About $29 billion in funding for the expansion of health coverage under the Affordable Care Act is expected to come from a tax on devices. Hip implants, MRI scanners and catheters to unclog heart arteries are all affected. Toothbrushes, contact lenses, hearing aids and other consumer products are exempt.
Last week, the CEO of AIG invoked the phrase "lynch mob" to compare the vitriolic reaction his company received about its employees' 2009 bonuses. Lynching was so common that a writer even referred to it being as "American as apple pie."
D. Charles is the mother of a six-year old who attends school in East Orange, New Jersey. Her daughter was sent away from the lunch line without a meal when her account appeared to be empty.
"At first I was upset that she was denied food, period, because even if her account wasn't up to date I felt like as a human being it's hard to sit and watch a child who is hungry, be hungry," she says.
The first grader went to another room to call her parents and wait for the other kids to be finished eating.
A little while later the lunch room monitor realized this child did have money in her account and so she was fed. Her parents left work and went to the school anyway.
"When her father and I got to the school we reliazed that it wasn't just her," says Charles. "There was a room full of kids who were not fed. Some of them did qualify for reduced lunch, which amounted to 40-cents per meal. The principle then informed us that she spoke to parents on the first day of school and that it was their responsibility to make sure their kids are fed."
East Orange school officials sent a note home to parents stating that their district could no longer afford to offer food to children who forget their lunch money. Prior to that letter, kids were offered a sandwich and milk. This is increasingly common in New Jersey and elsewhere around the country.
There's no federal guideline for what a public school should do when a child doesn’t have money to pay for lunch. That means the experience for a young child can be completely different, even at schools just miles apart. So even in kindergarten -- no money can equal no food.
Victor Demming is East Orange's school business administrator. He says the state does not allow school lunch programs to run a deficit, and theirs had topped $200,000.
"The deficit actually comes as a result of students not paying for meals," he says.
Demming implemented a variety of methods for getting children in need of free meals enrolled in the federal program, including using state records to auto-enroll the poorest families.
Still, there are lots of reasons a child’s lunch account may be in the red. Parents are busy people and may simply forget to check the balance. Financial situations change.
But a tough economy also impacts schools, and more of them are refusing to feed the kids who don’t pay.
"The USDA advises schools that they are not obligated to provide meals to children who forget their lunch money," says Diane Pratt Heavener, spokesperson at the School Nutrition Association. "There's very little guidance on the books about how schools should respond, and in the absence of any guidance, many schools struggle to come to a concensus on how to respond when unpaid meal charges balloon out of control."
Pratt Heavener says developing a policy can be an emotional and difficult task. However, without a budget to cover the cost of unpaid meals the debt can quickly pile up.
"There are some districts throughout the country that have racked up tens, even hundreds of thousands of dollars of debt by allowing students who don't have money for their meals to be able to charge meals time and time again," she says.
New York City is the most extreme example, in part because it serves more than 600,000 lunches a day. Children there without lunch money do not go hungry, but that comes at a huge expense. Over the course of 8 years, the price tag for unpaid meals famously topped $42,000,000, according to the city’s education department.
In many other states, debt collectors are hired to go after parents with unpaid bills. There is even a debt collection agency that specializes in collecting lunch debt from parents. Many districts use robo-calls. Some withhold report cards or deny access to school activities. Lawmakers in Louisiana tried another approach. Parents there who send a child to school three times without lunch, or the money to buy it, may get a visit from child protective services to look for signs of neglect.
Still, if there’s anything everyone agreed on, there’s also a cost to hungry kids.
"Children who are hungry do not do well in school," says Victor Demming, "and quite frankly, our energy here is to provide instruction to all of our young people."
For now, it appears schools all over the country are choosing between two bad options -- piles of debt or hungry kids.
Polls show that most Americans aren't happy with the Affordable Care Act, or Obamacare. But there are millions of Americans under 65 with pre-existing health conditions who've had to go without health insurance.
Until health care exchanges, established by the law, begin enrolling those folks on Tuesday.
One of those people is 41-year-old Aqualyn Laury. Seven years ago, she had gallbladder surgery at an Atlanta hospital, and began an odyssey through the healthcare system that she hopes will finally end tomorrow, when the insurance exchanges open.
Just weeks after her surgery, Laury, a marketing consultant in business for herself, said “calls were starting to come in.”
Bill collectors were asking, "'When are you going to pay this, when you going to pay that?'" she said. "I had no way of paying anything."
It turns out Laury’s insurance company, which she had signed on with just before having her surgery, didn’t check her medical history until after the claims started rolling in. The company termed her genetic blood disorder a pre-existing condition, ripped up her policy and stuck her with a $50,000 bill.
"The fire and the anger I have for that insurance company that did that to me," she said. "They and others like them do that to other people every day and get away with it. How do you fight that?"
Most people don’t have to. As many as 82 million Americans with pre-existing conditions get their insurance at work, so they can’t be denied.
And that was Laury’s story for a while.
She worked for a hot start-up in Cambridge, and spent years at Proctor and Gamble. But then she went out on her own, and joined the 25 million Americans with pre-existing conditions, who don’t have coverage.
Since then, Laury’s bounced back and forth between being insurance and not having coverage, a dangerous proposition for her.
"In May, I had a heart attack," she said. "And it was, I believe a result of not getting the maintenance I was supposed to have from my genetic blood disorder."
Laury says she’s lucky her coverage, even though it’s just temporary, had kicked in in time. Without it, she says, there’s no way she would have gone to the hospital to find out why she was in pain.
"I would have said, 'You know what, let me find another remedy. Maybe I should take some medicine, maybe it’s indigestion.' I was coming up with anything, maybe it’s not a heart attack," she said.
Laury says not being able to get insurance because of a pre-existing condition forces you to make choices that, rationally, you’d never make. Like when she had her gallbladder removed.
"I would never have imagined a day when I didn’t have to make those kinds of decisions about my body, worried about what the insurance company would say," she said. "That’s what Oct. 1 represents to me."
Laury admits she has no idea what plans she’ll find on Virginia’s exchange tomorrow. Maybe they’ll be too expensive for her to afford. Maybe there’ll be glitches.
But at least she’ll have a choice.
The curtain opens October 1 on a key part of President Obama’s health care reform law. The exchanges, where people can buy health insurance, will be going online. We got to thinking it’s a lot like opening day for a movie, which is the only day Hollywood cares about. But how much does opening day matter for the exchanges?
If you’re producing a big, expensive movie like the new "Hunger Games" sequel, you need to make a huge splash, right away. So, you start promoting the film months in advance with trailers that promise lots of action. The fate of a would-be blockbuster hangs not on opening day, but on a film’s opening hours.
“After the first show, we know,” says Peter Broderick, a film distribution strategist.
Broderick says it’s make or break. “A studio may have a plan and hopes for a movie and then, if it does very poorly to start with how much are they going to support it along the way?”
Especially if people are telling their friends how awful it was. Jonah Berger, who teaches marketing at the Wharton School, says the debut of the health care exchanges is like any new product launch. Word of mouth will be extremely important.
“The first time the Swiffer comes out for example -- what’s a Swiffer?" Berger says. "People look to see, do other people like this product or not? Is this movie good? Is it getting good reviews?”
But the health care exchanges will enter opening day with a disadvantage new movies and products don’t have. The exchanges are already getting bad reviews from opponents of health care reform who have spent millions and millions on ads.
Len Nichols, a health care economist at George Mason University, says if the exchanges have a good opening day, people could pile in fast. But, he says even if opening day is a mess, it won’t be like at the movies.
“And let’s just say they call, and the first day there’s a glitch," he says. "They’re not going to say I’m not going to get health insurance. They’re going to call back in a week.”
Nichols says the exchanges don’t have an opening day -- they have an opening six months, plenty of time to make a first impression. Not to mention, if you’re uninsured, they may be the only show in town.
Months after federal agents raided its Tennessee offices, Pilot Flying J's CEO says it is working to pay companies who were cheated. Seven members of the truck-stop company's sales staff have pleaded guilty to fraud charges.
For this week's Sandwich Monday, we try McDonald's new "Mighty Wings," which are basically McNuggets with a bone in them. And we choose not to think about the strange machine that put the bone there.
Valentine Road is a powerful and disturbing documentary that unravels the tragic murder of a young teenager who had begun exploring his gender identity. Guest host Celeste Headlee learns more from director and first-time filmmaker Marta Cunningham.