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Monday, 08/05/2013 3:09:52 AM

Monday, August 05, 2013 3:09:52 AM

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Ted Cruz taunts fellow Republicans in Obamacare fight


Cruz has said that many of his GOP colleagues are 'scared.'
AP Photo


By MANU RAJU and BURGESS EVERETT
7/31/13 4:58 AM EDT Updated: 7/31/13 11:13 PM EDT

Ted Cruz is taking his hardball tactics to a whole new level.

The Texas freshman senator and his senior aides are unleashing a barrage of attacks on their fellow Republicans for refusing to support their plan to choke off Obamacare as a condition for funding the government. Cruz’s chief of staff is lambasting fellow conservatives like Oklahoma’s Tom Coburn for serving in the “surrender caucus.” His top political strategist has compared Mitch McConnell to Barack Obama. And the senator himself has said [ http://www.politico.com/story/2013/07/ted-cruz-obamacare-glenn-beck-94858.html ] many Republicans are “scared” to wage this fight.

The results have sparked something of a GOP civil war over an issue that, ironically, the GOP is united behind — repealing Obamacare. Cruz’s strategy is a departure from the usually clubby chamber, as he’s grown increasingly alienated from his caucus.

The essence of the clash is this: Cruz can’t comprehend why his GOP colleagues don’t welcome the fight, while more senior Republicans think the junior Texan simply doesn’t understand — or care — about the dire political consequences for their party of a government shutdown. Plus, Cruz’s critics think the plan to repeal Obamacare is destined to fail.

But worries about a shutdown are falling on deaf ears.

“There is a powerful, defeatist approach among Republicans in Washington,” Cruz told conservative radio host Dana Loesch earlier this week. “I think they’re beaten down and they’re convinced that we can’t give a fight, and they’re terrified.”

Cruz isn’t alone in the crusade, which is also being waged by two other possible 2016 candidates — Marco Rubio of Florida and Rand Paul of Kentucky. Sen. Mike Lee, the Utah Republican and tea party favorite, is also leading the charge. Cruz, Rubio and Lee held a discussion of their proposal on the Senate floor on Tuesday — one immediately rebutted by Coburn, whose office on Tuesday distributed a new Congressional Research Service report [ http://www.coburn.senate.gov/public/index.cfm?a=Files.Serve&File_id=1933ce98-a8cf-48bc-af5c-b222c18fcb1d ] concluding that “if government were shut down, funding for Obamacare would still continue.”

But Cruz and his aides are going even further than the other conservatives, lashing out at GOP naysayers in unusually personal terms.

Indeed, Cruz is part of a new breed of Republicans who relish the intraparty warfare, believing that a push for GOP purity will help build their stature within the party while pulling Republicans further to the right. His tactics go even further than those employed by former South Carolina Sen. Jim DeMint, who waged intense battles over Senate primaries but was more selective in choosing which fights to wage against his party in the Capitol.

Cruz’s uncompromising style has won him legions of fans on the right — a fight that started earlier this year when he battled Chuck Hagel’s nomination as defense secretary, continued when he helped block House-Senate budget negotiations because of concerns over a debt ceiling hike, and intensified when he fought with Rubio and GOP senators over a bipartisan immigration bill.

The fight has intensified in recent weeks after Lee circulated a letter, which now includes 12 signatures, asking for support to oppose any budget bill that includes Obamacare funding. That letter has become a test among some GOP groups — including the Club for Growth — of whether Republicans are serious about eliminating the law before much of it takes effect at the beginning of 2014, and it has put McConnell and others up for reelection next year in a tough spot.

Some Republicans point out that even if funding for Obamacare is eliminated in the continuing resolution, much of the law will still stand because of mandatory health care spending enacted under the Affordable Care Act. Many Republicans have stark memories from the Clinton-era shutdown fights and believe the GOP took the lion’s share of the blame for a politically disastrous fight.

“We should do everything we can to delay the individual mandate for a year. But my view is that this is not really what the public is interested in. You shut the government down: That means people lose Social Security checks,” said Sen. Lindsey Graham (R-S.C.). “I don’t think linking the two is a very good idea.”

McConnell’s primary opponent, Matt Bevin, has called on the GOP leader to publicly pledge he will oppose any bill that provides funding for the law.

McConnell has repeatedly deflected questions about whether he will sign the Lee letter.

“We’ve had a lot of internal discussion about the way forward this fall,” McConnell said Tuesday. “There’s no particular announcement at this point.”

Others believe Cruz’s gambit is aimed at boosting his own brand ahead of a possible presidential bid.

A former top Senate GOP leadership aide, who asked for anonymity, said Cruz’s latest battle “isn’t about principle and it isn’t about party.”

“It’s about promoting Ted Cruz’s presidential ambitions, and he and his team are making clear that retaining the House or winning back a Senate GOP majority are all secondary to that goal,” the source said. “It’s a shortsighted and selfish political strategy but one that fellow Republicans are unfortunately having to get used to.”

“The Republican infighting is hurting our brand,” said one Senate Republican aide, who fretted that Cruz’s divisive tack would alienate voters and hurt GOP efforts to retake the Senate.

Most infuriating to his colleagues is that Cruz and GOP senators actually agree on the goal — repeal Obamacare — but they disagree on the approach. And they certainly think it makes little sense to publicly trade political potshots.

“Cruz has lots of support and is not intimidated by the establishment at all,” said Amy Kremer, the chairwoman of Tea Party Express, who said Cruz and his allies “are doing exactly what they were elected to do.”

Cruz has flatly said his GOP colleagues need to have the courage to fight this battle — and is urging the conservative base to redirect its ire at his fellow Republicans. At a Heritage Foundation event on Tuesday, Cruz said a potential shutdown is “not as calamitous as many paint it.”

Cruz also said the defunding effort stands in stark contrast from previous “symbolic” votes by Congress — especially the House — to repeal Obamacare. He chastised Republicans who “love to have a fig leaf vote” but hesitate to take real action on a must-pass spending bill.

“We need to get 41 Republicans in the Senate to make the same commitment or get 218 Republicans in the House,” Cruz said Tuesday. “A lot of Republicans are nervous about this fight. They’re nervous about being blamed for a government shutdown. My question that I have raised to a bunch of my colleagues: What’s the alternative? … I’ve yet to hear any alternative.”

Privately, a number of senior GOP aides are miffed at what they see as personal jabs launched on Twitter by senior Cruz aides, including the senator’s chief of staff, Chip Roy, a former aide to John Cornyn, a Texas senator who took his name off the Lee letter last week. Those aides were unapologetic Tuesday for their public criticisms.

Roy sarcastically quipped [ https://twitter.com/chiproytx/status/361109022620909568 ] on Twitter that it is “shocking” that Sen. John McCain (R-Ariz.) opposes the hardball Obamacare funding tactics given that McCain is “someone talking to [Sen. Chuck] Schumer 5x a day and the White House daily.”

Coburn told [ http://washingtonexaminer.com/coburn-defund-obamacare-campaign-dishonest-hype/article/2533554 ] The Washington Examiner, “The worst thing is being dishonest with your base about what you can accomplish, ginning everybody up and then creating disappointment.”

“Since when is a promise to fight disastrous policy ‘dishonest?’” Roy [ https://twitter.com/chiproytx/status/361118392222105600 ] tweeted [ https://twitter.com/chiproytx/status/360867247943716864 ] in response: “No, the worst thing is giving up & leaving your base believing there is no need to be a Republican any longer.”

Coburn downplayed the attacks Tuesday, saying he had “no ill will” toward Roy. But he quickly added: “He knows I’m not part of the surrender caucus.”

Jason Johnson, Cruz’s chief political strategist, publicly took on McConnell for not signing Lee’s letter.

“Ted Cruz, Mike Lee & Rand Paul support #DefundObamacare — Mitch McConnell, Karl Rove & Barack Obama oppose. Clearer now?” Johnson [ https://twitter.com/jasonsjohnson/status/360760184114647040 ] said [ https://twitter.com/jasonsjohnson/status/360586578852184064 ]. “Do GOP senators who say they’ll repeal #ObamaCare later really think they’ve earned our trust?”

Johnson has [ https://twitter.com/jasonsjohnson/status/360769021693526016 ] cast the Republican establishment’s reluctance to unite around Lee’s Obamacare letter as a strategy coming from “the brains” who spent $1 billion and promised a victory in 2012. He said it translates to: “Stand down on #DefundObamacare [ https://twitter.com/search?q=%23DefundObamacare&src=hash ] — trust us, we know how 2 win in ’14.”

Johnson wrote in an email that though his tweets represent only his view, the medium is important “to shatter the cone of silence preferred by the establishment so folks who don’t live in the D.C. bubble know what really happens in this town.”

“I didn’t sign up to help Sen. Cruz in order to notch another campaign victory on my belt, I signed up to do everything in my limited power to reduce the government’s role in our lives,” Johnson said. “Naive? Maybe, but we won’t give up the fight.”

Roy even suggested [ https://twitter.com/chiproytx/status/360867677092323329 ] the lack of unified GOP support for opposing spending bills with Obamacare funding is “a good way to lose the House.” But Coburn, and others, have disputed that analysis, saying in an interview [ http://www.politico.com/story/2013/07/gop-feuds-obamacare-tactics-94774.html ] last week that employing Cruz’s strategy will “make sure” Democrats take the House next year.

In emails to POLITICO, Roy said his job “is to advance and defend Senator Cruz’s policy priorities,” and winning the fight on defunding Obamacare is central to that job. Roy said he’s not been told to stand down by members or aides.

“The Washington establishment uses every tool at its disposal to push its own narrative on the American public — and in this case, it’s the narrative of ‘we can’t,’” Roy said. “They plant stories, strong-arm members and try to create fake ‘wins’ for cover that simply do not change the status quo. It is important that we push back.”

Some senators brushed off the attacks.

“He and Sen. Cruz are entitled to their opinions, but I don’t pay that much attention to that kind of thing because I believe in my position,” McCain said of the attacks by the senator’s chief of staff. “It wouldn’t be the first person who has criticized me.”

North Carolina Sen. Richard Burr, who has called the defunding push through the budget bill the “dumbest idea” he’d ever heard, shrugged off the attacks.

“It doesn’t matter to me what he does. The only thing that’s important is that I’m on Sen. Cruz’s bill to eliminate Obamacare.”

© 2013 POLITICO LLC

http://www.politico.com/story/2013/07/ted-cruz-republicans-obamacare-94950.html [with embedded videos, and comments]


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G.O.P. Governors Warn Party Members in Congress Not to Shut Government


Gov. Jan Brewer of Arizona, a Republican, during a session at the summer meeting of the National Governors Association in Milwaukee on Sunday.
Morry Gash/Associated Press


By JONATHAN MARTIN
Published: August 4, 2013

MILWAUKEE — Worried about the potential impact on the fragile economies in their states, Republican governors this weekend warned their counterparts in Congress not to shut down the federal government as part of an effort to block financing for President Obama’s health care law [ http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/health_insurance_and_managed_care/health_care_reform/index.html ].

A range of Republican governors, including some who have refused to implement elements of the health initiative in their states, said in interviews that a standoff in Washington before the new fiscal year this fall could backfire on the party if it is seen as being responsible for bringing the government to a halt.

“I have made the case that Obamacare is not good for the economy, but I have some real concerns about potentially doing something that would have a negative impact on the economy just for the short term — I think there are other ways to pursue this,” said Gov. Scott Walker of Wisconsin, who hosted about half of the country’s governors here for the summer meeting of the National Governors Association.

Gov. Jack Dalrymple of North Dakota said a government shutdown would invariably be blamed on the legislative branch.

“I’ve never felt that shutting down government function is a wise thing to do politically because I think, whoever is involved in it, it’s the Congress, regardless of what party they’re affiliated with, that will be blamed by the public,” Mr. Dalrymple said. “And so, to me, I don’t see what it accomplishes.”

Asked if Republicans would pay a political price for a shutdown, Mr. Dalrymple said, “Yeah, well, you do.”

Gov. Phil Bryant of Mississippi, who refused the law’s provision expanding Medicaid in his state, was even more pointed, capturing the tension between the Republican chief executives charged with running their states and the Republican members of Congress who have no such burden.

“Many of the members of this party do not want to fund Obamacare, but what we have to do as governors who work with our legislators is realize the reality of being able to get something passed,” Mr. Bryant said.

He added that if a measure refusing to finance the health law is not going to get passed, “How much blood are we going to leave on the floor over this?”

The Republican divide on just how far they should go to torpedo Mr. Obama’s signature domestic achievement is increasingly becoming a stand-in for the broader party dispute between purists and pragmatists.

A group of Tea Party-aligned senators — like the potential presidential prospects Senators Rand Paul of Kentucky and Ted Cruz of Texas — are pushing their fellow Republicans in Congress to oppose a stopgap measure that would keep the federal government running after Sept. 30 if it includes financing for the Affordable Care Act.

But many Republicans, including high-profile conservatives like Senator Tom Coburn of Oklahoma, fear that Mr. Obama and the Democrats will only benefit in the 2014 elections from a doomed effort to block spending on the new law because Congressional Republicans would bear the blame for the subsequent shutdown of the government.

Because of the very nature of their jobs, Republican governors mainly fall into the pragmatist camp on this issue.

The prospect of even a temporary halt to the federal government, they say, would frighten their state’s businesses and disrupt some core services.

“It would affect all 50 of us,” Mr. Walker said. “The worst part is the uncertainty. My great fear would be anything that provides great uncertainty for the employers of our country.”

Mr. Bryant’s advice to Congressional Republicans: “Take the battle to the floor, debate it, do all that you can to get that bill passed because we believe in eliminating Obamacare completely, that’s why we didn’t expand it. But at some point perhaps we have to realize that the federal government — because of the support of our military, support of our public safety, our infrastructure — we have to have a budget.”

The possibility of a government shutdown and fears of the uncertainty it may bring was raised by a pair of governors — Neil Abercrombie of Hawaii, a Democrat, and Mary Fallin of Oklahoma, a Republican — during one of the public sessions during the weekend.

But the topic was brought up more in informal conversations among the governors rather than in the regular, more scripted forums, one governor said.

As the governors tend to do when they come together for such gatherings, many of those here for a four-day mix of policy talk, batting practice at Miller Park and Harley-Davidson rides were quick to contrast their jobs with those in Congress.

Gov. Terry E. Branstad of Iowa, a Republican who also served four terms as governor in the 1980s and 1990s, pointed to the compromise he reached with his legislature on how to broaden health care coverage for low-income residents without simply accepting the Medicaid expansion that is part of the federal health law. Such efforts on the state level, he said, are what is needed — not more bitter fights in Washington.

“It just causes too much disruption, and people don’t understand,” Mr. Branstad said about using the threat of a government shutdown as leverage. “People want problems solved. They’re tired of the gridlock. They’re tired of the fighting.”

Ms. Fallin, who was in Congress before becoming governor and is the new chairwoman of the National Governors Association, said she was deeply concerned about federal spending.

But she said she would like to see Washington find ways to go about addressing that issue without shutting down the government.

“They need to buckle down, work hard, find consensus on things and certainly find ways of reducing our deficit,” said Ms. Fallin, who rejected the Medicaid expansion in Oklahoma and declined to set up a state health insurance marketplace.

At least one Republican governor here, though, voiced support for the effort to tie spending on the health care law to the broader measure that finances the federal government: Bobby Jindal of Louisiana, the head of the Republican Governors Association and a potential 2016 presidential candidate who most likely does not want to cede any space to his right.

“We absolutely should use whatever opportunity and tactic we can to repeal and replace Obamacare,” said Mr. Jindal, deeming the prospect of a shutdown nothing more than “a false threat” and “scare tactics” from Mr. Obama’s administration.

To the Democratic governors here, the prospect of a shutdown is frightening from a governing perspective.

But politically, they already seem to have their message down should the federal government close this fall.

“People are getting very tired of politicians who appear to only want to shut things down and not build things up,” said Gov. Jack Markell of Delaware, a Democrat, who with a wry grin added of Republicans: “Far be it from me to give them advice, but it can’t be helpful to them.”

© 2013 The New York Times Company

http://www.nytimes.com/2013/08/05/us/politics/gop-governors-warn-party-members-in-congress-not-to-shut-government.html [ http://www.nytimes.com/2013/08/05/us/politics/gop-governors-warn-party-members-in-congress-not-to-shut-government.html?pagewanted=all ]


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Tea Party Plans To Abandon GOP Stars



By MICHAEL J. MISHAK
08/04/13 06:04 PM ET EDT

MIAMI — This wasn't the revolution the tea party had in mind.

Four years ago, the movement and its potent mix of anger and populism persuaded thousands of costumed and sign-waving conservatives to protest the ballooning deficit and President Obama's health care law. It swept a crop of no-compromise lawmakers into Congress and governor's offices and transformed political up-and-comers, including Florida Sen. Marco Rubio, into household names.

But as many tea party stars seek re-election next year and Rubio considers a 2016 presidential run, conservative activists are finding themselves at a crossroads. Many of their standard-bearers have embraced more moderate positions on bedrock issues such as immigration and health care, broadening their appeal in swing states but dampening grass-roots passion.

"They keep sticking their finger in the eyes of the guys who got them elected," said Ralph King, a co-founder of the Cleveland Tea Party Patriots. "A lot of people are feeling betrayed."

The tea party is a loosely knit web of activists, and some are hoping to rekindle the fire with 2014 primary challenges to wayward Republicans. But many more say they plan to sit out high-profile races in some important swing states next year, a move that GOP leaders fear could imperil the re-election prospects of former tea party luminaries, including the governors of Florida and Ohio.

"It changes the playing field for us," said Tom Gaitens, former Florida director of FreedomWorks, a political action committee that has spent millions of dollars to help tea party candidates. "The most powerful thing we have as a movement is our feet and our vote."

In the summer of 2009, tea party supporters stormed congressional town hall meetings, shouting down lawmakers who had voted for the bank bailout and the stimulus package. The movement's voice grew louder after Democrats passed the health care overhaul, and voters took their outrage to the polls in 2010. The tea party wave stunned Democrats and many moderate Republicans, sweeping the GOP into control of the House and changing the balance of power in many statehouses.

But not long after some tea party stars took office, political analysts said, they were forced to adapt to a changing landscape, particularly in states Obama won in 2012, and to the realities of governing.

The tea party also fell out of favor with many people. At its height after the 2010 elections, a CBS News poll found that 31 percent of those surveyed considered themselves tea party supporters. A May survey found just 24 percent identified with the movement.

Facing sagging approval ratings, tea party Republicans, some of whom were elected by slim margins, shifted tactics.

Fla. Gov. Rick Scott, a former health care company executive who won office by attacking the health law and calling for deep cuts to state spending, later endorsed the health law and signed one of the largest budgets in state history, complete with pay raises for teachers. Similarly, Gov. John Kasich, R-Ohio, and Rick Snyder, R-Mich., are battling their GOP-dominated legislatures to expand Medicaid, a big part of the health law.

Tea party supporters were most struck by Rubio, the son of Cuban immigrants. His personal story and unlikely rise to power made him perhaps the most prominent figure in the movement.

As a Senate candidate in 2010, he denounced as "amnesty" any plan that would offer a path to citizenship for those who were in the country illegally. Yet in recent months, he has emerged as a leader of a bipartisan Senate group that developed a plan that includes such a provision. The plan has been panned by conservatives but ultimately could bolster Rubio's standing with Hispanics, a growing demographic group that has voted overwhelmingly Democratic in recent years.

One sweltering July day, a half-dozen tea party protesters gathered under a tree in front of Rubio's Miami office, seeking shade as they denounced his support for an immigration overhaul. But the protest soon turned into more of a support group, with the four men and two women grousing to each other about how Rubio had turned into a "back-stabber," a "liar" and a "flip-flopper."

Juan Fiol, a real estate broker who organized the protest, kept looking at his phone, waiting for calls from fellow tea party supporters that never came.

"It was supposed to be a big event," he said as he waved a large "Don't Tread on Me" flag.

The movement's top strategists acknowledge the tea party is quieter today, by design. It has matured, they said, from a protest movement to a political movement. Large-scale rallies have given way to strategic letter-writing and phone-banking campaigns to push or oppose legislative agendas in Washington and state capitals. In Michigan and Ohio, for example, leaders have battled the implementation of the president's health law and the adoption of "Common Core" state school standards.

Local activists say they have focused largely on their own communities since Obama's re-election and the ideological drift of some tea party-backed politicians. Many are running for school boards, county commissions and city councils, focusing on issues such as unfunded pension liabilities and sewer system repairs.

"The positions that people are filling at the local levels are more important for the future of the movement and the future of the country," said Jenny Beth Martin, co-founder of the Tea Party Patriots, a national umbrella organization. "It's creating a farm team for the future."

The Republican establishment, however, is concerned about 2014. Party leaders worry about the GOP's most passionate advocates walking away, particularly those supporters angered by the Senate's immigration bill. In a nod to the tea party, business and conservative groups have launched ad campaigns recasting the bill as a national security measure.

The conservative American Action Network spent $750,000 on pro-reform commercials. One ad aimed at Florida voters called the legislation "the toughest border security plan ever passed by Congress" and urged viewers to thank Rubio for "keeping his promise and fighting to secure the border."

National tea party leaders hope to re-energize followers by focusing on two of the movement's chief targets: the Internal Revenue Service and the health law. They said the Obama administration had handed them a recruiting tool when it delayed the law's implementation and when the IRS singled out tea party groups and other conservative political organizations for special scrutiny.

"The very issues that brought us together in the first place are emerging as more center stage than they were in 2009 and 2010," said Matt Kibbe, president of FreedomWorks. "That animates the political conversation and mobilizes our grass roots going into the 2014 election."

Some Republicans are also moving to repair their relationships with the movement.

Rubio recently spoke to about 50 conservative activists and other lawmakers at a meeting of the Senate's tea party caucus. Organizers said he breezed past immigration, instead devoting much of his speech to repealing the health law.

© 2013 Associated Press

http://www.huffingtonpost.com/2013/08/04/tea-party-gop-rift_n_3703351.html [with embedded video report, and comments]


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Finally, Thousands of Old Rape-Evidence Kits Are to Be Tested

August 3, 2013
Thousands of evidence kits collected from rape victims that have sat untested for years in Texas can now be analyzed, thanks to an $11 million budget appropriation earmarked for the Texas Department of Public Safety.
The line-item financing disbursement was passed as part of the state’s biennial budget during the regular 83rd legislative session. It follows the 2011 approval of related legislation filed by Senator Wendy Davis, Democrat of Fort Worth.
[...]

http://www.nytimes.com/2013/08/04/us/finally-thousands-of-old-rape-evidence-kits-are-to-be-tested.html


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Contraception and Corporations

By THE EDITORIAL BOARD
Published: August 2, 2013

At least three dozen lawsuits have been filed by private businesses challenging, on religious grounds, the new health care law’s requirement that most company health plans provide no-cost coverage of contraceptives. The lawsuits share a basic flaw: Profit-making corporations are not human beings capable of engaging in religious exercise to begin with.

The United States Court of Appeals for the Third Circuit recognized that fundamental reality last week when it allowed the contraceptive coverage rule to apply to a Pennsylvania-based cabinetmaking company, the Conestoga Wood Specialties Corporation. Conestoga, a 950-worker company owned by a devout Mennonite family, had argued that the federal mandate violated the company’s rights under the Constitution and the Religious Freedom Restoration Act.

There is a line of Supreme Court decisions upholding corporate free speech rights. However, as the appeals court observed, there is “a total absence of case law” (before the present round of litigation) to support the notion that the “personal right” of free exercise of religion protected by the First Amendment applies to artificial creations like corporations.

“We simply conclude that the law has long recognized the distinction between the owners of a corporation and the corporation itself,” Judge Robert Cowen wrote in the panel’s majority opinion [ http://www2.ca3.uscourts.gov/opinarch/131144p.pdf ]. “A holding to the contrary — that a for-profit corporation can engage in religious exercise — would eviscerate the fundamental principle that a corporation is a legally distinct entity from its owners.” The court might have added that to rule the other way would restrict the rights and risk the well-being of female employees who do not share the owners’ religious views.

The Conestoga decision conflicts with a recent ruling by the United States Court of Appeals for the 10th Circuit, in Denver, in a similar case brought by the owners of a craft store chain, Hobby Lobby. This means that the issue could well reach the Supreme Court in the coming term.

The fact is that almost all women of childbearing age use some form of contraception, as a matter of independent choice, whatever their religious identity. In that sense, the legal assault against the contraception mandate amounts to an attempt by religious groups and individuals to hijack the courts to fight a social reality they do not like, brandishing overwrought claims of religious infringement. The Third Circuit was right not to go along.

© 2013 The New York Times Company

http://www.nytimes.com/2013/08/03/opinion/contraception-and-corporations.html


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In Need of a New Hip, but Priced Out of the U.S.

August 3, 2013
http://www.nytimes.com/2013/08/04/health/for-medical-tourists-simple-math.html [with comments]


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End of Life, at Birth


Wesley Allsbrook

By APRIL R. DWORETZ
Published: August 4, 2013

ATLANTA — FIFTY years ago this Wednesday, Americans were gripped by the fate of a baby — Patrick Bouvier Kennedy, the first child born to a sitting president since the 19th century, and John F. Kennedy’s last. He arrived on Aug. 7, 1963, five and a half weeks premature. Despite medical heroics, including the use of a hyperbaric oxygen chamber, he died 39 hours later.

Neonatal care has improved greatly since then. Were he born today, Patrick, who was delivered at 34 weeks’ gestation, would very likely survive and have a healthy life, too.

For all the biomedical advances, though, the key ethical problems surrounding premature birth remain. Today, babies as much as 11 weeks younger than Patrick can be saved at birth. The problem is that their prognoses are often much worse than his would have been.

I am a neonatologist. I save babies. Most of them, especially those born after 28 weeks, will at most suffer mild or moderate disabilities. But of those born before 28 weeks — 30,000 of the half million babies born prematurely each year in this country — many will have serious physical, social or cognitive problems.

Consider that a one-pound, one-ounce girl born unexpectedly at 23 weeks’ gestation has a 92 percent chance of dying early or having moderate to severe neurodevelopmental impairment.

Most extremely premature babies [ http://health.nytimes.com/health/guides/disease/premature-infant/overview.html ] will experience at least one complication — bleeding in the brain, infections, intestinal perforation [ http://health.nytimes.com/health/guides/disease/gastrointestinal-perforation/overview.html ], severe lung damage — before discharge. Many will need treatment long after birth, sometimes for life, at great financial and emotional cost to them and those around them.

A few months ago I cared for just such a child. Let’s call her Miracle. She was born at 23 weeks’ gestation and weighed a little over a pound. Despite the bleak prognosis, her parents asked that we resuscitate her in the delivery room.

So we did. But over the next eight weeks, to keep her alive, we had to prick Miracle’s heel so many times she developed scarring. We suctioned her trachea hundreds of times. We put tubes through her mouth and into her stomach, we stabbed her again and again to insert IVs, and we took blood from her and then transfused blood back. We gave her antibiotics [ http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/antibiotics/index.html ] for two severe infections.

Each of these events created suffering, for Miracle and her parents. Her mother visited daily and developed an anxiety disorder [ http://health.nytimes.com/health/guides/disease/generalized-anxiety-disorder/overview.html ]. Her father came in only once a week, the pain and sadness was so great.

After eight weeks, Miracle came off the ventilator we had put her on. But three days later we had to turn it back on, and it was possible she would die or remain on the ventilator permanently if we didn’t give her steroids [ http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/steroids/index.html ], which can have side effects as serious as cerebral palsy [ http://health.nytimes.com/health/guides/disease/cerebral-palsy/overview.html ]. Her mother opted for the steroids. But Miracle’s father was angry. He muttered to me: “Why do you do this? Why do you keep these babies alive?”

I’ve been thinking about that question for decades and haven’t found a simple answer. Some parents believe that withholding or withdrawing life-sustaining treatment will prevent their infant from suffering and living a life not worth living; others consider it murder. Some families soar in caring for their disabled kids; others disintegrate.

Ultimately, parents have the right to decide, but we physicians must help them make informed decisions. I asked Miracle’s father whether anyone had talked to him about resuscitating Miracle before she was born. He vaguely remembered a conversation, but hadn’t understood what treating such a tiny premature baby meant.

And nobody talked to him after Miracle was born about continuing life-sustaining treatment. In fact, he had gotten to her two-month birthday without realizing that her suffering might end in death. We had updated his wife, but she didn’t like to hear bad news, and didn’t tell him.

Luckily, the news has improved. Miracle is off the ventilator and will likely survive to be discharged, though she will suffer from chronic lung disease.

Even so, we need to make sure both parents are always kept part of the discussion, to ensure we have their informed consent throughout treatment. It can’t be just one conversation.

More broadly, when in the first trimester obstetricians talk with pregnant women and their partners about testing for genetic anomalies, they should include discussion of values and attitudes toward life, death and disability, or at least recommend such discussions. Certainly parents at high risk of giving birth to premature babies, or to babies with severe congenital defects, should receive such counseling, including from neonatologists and other specialists.

Sometimes, I think we doctors need to do more than inform. On occasion, I’ve offered to make a life-or-death decision for parents. If they agree, they are essentially making the decision, but are shifting the burden to me. It’s harder for parents to say, “I unplugged my baby,” than to let the doctor do it.

Our culture is slowly growing more comfortable talking about end-of-life issues as they relate to the elderly: whether to allow a natural death or prolong life even if it means suffering.

In my world, though, the “surrogate” decision makers are young parents of infants like Miracle. And they are still completely unprepared. It’s time we broaden the discussion to include them.

April R. Dworetz [ http://www.pediatrics.emory.edu/information/employee/faculty1.cfm?pid=174&did=4 ] is an assistant professor of pediatrics, specializing in neonatology, at Emory University.

© 2013 The New York Times Company

http://www.nytimes.com/2013/08/05/opinion/end-of-life-at-birth.html [with comments]


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Marriage and Minorities



By CHARLES M. BLOW
Published: August 2, 2013

We often hear that marriage is a panacea for our problems — as a nation as a whole, and especially for the black community, in which more than 70 percent of children are now born to unmarried women.

Less discussed are the societal factors contributing to this phenomenon.

Let’s start with this: while marriage may be losing a bit of its luster for some, it is still a desirable institution for most.

According to a Gallup poll released Friday [ http://www.gallup.com/poll/163802/marriage-importance-dropped.aspx ], a majority of American adults (54 percent) are married. Another fifth have been married or did not classify a marital status. Yet another fifth has never married but wants to.

And among younger people, nonwhites were less likely than whites to be married, but they were more likely to say that they wanted to be. Only 6 percent of whites and 12 percent of nonwhites said that they had never been married and didn’t want to get married.

So most Americans — both whites and minorities — still believe in marriage, but there are factors working against marriage for many, factors that need to be acknowledged.

One is mass incarceration.

In the two decades preceding the Great Recession, the American prison population nearly tripled, according to the Pew Center on the States. And make no mistake: mass incarceration rips at the fabric of families and whole communities.

According to the 2011 book “A Plague of Prisons [ http://www.amazon.com/Plague-Prisons-Epidemiology-Incarceration-America/dp/1595588795 ]” by Ernest Drucker, a public health expert:

- “The risk of divorce is high among men going to prison, reaching 50 percent within a few years after incarceration.”

- “The marriage rate for men incarcerated in prisons and jails is lower than the American average. For blacks and Hispanics, it is lower still.”

- “Unmarried couples in which the father has been incarcerated are 37 percent less likely to be married one year after the child’s birth than similar couples in which the father has never been incarcerated.”

Related to mass incarceration is the disastrous drug war, which essentially has become a war on marijuana waged primarily against young black men, even though they use the drug at nearly the same rate as whites.

Then there’s the Aid Elimination Provision of the Higher Education Act, a provision that took effect in 2000. It denied financial aid to students with drug convictions. A couple of years after it took effect, the American Civil Liberties Union called the law [ http://www.aclu.org/drug-law-reform/injustice-101-higher-education-act-denies-financial-aid-students-drug-convictions ] “unjust and counterproductive” and “both morally wrong and unconstitutional.”

Researchers at Cornell found [ http://www.human.cornell.edu/pam/people/upload/Finaid-2-22-2012.pdf ] last year that the provision “had a large negative impact on the college attendance of students with drug convictions” — that students who were affected delayed college enrollment or were made “less likely to ever enroll in college,” among other things.

Add to that the explosion in student loan debt, which has passed the trillion-dollar mark, according to the Consumer Financial Protection Bureau. Such debt is now held by a record one in five households, said a Pew report last year.

But this debt crisis isn’t evenly distributed. According to a report last year by the Center for American Progress: “African-American and Latino students are especially saddled with student debt, with 81 percent of African-American students and 67 percent of Latino students who earned bachelor’s degrees leaving school with debt. This compares to 64 percent of white students who graduate with debt.”

The debt burden is having a significant impact on marriage. A survey [ http://www.aicpa.org/press/pressreleases/2013/pages/aicpa-survey-reveals-effects-regrets-student-loan-debt.aspx ] published in May by the American Institute of Certified Public Accountants showed that 15 percent of respondents delayed marriage because of student loan debt.

Furthermore, for the poorest Americans, there are marriage penalties built into many of our welfare programs. As the Heritage Foundation has pointed out: “Marriage penalties occur in many means-tested programs, such as food stamps, public housing, Medicaid, day care and Temporary Assistance to Needy Families. The welfare system should be overhauled to reduce such counterproductive incentives.”

This is not to explain away why people don’t marry or delay marriage or have children before marriage, but to give the discussion context.

In a report financed by the Department of Justice a decade ago, Donald Braman, a George Washington University law professor, argued, “For generations, social institutions from slavery and segregation to broadly punitive criminal sanctions have borne down unremittingly on poor and minority families and communities.”

One can’t bemoan the breakdown of the family — particularly the black family — without at least acknowledging the structural and systematic forces working against its cohesion.

© 2013 The New York Times Company

http://www.nytimes.com/2013/08/03/opinion/blow-marriage-and-minorities.html [with comments]


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Sandy Rios, Conservative Radio Host, Links Gay Love To Ariel Castro Rape And Torture


A conservative radio host linked gay love to the "love" Ariel Castro had for his victims and child born of rape.
(AP)


By Cavan Sieczkowski
Posted: 08/04/2013 1:10 pm EDT | Updated: 08/04/2013 1:32 pm EDT

A conservative radio host linked lesbian, gay, bisexual and transgender (LGBT) love to the "love" Ohio kidnapper and rapist Ariel Castro had for his victims while discussing her opposition towards the legalization of same-sex marriage.

Sandy Rios, American Family Association talk show host and Fox News contributor, broached the topic of same-sex marriage while speaking with Chicago anti-gay pastor Erwin Lutzer last week, Right Wing Watch notes. Lutzer said one opposition against same-sex marriage is that the city's crime is bad enough and they don't need the "destruction of marriage" as well.

The two also agreed that love shouldn't be reason enough to allow same-sex couples to marry [ http://www.rightwingwatch.org/content/rios-and-lutzer-link-homosexuality-pedophilia-crime-and-cleveland-kidnapper-ariel-castro ].

"A pedophile I'm sure says that he loves children -- as a matter of fact, he does -- but you can see how destructive that love is," Lutzer said. "Once love is undefined as kind of this 'I want to do this and so I'm loving' then, of course, we end up where we are ending up today with a great slide in morality, the destruction of the family, the confusion that children grow up with. All of these implications..."

"You know, the gentleman that was just sentenced yesterday for holding those women hostage in Ohio, and molesting them for years, and doing terrible things to them," Rios continued, "His defense was that he ‘loved’ his family, he ‘loved’ his child that was born out of one of the rapes that he did of the woman. He ‘loved’ and he couldn’t understand [ http://www.rawstory.com/rs/2013/08/03/fox-contributor-lgbt-love-is-like-cleveland-kidnapper-castros-love-for-victims/ ]. He said, ‘I’m not a monster.’”

Rios was referring to Castro, a kidnapper and rapist [ http://www.cnn.com/2013/08/01/justice/ohio-castro ] who kept victims Amanda Berry, Michelle Knight and Gina DeJesus captive in his Cleveland home for a decade. Castro pleaded guilty to 937 counts last week, including murder and kidnapping, and was sentenced to life plus 1,000 years in prison. During the Aug. 1 hearing, he claimed “most of the sex that went on in that house, probably all of it, was consensual [ http://tv.msnbc.com/2013/08/01/cleveland-kidnapper-ariel-castro-the-sex-was-consensual/ ].” He also denied being a monster, saying he "simply kept them [in his house] without them being able to leave.”

David Badash of the New Civil Rights Movement called Rios' comments both "offensive and ludicrous [ http://thenewcivilrightsmovement.com/1-gays-love-each-other-just-like-ariel-castro-loved-the-women-he-raped-say-fox-contributor/discrimination/2013/08/02/72375 ]."

The conservative pundit has previously falsely claimed that sexual abuse in the gay male community is an "epidemic" [ http://thenewcivilrightsmovement.com/sexual-abuse-in-the-male-gay-community-is-epidemic-sandy-rios-claims/news/2013/06/10/68441 ]; teaching kids about equality is like teaching them to use crack [ http://www.towleroad.com/2013/07/rios-radio-show-teaching-kids-about-equality-just-like-teaching-them-to-use-crack.html ]; and gay-inclusive curricula is to blame for falling test scores [ http://www.huffingtonpost.com/2013/02/25/sandy-rios-gay-schools_n_2759472.html ].

Listen to a portion of Sandy Rios' interview below.

[ https://soundcloud.com/rightwingwatch/rios-lutzer-gays-love-not (embedded)]

Copyright © 2013 TheHuffingtonPost.com, Inc.

http://www.huffingtonpost.com/2013/08/04/sandy-rios-gay-ariel-castro_n_3704253.html [with comments]


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Vitaly Mutko, Russian Sports Minister, Says Anti-Gay Laws Will Be Upheld At Sochi Olympics
08/02/2013
http://www.huffingtonpost.com/2013/08/02/russian-sports-minister-anti-gay-olympics_n_3696611.html [with embedded video report, and comments]


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Gosford Anglican Church In Australia Posts Amazing Pro-Gay Sign For Homophobic Christians: 'Get Over It'

08/02/2013
http://www.huffingtonpost.com/2013/08/02/gosford-church-pro-gay-sign-homophobic-christians_n_3695857.html [with comments];
https://www.facebook.com/photo.php?fbid=10151523447756643&set=a.430496241642.238443.287718711642&type=1 [with comments];
http://www.dailytelegraph.com.au/newslocal/central-coast/gay-rights-post-by-gosford-anglican-parish-minster-rod-bower-goes-viral-on-facebook/story-fngr8h0p-1226687874235


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Greensburg, KS - 5/4/07

"Eternal vigilance is the price of Liberty."
from John Philpot Curran, Speech
upon the Right of Election, 1790


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