualify for special enrollment, such as proof of prior job-based coverage. The Obama administration in 2016 began random checks of these documents and the Trump administration stepped up that scrutiny in response to insurers concerns that some people were gaming the system with special enrollments, waiting to sign up until they were sick, thus driving up health spending. The claim was controversial, with little evidence presented on how prevalent a problem it was.

Because of COVID-19, some navigators report, these requirements have been loosened. Specifically, the Trump administration appears to have cut back on preapproval documentation checks perhaps a nod to the difficulty of obtaining the necessary paperwork from employers since so many offices are operating remotely.

Even in good times, employees almost always need help from their HR department to identify what they needed to provide, said Deepak Madala, program manager for Enroll Virginia, a nonprofit that helps people sign up.

The administration has, reportedly, stayed vigilant in its document requirements regarding the immigration status of applicants. Undocumented immigrants are not eligible to enroll in ACA plans, Medicare, Medicaid or the Childrens Health Insurance Program.

Time Is Of The Essence

Its important to remember, too, that the clock is ticking. In general, people have 60 days after they lose their job-based insurance to use that as a reason to qualify under an ACA special enrollment period.

Those in the first tranche of layoffs would need to act quickly to get into the marketplace, said Tara Straw, a senior policy analyst with the Center on Budget and Policy Priorities.

Its also important to watch the calendar if you live in a state that runs its own marketplace and opened it for a special enrollment period because of the coronavirus outbreak. Some windows of opportunity have now closed, but in Maryland and Vermont, the deadline is June 15. Special enrollment in California is scheduled to remain open until at least June 30 and in the District of Columbia until Sept. 15.

There is no national tally of how many people have signed up for ACA coverage since January, as the federal marketplace does not release statistics. However, some states do. In California, the largest market, more than 125,000 have enrolled, more than two times the typical special enrollment rate. Smaller numbers are seen in other states.

Finally, an option few may be aware of: People who otherwise qualified for a special enrollment say, by losing job-based insurance but failed to sign up within the 60-day window because they were affected by the COVID-19 emergency perhaps they were sick or were caring for someone who was ill might qualify for additional time, according to the federal governments website, healthcare.gov. This is similar to what the government has done in cases of natural disasters, such as hurricanes.

If seeking this special enrollment, applicants may need to ask for a supervisor when calling healthcare.gov, said Straw, as front-line staff may not be as well versed in the exception.

Other Avenues

The best bet for some applicants is Medicaid, said Straw.

Thats because this joint federal-state health program doesnt require a special enrollment period. Applicants can seek to enroll at any time during the year and eligibility is based on income and other qualifying factors.

Generally, Medicaid and the Childrens Health Insurance Program cover families with children, pregnant women, older adults and people with disabilities. Income eligibility varies by state. Maximum income levels vary and can be restrictive in some states, but applicants should know that the additional $600 weekly in unemployment benefits Congress approved in the CARES Act does not count toward that total (although it does for ACA plans).

Another complication: Fourteen states have not expanded their Medicaid programs under the ACA, and another, Nebraska, has enacted, but not implemented, an expansion. In those states, some people, especially adults below the poverty line with no dependent children, might not be eligible for Medicaid coverage at all. This creates a catch-22: They dont earn enough to get them over the poverty line, but they dont qualify for a subsidized ACA plan, either. These people are caught in what is called the coverage gap.

Still some good news some adults in that gap might be lifted out of it by the additional $600-a-week payment for unemployment.

The vast majority of people we see are getting coverage and reach 100% of the federal poverty level with unemployment benefits and year-to-date income, said Van Arnam in North Carolina, one of the states that have not expanded Medicaid. They are usually able to get an ACA plan with a zero or low premium, which is a big weight off their shoulders.

Staying on a former employers plan, through a law commonly known as COBRA, is also an option for some. The deadline to enroll in this has been extended until 60 days after the national COVID emergency ends, although people who wait to enroll are still liable for past premiums dating back to when they lost their coverage.

And those could be substantial. In COBRA, employees must pay the full cost of the premium although some employers are sharing that cost during the pandemic and Congress may consider a full or partial subsidy in upcoming legislation.

by

Julie Appleby, Kaiser Health News

Kaiser Health News

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

Originally posted here:
If Youve Lost Your Health Plan In The COVID Crisis, Youve Got Options - Physician's Weekly

A restaurant in the Bronx borough of New York | Mark Lennihan/AP Photo

New York

Everyone loves small businesses, said New York City Council Member Brad Lander.

By JANAKI CHADHA

06/16/2020 05:00 AM EDT

NEW YORK As New York City begins to emerge from the coronavirus shutdown, thousands of its small businesses many already struggling before the pandemic hit will face a near-impossible road to recovery.

From Brooklyn dive bars to Soho boutiques, small businesses are written into the citys DNA. But even before the rise of Etsy and Amazon, they operated on tight margins. And while residential tenants have been able to organize their political power to bring about a sea change in Albany and New York City Hall, small business has never been a unified political force in the biggest U.S. city.

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Everyone loves small businesses, said New York City Council Member Brad Lander. Its the kind of thing that rhetorically brings right and left together, but it hasnt converted into effective political power or leverage.

Many businesses are facing months of missed rent payments, with little ability to pay off their arrears. Others are unsure if business will recover swiftly enough for them to be able to come back at all. The shift threatens to decimate commercial strips that rely on these businesses and upend a sector that generates upwards of 3 million jobs.

Yet the citys answer to business owners pleading for relief has largely been that the problem is out of its hands. The solution, city officials have said, depends on a bailout from the Trump administration, which has thus far shown little urgency to bring New York out of its coronavirus-induced fiscal turmoil. And there is no clear backup plan if that aid doesnt arrive.

The scale of this crisis simply requires the resources of the federal government, said Jonnel Doris, commissioner of the citys Department of Small Business Services, at a recent City Council hearing.

While we continue to hope that much of that need be met by the federal government hope isnt a plan," said Council Member Daniel Dromm at the same hearing.

The domino effects of the damage are already becoming apparent one recent survey of building owners said approximately 64 percent of ground-floor retail tenants didnt pay rent in May, a loss of income they warn will hurt their own ability to make mortgage payments and keep up with property tax bills.

While several piecemeal solutions have been introduced opening streets so restaurants have more space for customers, reversing funding cuts for a lease assistance program there remains little clarity how to meet the scale of the problem.

A fix to save struggling small businesses has long eluded politicians, even as theyve lamented the demise of beloved mom-and-pop shops. The sheer variety of small businesses means they come with disparate problems and often competing interests, defying a simple solution. The small business agencys 3 million jobs number is based on businesses that have up to 125 employees, but a spokesperson said 62 percent of small businesses in the city have fewer than five.

Now, as the pandemic plunges many local stores into even worse straits, enacting a workable solution has only become more difficult.

There is no silver bullet, said former City Council Speaker Christine Quinn, who worked on various small business-related initiatives during her time in the Council. Its a great issue to be rhetorical on and itll get you cheers. Its a harder issue to follow up on.

The most pressing probelm for many businesses now is catching up with rent payments, which have often remained their largest fixed cost as sales have plunged. But the need for financial assistance for businesses is coming up against the city and states own budget woes.

While some business leaders have floated property tax reductions for landlords in exchange for commercial tenant relief, the city has shown little inclination to back a policy that would curb its tax revenue at a time when its facing steep shortfalls. And while state lawmakers have in recent years pushed tax hikes to fund various budget priorities, enacting such a measure to help small businesses has not been a prominent topic of discussion in Albany.

Even before the pandemic, small businesses were a fractured political bloc. Residential tenant groups organized for years around a series of changes to rent laws, enough to make their concerns a central issue in elections to the state Senate that turned the body from Republican to Democrat. Within months, the new tenant-friendly legislators overturned decades of laws that had favored landlords.

Small businesses havent had the same political agency.

"What's ended up happening with small businesses is they've self-organized politically in their respective industries and more in their racial or ethnic groups where they've found common purpose, and oftentimes thats geographic," said Neal Kwatra, a Democratic operative who's advised Gov. Andrew Cuomo, Mayor Bill de Blasio and prominent labor groups.

"Those groups are pretty effective in their own districts, their own neighborhoods," he added. "I think the challenge is where you have a citywide impact like this and all of them are affected."

The de Blasio administration created a new role last month for former Small Business Services Commissioner Gregg Bishop, focused on seeking private and philanthropic sources for relief. A spokesperson said the agency has connected businesses to $65 million in assistance through lenders and philanthropic funding, but could not say how many businesses have received funding through this effort. Bishop said at a hearing earlier this year he estimated small businesses in the city will eventually need between $1.5 and $2 billion in relief.

Many city businesses have had some help from the federal Small Business Administrations Paycheck Protection Program, but owners say its been difficult to navigate. Congress recently enacted changes that extend the length of time owners have to spend the funds and allow owners to spend a larger percentage on overhead costs. But the majority of the loan still has to go towards labor, and missed rent has continued to be a major issue.

Even though theres a moratorium for eviction proceedings, the rent bill is really accumulating, said Randy Peers, president and CEO of the Brooklyn Chamber of Commerce. This is going to be the big challenge, because even if you open your doors in the next few weeks, thats three months worth of rent, that in itself can put businesses out of business.

A recent survey from the Brooklyn Chamber of Commerce found 46 percent of businesses missed their May rent payments. A similar survey from the hospitality alliance found 87 percent of bars and restaurants couldnt make rent last month.

Jagdish Shetty, owner of Samudra Restaurant in Jackson Heights, hasnt been able to pay rent since the shutdown order went into effect. Takeout and delivery havent come close to the business the restaurant was bringing in before the pandemic, he said, but he hasnt yet obtained relief through the federal program, and his landlord hasnt cut him a break.

A lot of people used to come here, people used to come from all over. Now, nobody comes, he said. But you still have to pay rent. Theyre not lowering the rent or anything, so Im going to have to close the restaurant.

Lander, whose Park Slope district is overflowing with indie coffee shops and artisanal boutiques, said the majority of small businesses hes spoken to havent been able to strike deals with their landlords, leaving them vulnerable to permanent closure and potentially sparking a surge in commercial vacancies.

He suggested the state look at creating new revenue sources through tax hikes and floated a long-term tax break for landlords who provide rent relief.

There is not enough urgency ... We have to move quickly if were going to save a set of existing small businesses, said Lander. Everyones waiting and hopefully the federal government will provide some money, but if they dont, the state could plausibly take some steps.

A coalition of progressive advocacy groups that have backed measures like commercial rent regulation agreed that tax hikes should be seriously considered, at a time when rent relief is so desperately needed and the availability of federal funding remains unclear.

But there hasnt been a groundswell of support behind any one proposal that would accomplish this, and different groups have been pushing different priorities.

Jessica Walker, president of the Manhattan Chamber of Commerce, said her group wants state lawmakers to reform business interruption insurance, which for the most part does not currently cover pandemics but would be helpful to many struggling businesses if it were available.

When the pandemic first hit, she and other chambers of commerce were looking at proposals that would have the city or state play more of a role in providing relief funds.

It just was too costly, the city and state just dont have the money, so its definitely a tough issue, said Walker. Insurance reforms, the group decided, were a more realistic way to go, she said.

Peers said all the players involved in missed rent payments commercial tenants, but also their landlords, banks holding mortgages and government, which needs property tax revenue should carry part of the weight.

Some creative solution has got to involve a shared burden by all four of those actors because they all have a stake in the equation, he said.

But its unclear such a shared solution will emerge in time to save many of the businesses devastated by the virus.

We are definitely going to lose a lot of them, regardless of how much we do, because some were on thin ice during an era of prosperity, said Kathy Wylde, head of the pro-business Partnership for New York City. They are not going to survive, no matter what anybody does.

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Swaths of New York City small businesses face extinction in the wake of coronavirus - Politico