By HANNAH SCHOENBAUM (Associated Press/Report for America)

RALEIGH, N.C. (AP) — Transgender youth in North Carolina lost access Wednesday to gender-affirming treatments after the Republican-led General Assembly overrode the Democratic governor’s vetoes of that legislation and other bills touching on gender in sports and LGBTQ+ instruction in the classroom.

GOP supermajorities in the House and Senate enacted — over Gov. Roy Cooper’s veto — a bill barring medical professionals from providing hormone therapy, puberty-blocking drugs and surgical gender-transition procedures to anyone under 18, with limited medical exceptions.

The policy takes effect immediately, but minors who had begun treatment before Aug. 1 may continue receiving that care if their doctors deem it medically necessary and their parents consent.

North Carolina becomes the 22nd state to enact legislation restricting or banning gender-affirming medical care for trans minors. But most of those laws face legal challenges, and local LGBTQ+ right advocates vowed to challenge the ban in court. The Senate voted 27-18 to complete the veto override after the House voted 73-46 earlier.

Republican Sen. Joyce Krawiec, primary sponsor of the bill restricting gender-affirming care, said the state has a responsibility to protect children from receiving potentially irreversible procedures before they are old enough to make their own informed medical decisions.

But Democratic Sen. Lisa Grafstein, North Carolina’s only out LGBTQ+ state senator, said the gender-affirming care bill “may be the most heartbreaking bill in a truly heartbreaking session.”

Some LGBTQ+ rights advocates in the Senate gallery began yelling after Republican Lt. Gov. Mark Robinson, who was presiding, cut off Grafstein to let another lawmaker speak. Several people were then escorted from the chamber by capitol police.

Earlier, the Senate and House voted minutes apart to override another Cooper veto of a bill limiting LGBTQ+ instruction in the early grades, also making that law. The measure requires public school teachers in most circumstances to alert parents before they call a student by a different name or pronoun. And the law also bans instruction about gender identity and sexuality in K-4 classrooms, which critics have previously likened to a Florida law opponents call “Don’t Say Gay.”

Both chambers also voted Wednesday to override Cooper’s veto of another bill banning transgender girls from playing on girls’ sports teams from middle and high school through college. It, too, immediately became law.

A day of divisive deliberations saw anger and emotion boil over at times in the assembly.

Democratic state Rep. John Autry of Mecklenburg County, who has a transgender grandchild, choked up while debating the gender-affirming care bill on the House floor. “Just stop it,” he begged his Republican colleagues shortly before they voted to enact the law.

And Cooper blasted the decisions of the Republican-controlled chambers in a statement, calling them “wrong priorities” even before lawmakers had completed all their votes.

“The legislature finally comes back to pass legislation that discriminates,” he said, adding it would have several negative impacts for North Carolina. “Yet they still won’t pass a budget when teachers, school bus drivers and Medicaid Expansion for thousands of working people getting kicked off their health plans every week are desperately needed.”″

Parents of transgender and nonbinary children, like Elizabeth Waugh of Orange County, said hours before the voting started that they have been considering whether to move their families out of North Carolina so their children will have unrestricted access to gender-affirming care.

Waugh’s nonbinary child did not begin receiving treatment before Aug. 1 and would need to travel elsewhere if they decide they want to start taking hormones.

“I have felt like I had a lump in my throat for months,” Waugh said. “Just talking to other families who are dealing with this, I mean, the pain that they are feeling, the suffering, the fear for their children — it’s devastating.”

Gender-affirming care is considered safe and medically necessary by the leading professional health associations, including the American Academy of Pediatrics, the American Medical Association and the Endocrine Society. While trans minors very rarely receive surgical interventions, they are commonly prescribed drugs to delay puberty and sometimes begin taking hormones before they reach adulthood.

The House kicked off the day’s rush of votes with a 74-45 vote to override Cooper’s veto of a bill that would prohibit transgender girls from playing on girls’ middle school, high school and college sports teams. The Senate completed the override soon after.

A former Olympic swimmer, Rep. Marcia Morey, had spoken in House floor debate before the vote about possible repercussions for young athletes.

“This bill affects 10-, 11-, 12-year-olds who are just starting to learn about athletics, about competition, about sportsmanship,” Morey, a Durham County Democrat, said. “To some of these kids, it could be their lifeline to self-confidence.”

Critics have said limits on transgender girls’ participation in sports were discriminatory and have called it a measure disguised as a safety precaution that would unfairly pick on a small number of students.

But such supporters of the bill as Payton McNabb, a recent high school graduate from Murphy, argued that legislation is needed to protect the safety and well-being of young female athletes and to preserve scholarship opportunities for them.

“The veto of this bill was not only a veto on women’s rights, but a slap in the face to every female in the state,” said McNabb, who says she suffered a concussion and neck injury last year after a transgender athlete hit her in the head with a volleyball during a school match.

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Hannah Schoenbaum is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.

By HANNAH SCHOENBAUM (Associated Press/Report for America)

RALEIGH, N.C. (AP) — North Carolina’s Senate and House voted minutes apart Wednesday to override Gov. Roy Cooper’s veto of a bill limiting LGBTQ+ instruction in the early grades, immediately making it law.

The law, which is expected to face a legal challenge, requires public school teachers in most circumstances to alert parents before they call a student by a different name or pronoun. It also bans instruction about gender identity and sexuality in K-4 classrooms, which critics have previously likened to a Florida law opponents call “Don’t Say Gay.”

The Senate voted 27-18 for the override, followed swiftly by a 72-47 decisive House vote. That came on an afternoon of intense activity in the state’s General Assembly.

Both chambers also voted to override Cooper’s veto of another bill banning transgender girls from playing on girls’ sports teams from middle and high school through college. That bill also immediately became law.

Earlier, a GOP supermajority in the North Carolina House voted Wednesday to override the Democratic governor’s veto of legislation to ban gender-affirming treatments for transgender minors, putting those youth just a vote away from losing access to that care.

The House vote was 73-46 to overturn Cooper’s veto of the bill that would bar medical professionals — with limited exceptions — from providing hormone therapy, puberty-blocking drugs and surgical gender-transition procedures to anyone under 18. Minors who began treatment before Aug. 1 could continue receiving that care under parental consent if their doctors deem it medically necessary.

Democratic state Rep. John Autry of Mecklenburg County, who has a transgender grandchild, choked up while debating the gender-affirming care bill on the House floor. “Just stop it,” he begged his Republican colleagues shortly before they voted to enact the law.

The House vote left North Carolina one vote away from becoming the latest state to ban gender-affirming health care for transgender youth.

The Senate has a similarly veto-proof GOP majority as the House. If Republicans in the Senate succeed as expected, they would make North Carolina the 22nd state to enact legislation restricting or banning gender-affirming medical care for trans minors. Many of those laws are facing court challenges and advocates have promised similar challenges in North Carolina.

Cooper blasted the votes in the Republican-controlled chambers, calling them “wrong priorities.”

“The legislature finally comes back to pass legislation that discriminates,” he said, adding it would have several negative impacts for North Carolina. “Yet they still won’t pass a budget when teachers, school bus drivers and Medicaid Expansion for thousands of working people getting kicked off their health plans every week are desperately needed.”″

Gender-affirming care is considered safe and medically necessary by the leading professional health associations, including the American Academy of Pediatrics, the American Medical Association and the Endocrine Society. While trans minors very rarely receive surgical interventions, they are commonly prescribed drugs to delay puberty and sometimes begin taking hormones before they reach adulthood.

Parents of transgender and nonbinary children, like Elizabeth Waugh of Orange County, said they have been considering whether to move their families out of North Carolina so their children will have unrestricted access to gender-affirming care.

Waugh’s nonbinary child did not begin receiving treatment before Aug. 1 and would need to travel elsewhere if they decide they want to start taking hormones.

“I have felt like I had a lump in my throat for months,” Waugh said Wednesday before the House vote. “Just talking to other families who are dealing with this, I mean, the pain that they are feeling, the suffering, the fear for their children — it’s devastating.”

Local LGBTQ+ rights advocates had braced in expectation of House and Senate override votes succeeding Wednesday, and vowed to challenge them in court.

The first override vote by the House came Wednesday on Cooper’s veto of a bill that would prohibit transgender girls from playing on girls’ middle school, high school and college sports teams. The House overrode that veto 74-45. The Senate later in the day cast the clinching override vote, enacting that measure into law.

A former Olympic swimmer, Rep. Marcia Morey, had spoken in House floor debate earlier about the repercussions of that bill on young athletes.

“This bill affects 10-, 11-, 12-year-olds who are just starting to learn about athletics, about competition, about sportsmanship,” Morey, a Durham County Democrat, said. “To some of these kids, it could be their lifeline to self-confidence.”

Critics have said limits on transgender girls’ participation in sports were discriminatory and have called it a measure disguised as a safety precaution that would unfairly pick on a small number of students.

But supporters of that bill such as Payton McNabb, a recent high school graduate from Murphy, argued that legislation is needed to protect the safety and well-being of young female athletes and to preserve scholarship opportunities for them.

“The veto of this bill was not only a veto on women’s rights, but a slap in the face to every female in the state,” said McNabb, who says she suffered a concussion and neck injury last year after a transgender athlete hit her in the head with a volleyball during a school match.

The GOP holds veto-proof majorities in both chambers for the first time since 2018, affording Republicans a clear path to consider certain LGBTQ+ restrictions that had not previously gained traction in North Carolina.

___

Hannah Schoenbaum is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.

By HANNAH SCHOENBAUM (Associated Press/Report for America)

RALEIGH, N.C. (AP) — A GOP supermajority in the North Carolina House voted Wednesday to override the Democratic governor’s veto of legislation to ban gender-affirming treatments for transgender minors, putting those youth just a vote away from losing access to that care.

The vote followed by mere minutes an earlier vote by the chamber overriding Gov. Roy Cooper’s veto of another bill banning transgender girls from playing on girls’ sports teams from middle and high school through college.

House lawmakers voted 73-46 to surmount Cooper’s veto of the bill that would bar medical professionals — with limited exceptions — from providing hormone therapy, puberty-blocking drugs and surgical gender-transition procedures to anyone under 18. Minors who began treatment before Aug. 1 could continue receiving that care under parental consent if their doctors deem it medically necessary.

Democratic state Rep. John Autry of Mecklenburg County, who has a transgender grandchild, choked up while debating the gender-affirming care bill on the House floor. “Just stop it,” he begged his Republican colleagues shortly before they voted to enact the law.

The House vote left North Carolina one vote away from becoming the latest state to ban gender-affirming health care for transgender youth. Votes were also expected on both measures in the Senate later Wednesday to enact the legislation over Cooper’s vetoes.

But the Senate’s first action late Wednesday afternoon was on another veto override bid entirely. In a 27-18 vote, the Senate completed the first half of an override vote on a bill requiring public school teachers in most circumstances to alert parents before they call a student by a different name or pronoun. It would also prohibit instruction about gender identity and sexuality in K-4 classrooms, which critics have likened to the Florida law that opponents call “Don’t Say Gay.” The Senate immediately sent the bill to the House for a final vote Wednesday night.

The Senate has a similarly veto-proof GOP majority as the House. If Republicans in the Senate succeed as expected, they would make North Carolina the 22nd state to enact legislation restricting or banning gender-affirming medical care for trans minors. Many of those laws are facing court challenges and advocates have promised similar challenges in North Carolina.

Gender-affirming care is considered safe and medically necessary by the leading professional health associations, including the American Academy of Pediatrics, the American Medical Association and the Endocrine Society. While trans minors very rarely receive surgical interventions, they are commonly prescribed drugs to delay puberty and sometimes begin taking hormones before they reach adulthood.

Parents of transgender and nonbinary children, like Elizabeth Waugh of Orange County, said they have been considering whether to move their families out of North Carolina so their children will have unrestricted access to gender-affirming care.

Waugh’s nonbinary child did not begin receiving treatment before Aug. 1 and would need to travel elsewhere if they decide they want to start taking hormones.

“I have felt like I had a lump in my throat for months,” Waugh said Wednesday before the House vote. “Just talking to other families who are dealing with this, I mean, the pain that they are feeling, the suffering, the fear for their children — it’s devastating.”

Local LGBTQ+ rights advocates had been bracing for House and Senate override votes expected Wednesday. They said the were expecting both bills would become law and have vowed to challenge them in court.

The first override vote by the House came Wednesday on Cooper’s veto of a bill that would prohibit transgender girls from playing on girls’ middle school, high school and college sports teams. The House overrode that veto 74-45.

A former Olympic swimmer, Rep. Marcia Morey, spoke in House floor debate about the impact of that bill on young athletes.

“This bill affects 10-, 11-, 12-year-olds who are just starting to learn about athletics, about competition, about sportsmanship,” Morey, a Durham County Democrat, said. “To some of these kids, it could be their lifeline to self-confidence.”

Critics have said limits on transgender girls’ participation in sports were discriminatory and have called it a measure disguised as a safety precaution that would unfairly pick on a small number of students.

But supporters of that bill such as Payton McNabb, a recent high school graduate from Murphy, argued that legislation is needed to protect the safety and well-being of young female athletes and to preserve scholarship opportunities for them.

“The veto of this bill was not only a veto on women’s rights, but a slap in the face to every female in the state,” said McNabb, who says she suffered a concussion and neck injury last year after a transgender athlete hit her in the head with a volleyball during a school match.

The GOP holds veto-proof majorities in both chambers for the first time since 2018, affording Republicans a clear path to consider certain LGBTQ+ restrictions that had not previously gained traction in North Carolina.

___

Hannah Schoenbaum is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.

FREDERICKSBURG (AP) — Drivers on one of the nation’s most congested stretches of highway can soon utilize a 10-mile extension of Virginia’s Express Lanes network that allows solo drivers to pay a fee to bypass the regular lanes.

Virginia Gov. Glenn Youngkin announced Wednesday that the extension of the I-95 Express Lanes from Stafford County to Fredericksburg, in the outer suburbs of the nation’s capital, will open to motorists beginning Thursday night.

The $670 million public-private partnership to extend the Express Lanes has been in the works since 2018, when the deal between the state and Transurban, the private company that operates the Express Lanes, was first announced. At the time, authorities expected the lanes to open in 2022,

Vehicles with three or more occupants can use the lanes for free with an E-ZPass Flex transponder. Others can use the the lanes by paying a toll that varies depending on traffic volume.

The Express Lanes reverse directions based on the primary traffic flow, typically northbound in the morning and southbound in the evening, and run parallel to the regular lanes. The I-95 and 395 Express Lanes, which now run from the Potomac River at the District of Columbia border to the Rappahannock River in Fredericksburg, is the longest reversible road in the U.S., according to Youngkin’s office.

While drivers will be able to use the full 10 miles (16 kilometers) of the extension beginning late Thursday, construction work will continue to build access and exit ramps at several points over the next few months.

Authorities believe the new southern terminus is designed in ways that will minimize backups that often occur at the existing Express Lanes stopping point.

A 2017 study found a segment of I-95 in northern Virginia to be the worst traffic hotspot in the country.

The Newport News School Board approved final design plans for Huntington Middle School on Tuesday night, paving the way for completion in the spring of the 2025-26 school year.

The finalized plans will see Huntington move several blocks south from its current location on 3401 Orcutt Ave. to 28th Street. A city community center will be built there, using Huntington’s historic façade.

Huntington opened in 1936 and was the city’s only high school for Black students for several years, before being turned into a middle school for students in southeast Newport News. It was closed in June 2018 because the building was deteriorating.

During the years of planning for the new school, many Huntington alumni spoke up against relocating the school, preferring that the new building remain at the same location.

On Tuesday, board members were told it would take a minimum of $2.5 million to re-start the planning process to flip the locations of the school and community center, and cause a delay of not less than 8-10 months.

Vice Chair Terri Best, who had opposed the plan to move the school location and had said that alumni and other community members were not heard as they should be, said it was time to move forward.

“At some point in this process, we have to get to a point where we have to make some movement,” Best said before voting for the plan.

She said the board could keep stalling and pushing the decision out, but it was too late to make changes.

“That train has already left the tracks,” she said.

Best and other board members said it would be students who pay the cost of continued displacement from their school if the project continues to stall.

Originally, Huntington was expected to re-open in fall 2024. But numerous delays in the process now place projected opening for spring 2026. Groundbreaking is expected to begin in April after the completion of the bidding process.

The plan was approved in a 6-1 vote.

Douglas Brown, who cast the dissenting vote, said since the beginning of the process the board has been given a plan that was not of its choosing, and told there were no alternatives. He said he promised the community that he would at least find out a figure for what it would cost to flip the plan and allow for Huntington to remain at its current location. Brown said he was not satisfied that the board received a complete answer to that question.

“We’re in a position as leaders and as elected officials, to actually be accountable to citizens to say, ‘Well, how much was it to keep the school where it was?’

“And in five years, I’ve not been able to get an answer to what I consider to be a simple question. That, I think, should be unacceptable to the entire board.”

Since the last update to the board in the spring, the architect added a four-lane, 330-meter track around the school’s multi-purpose athletic field.

Rusty Fairheart, the division’s chief operations officer, told the board that their questions regarding the size of the auditorium and the ability to re-establish a magnet program at the new school were also reviewed.

Fairheart said Huntington’s auditorium will be 5,700-square feet, including a 660-square-foot stage. He said Hines and Gildersleeve middle schools, which both serve more students than Huntington will serve, each have a 3,800-square-foot auditorium with a 500-square-foot stage.

“So we feel that the auditorium is adequate to meet the needs and the capacity of the school,” he said.

Fairheart said additional instructional space has been identified for the possible re-establishment of a magnet program in the building.

The new school is being built to hold 600 students. The design also allows room for expansion if needed in future, Fairheart said.

The revised design plans are expected to be complete by late November, with bid solicitation beginning in January.

Nour Habib, [email protected]

Lacey Pfalz | (TNS) TravelPulse

European countries are some of the most popular destinations of the summer, and many of the cities and destinations facing record numbers of summer travelers are also putting new rules and regulations in place to hopefully curb the negative aspects of too many tourists.

What is overtourism?

The term ‘overtourism’ is getting more popular as destinations begin thinking long-term about their tourism strategies. It often goes hand-in-hand with sustainability initiatives, because having too many tourists than a destination can successfully manage is unsustainable.

Overtourism can lead to housing shortages for locals — in February, Portugal passed laws that restricted the number of Airbnbs allowed in the country after foreigners began outpricing Portuguese locals, causing a housing crisis.

It can also create more traffic, both pedestrian and automotive, as well as lead to greater pollution and litter. Droves of tourists can also be a drain on the residents who live in these destinations, making them less enjoyable places to live full-time.

There have been several announcements made by countries across Europe trying to curb tourism by the millions.

Italy’s Trentino-Alto Aldige region, which saw 34 million overnight visitors in 2022 alone, began capping its visitor numbers in September 2022, significantly reducing the number of overnight visitors it welcomes each year. One of the ways it does this is by capping the number of hotel beds available in the region for travelers.

In June, the heavyweight cruise ship destination and the largest Mediterranean cruise port of Barcelona announced it would be looking for ways to curb the number of cruise ships porting each year. In 2019, it was named Europe’s most polluted port and welcomed over 3 million visitors by cruise ship, many of whom stayed in the city for less than four hours.

In early July, Greece announced that it would be implementing new ways to streamline visitation to the Acropolis. The 3,300-year-old archaeological wonder saw an 80% increase from 2019’s visitor numbers this June and July.

More recently, the city of Amsterdam announced it was banning large cruise ships from docking in the small city, which welcomes 22 million travelers each year. The reasons include incompatibility with its sustainability goals and as a way to curb mass tourism.

According to an article on the subject published by Forbes, the European Union hasn’t yet made an official statement on the matter, though there have been some new initiatives by different countries to discourage travelers from visiting by the millions.

The United Nations’ World Tourism Organization is offering new ways for countries to view sustainable tourism development by focusing on spreading economic and tourism opportunities to rural areas. The organization offers a global list of Best Tourism Villages encouraging travelers to visit, as well as guidelines for nations willing to participate in rural tourism initiatives.

There are some methods that travelers can employ to help be a part of the solution to overtourism.

The biggest method is to think broader: don’t simply visit Paris or London or Rome. Head to the smaller destinations, the less popular locales, and get a taste of a more authentic, less crowded Europe.

You might find you enjoy it better.

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©2023 Northstar Travel Media, LLC. Visit at travelpulse.com. Distributed by Tribune Content Agency, LLC.

“How much is the ice cream?” A simple enough question, featured on a new TV and online advertisement, posed by a man who just wants something cold. A woman behind the counter responds with a smile: “Prices? No, we don’t have those anymore. We have estimates.”

The satirical ad pretends to be a news report highlighting a “trend” in which more retail outlets take up “the hospital pricing method”: substituting estimates for actual prices for the cost of meals, merchandise on store shelves, and clothing. The scene ends with a partially deleted expletive from the ice cream-seeking man.

While the use of estimates in retail settings is imaginary and preposterous, the advertisement is part of an ongoing campaign by the advocacy group Patient Rights Advocate, which contends that some hospitals are still falling short of a law that went into effect in 2021 requiring them to publicly post their prices. Even then, said Cynthia Fisher, the group’s founder and chairperson, too many post estimates rather than exact dollar-and-cent figures.

“People need price certainty,” said Fisher. “Estimates are a way of gaming the people who pay for health care.”

Although government data shows that hospitals’ compliance with price transparency rules has improved, updating the requirements of that law is the focus of a new proposal by the Biden administration, which aims to further standardize the required data, increase its usefulness for consumers, and boost enforcement. Even with all that, however, the goal of exact price tags in every situation is likely to remain elusive.

“We’re closer to that, but we’re not there,” said Gerard Anderson, a professor at the Johns Hopkins Bloomberg School of Public Health, who studies hospital pricing using the data that hospitals have already posted.

The proposed rule is designed to make it easier for consumers to learn in advance exactly what they might owe for nonemergency hospital care — though that was what the original price transparency rules were supposed to do.

Requiring hospitals to post their prices is part of a larger effort to make medical costs less opaque, which could help individual consumers predict their expenses and possibly slow health cost inflation, if it leads employers and insurers to contract with less expensive providers.

But the data files themselves are massive, often hard to find, and complex to decipher.

“Even for us, it’s really hard to use,” said Anderson.

Under current regulations, hospitals must publicly post prices for every service they offer, from drugs to stitches to time a patient spends in an operating room, as well as show all the bundled costs associated with 300 “shoppable” services, which are things people can plan for, such as a hip replacement or having a baby. Several different prices are required, including those they’ve negotiated with insurers and what they charge cash-paying customers.

Similar regulations, but with more prescriptive details and tougher penalties for noncompliance, went into effect for insurance companies in 2022, requiring them to post prices not only for hospital care, but also for outpatient centers and physician services.

The new hospital requirements proposed by the Centers for Medicare & Medicaid Services help “catch up to what they did with health plans,” said Hal Andrews, CEO and president of Trilliant Health, a market research and analysis company.

“It’s a step down the path to making the data more accessible” to data analysis firms that create online price comparison tools, said Jeff Leibach, a partner at the consulting firm Guidehouse. “And, ultimately, consumers who want to shop will then find this data more easily.” Many hospitals, insurers, and third-party data firms have made such cost comparison tools available.

Even the new requirements may not resolve the demand that is central to the dystopian ad’s ice cream-seeking man: getting exact prices, in dollars and cents. Such specificity may remain elusive for some consumers, if only because of the nature of medical care.

“Each patient is unique and uses a slightly different bundle of services,” said Anderson of Johns Hopkins. “You might be in the operating room for 30 minutes, or it might be 45. You might need this lab test and not that one.”

The proposed rule would, for one thing, further standardize the data required so that reporting is more comparable between facilities. It also mandates hospitals make their data sets easier to find on their websites, which could help data aggregators and consumers alike, and puts administrators in the hot seat to attest that their hospitals have posted all the required information accurately.

Individual hospitals that fail to post properly would face additional publicity by federal regulators: “Consider it a public naughty list,” said Marcus Dorstel, vice president of operations at data analysis firm Turquoise Health, which provides an online tool consumers can use to check prices across hospitals.

In addition, the proposal adds a data category awkwardly called “consumer-friendly expected allowed charges,” aimed at giving more information tied to the varied ways hospitals set prices. In plainer language, those allowed amounts are what hospitals expect to be reimbursed by insurance companies.

Some experts say that will be helpful.

For example, Dorstel said, currently a service might not be listed as a particular dollar amount, but the hospital will show the price is based on “70% of charges.”

“Without the expected allowed amount, that doesn’t tell you anything,” Dorstel said.

Still, critics — such as Patient Rights Advocate, the group behind the new ad campaign — say that nodding to such allowed amounts will lead to even more estimates, rather than what they prefer: dollar-and-cent assessments.

“You and I would not buy a blouse at an average estimated amount,” said Fisher.

Health care isn’t like blouses or ice cream, responded executives from the American Hospital Association when asked about the advertisement and Fisher’s concerns about exact, upfront amounts. In many situations, for example, it may be hard to know ahead of time exactly what kind of care a patient will need.

“Very few health services are so straightforward where you can expect no variation in the course of care,” which could then result in a different cost than the original assessment,” said Molly Smith, AHA’s group vice president for public policy. “Organizations are doing the best they can to provide the closest estimate. If something changes in the course of your care, that estimate might adjust.”

While hospitals’ compliance with posting price information has improved, it still falls short, said Fisher, whose group in a July report said only 36% of 2,000 hospitals it reviewed complied with all aspects of the current law, marking as deficient those that had incomplete data fields or used formulas instead of dollar prices.

But the American Hospital Association says Fisher’s group “misconstrues” hospital compliance, in part because hospitals are allowed to leave spaces blank, if, for example, they don’t have a cash-only price. And formulas are allowed if that is how the prices are set.

The hospital group points instead to a CMS report from earlier this year that showed compliance was increasing year over year. It said 70% of hospitals were compliant with the current requirements of the law.

It took some doing to get that far. Since 2021, the federal government has sent more than 900 warning letters to hospitals about their posted data, with most resolving those concerns, according to the proposed rule. Four hospitals have been fined for failing to comply with the transparency law.

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(KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2023 KFF Health News. Distributed by Tribune Content Agency, LLC.

By David Voreacos and Erik Larson, Bloomberg News

Donald Trump and 18 codefendants have fewer than 10 days to turn themselves in for arraignment in Atlanta on charges they engaged in a sweeping criminal operation to keep the former president in office after he lost the 2020 election.

In a 41-count indictment issued this week, 161 specific acts are stitched together under the umbrella of a racketeering statute that spanned remarkable months in U.S. history after President Joe Biden defeated Trump in Georgia.

Fulton County District Attorney Fani Willis uses Georgia’s racketeering statute to tell the story of a criminal organization, allegedly led by Trump, that gave false testimony to Georgia lawmakers, empaneled a phony slate of electors, intimidated poll workers, stole election machine data and beseeched state officials to toss out votes.

As with his previous three indictments, Trump denies all of this as a partisan attack to thwart his bid to run for the White House in 2024. Here are some key dates:

Oct. 31, 2020

Four days before the election, Trump begins the alleged conspiracy by discussing a draft speech with an unindicted co-conspirator that falsely declares victory and alleges voter fraud, which prosecutors say set the stage for coordinated efforts to undermine faith in the results.

Nov. 4, 2020

One day after Trump loses to Biden, the outgoing Republican president delivers the speech to a nationally televised audience, hinting at a constitutional crisis. “The speech was an overt act in furtherance of the conspiracy,” the indictment says.

Nov. 15, 2020

Attention shifts to Georgia, a key swing state. One of Trump’s election attorneys, former New York City Mayor Rudy Giuliani, leaves an 83-second voicemail for another unindicted co-conspirator, making what the indictment says are false statements about election fraud in Fulton County.

Nov. 19, 2020

Giuliani and two other lawyers charged in the case, Jenna Ellis and Sidney Powell, make false statements about voter fraud in Georgia and other states during a televised press conference at the Republican National Committee headquarters in Washington. Their claims about the election being rigged by voting-machine companies is widely mocked but takes root with Trump’s base.

Nov. 20, 2020

David Shafer, the former chair of the Georgia Republican party, who was also indicted, sends an email seeking assistance for Scott Graham Hall, an Atlanta-area bail bondsman, who is “looking into election fraud” on behalf of Trump. Willis alleges Shafer, like the others, knew there was no such fraud.

Nov. 21, 2020

Trump’s Chief of Staff Mark Meadows texts U.S. Representative Scott Perry of Pennsylvania, requesting phone numbers for the speaker and leader of that state’s legislature. This is one of many acts in the indictment that took place in another state but was nevertheless used to show a conspiracy under Georgia law.

Nov. 22, 2020

Trump and Giuliani phone Arizona House Speaker Russell “Rusty” Bowers, a Republican, making claims about voter fraud and pressing him to appoint Trump-supporting electors in the swing state even though Biden had won it. Bowers refused and later testified to the U.S. House Jan. 6 committee that probed the attack on the U.S. Capitol, saying “I would not break my oath.”

Dec. 3, 2020

Attorneys for Trump make the first of three appearances before state lawmakers, making what prosecutors say are false claims about election fraud in an effort to persuade them to reject the state’s “duly elected and qualified presidential electors” for Biden. Claims included that 2,506 felons, 10,315 dead people and 66,248 underage citizens voted illegally. Similar presentations were made in other swing states, too.

“Wow! Blockbuster testimony taking place right now in Georgia,” Trump tweets. “Ballot stuffing by Dems when Republicans were forced to leave the large counting room. Plenty more coming, but this alone leads to an easy win of the State!”

Dec. 6, 2020

Trump and others call RNC Chair Ronna McDaniel to seek the organization’s help coordinating the alleged fake-electors scheme. It would end up involving pro-Trump electors in Georgia as well as six other states: Arizona, Michigan, Nevada, New Mexico, Pennsylvania, and Wisconsin. McDaniel isn’t accused of wrongdoing.

Dec. 7, 2020

Georgia Secretary of State Brad Raffensperger recertifies Biden’s win following a recount requested by Trump’s campaign. That same day, then-Georgia State Senator Burt Jones tweeted a “call to action” that urged Trump’s supporters to contact state lawmakers to sign a petition for a special session of the legislature to ensure “free & fair elections.” Willis was barred by a judge from investigating Jones because he found she had a conflict of interest having hosted a fundraiser for the Democrat who lost to Jones in the 2022 lieutenant governor race.

Dec. 8, 2020

Trump calls Georgia Attorney General Chris Carr and pressures him to support an election lawsuit filed by Texas Attorney General Ken Paxton. The case asks the U.S. Supreme Court to block Georgia, Michigan, Pennsylvania and Wisconsin from casting their collective 62 electoral votes for Biden. On Dec. 12, the Supreme Court rejected the lawsuit, which Trump had called “the big one.”

Dec. 31, 2020

Trump files a federal lawsuit in Georgia accusing election officials of counting illegally cast votes and claiming there was “misconduct” at ballot-counting facilities. His team asks for an “emergency injunction” to de-certify the election results in the state and includes a verification signed by Trump attesting to the truthfulness of the claims. In emails later made public, Trump attorney John Eastman expresses concern about Trump signing it because “he has since been made aware that some of the allegations (and evidence proffered by the experts) has been inaccurate.”

Jan. 2, 2021

Trump makes his infamous phone call to Raffensperger. In a recorded conversation lasting more than an hour, Trump urges him to “find 11,780 votes” — the exact amount needed to win Georgia — and presses several conspiracies that the secretary of state had already debunked. Georgia had already conducted a hand recount of all ballots and found no widespread fraud. Those on the call included Meadows and attorney Cleta Mitchell, who isn’t charged.

Jan. 3, 2021

Harrison William Prescott Floyd, the director of Black Voices for Trump, calls and texts Ruby Freeman, a Fulton County election worker. Floyd also calls Trevian Kutti, a publicist who has worked for musician Kanye West. Freeman later testified to the congressional Jan. 6 committee about the harassment she experienced and came to represent the human cost of the Trump allies’ conspiracy theories.

Jan 4, 2021

Kutti travels from Chicago to meet with Freeman. He tells Freeman he can help her, and they meet at a police station in Cobb County. Kutti and Floyd, who joins by speakerphone, offer protection and help, but instead pressure her to lie. Members of the enterprise “traveled from out of state to harass Freeman, intimidate her, and solicit her to falsely confess to election crimes that she did not commit,” according to the indictment.

Jan. 6, 2021

A mob of Trump supporters attack the U.S. Capitol in a failed attempt to stop Congress from certifying Biden’s victory, fueled by Trump’s claims.

Jan. 7, 2021

Cathleen Latham, Republican party chair in Coffee County, brings bail bondsman Hall to the county elections office to breach election equipment. Powell, Hall, Latham and Misty Hampton, the county’s elections director, agree to copy software and data from the equipment, prosecutors say. Over several more days, unindicted co-conspirators download that data.

The timeline of events is spelled out over 97 pages in the indictment brought by Willis, who took office amid Trump’s effort to stay in power. She opened the criminal probe in February 2021 and it would ultimately last 2 1/2 years, overlapping with a parallel federal investigation. The Georgia case is now one of three Trump faces as he seeks to return to the White House in the 2024 presidential election. He recently has doubled down on his claim that the 2020 vote was rigged — without evidence.

With assistance from Zoe Tillman.

©2023 Bloomberg L.P. Visit bloomberg.com. Distributed by Tribune Content Agency, LLC.

CHESAPEAKE — City Council is discussing the appointment of a permanent city auditor more than two years after the former fiscal watchdog retired.

Jay Poole retired from the role in early 2021 after two decades in the department. Darren Padilla, one of his deputies, has served in the interim role since.

City Council members were unable to agree on the best path forward following Poole’s departure, so they instead opted to rely on a hybrid model, calling on some outside expertise to supplement internal auditing among the four-person department.

But now, City Council members are seeking a permanent appointment, meeting in closed sessions to discuss and interview candidates. In April, the council contracted with Raftelis, a local government consulting firm, to conduct a nationwide search at a cost of $21,900, according to information provided by the city clerk.

Council members Don Carey and Debbie Ritter sit on the Audit Committee. Carey said council members have narrowed their search to three candidates, who are currently being interviewed in closed session meetings.

The department is responsible for conducting performance, financial and special audits of city departments and programs, as well as reviewing city policies and regulations. The department also handles complaints from the city’s fraud, waste and abuse hotline, and works with finance staff on the city’s external audit contract to compile the annual comprehensive financial report.

Carey said he thinks Padilla and staff have done a good job, but his biggest concern has been the city’s lack of urgency to permanently fill the role, particularly because Chesapeake is the second-largest city in the commonwealth. Hiring a permanent auditor also provides stability and security for those working in the department, he added.

“(Chesapeake) should look at itself a bit different than what we have in the past. We are not the ‘little brother city’ of Hampton Roads,” Carey said. “We should have a nationwide search for the best, the brightest, the best leaders, the most competent individuals to fill those seats.”

In 2003, the city auditor position became a council-appointed one similar to the city attorney, city clerk and city manager. Norfolk and Virginia Beach also have city auditors, as do Fairfax County and Richmond.

No formal decision came out of the council’s Tuesday night closed session meeting, but Carey said he anticipates one “very, very soon.” Council members are in the “due diligence” stage of checking on references and candidate backgrounds.

“We have several wonderful candidates that we’re interviewing and I’m confident that council is going to make the right decision,” he said.

Padilla told City Council in a 2022 annual report that the department completed audits for the city’s emergency medical services billing program, and the Community Risk Reduction Operations billing and collections. Follow up audits were also conducted for the city’s police department, central fleet, small purchase policy and economic development. Audits related to health care claims, public utilities credit care and other billing services are also underway.

Mayor Rick West said besides having varying ideas about how to move forward, issues within the City Treasurer’s Office further “complicated” the process and demanded more attention. Since last year, audit services department staff have aided the treasurer’s office, which saw some of its duties moved under the supervision of the city manager in May following years of insufficient staffing and other concerns. With that move, city staff took over the management of city bank accounts, cash and investments and billing services.

Padilla said in the 2022 report released in May that she was “proud of what we accomplished in the past year” and credited the department with being only the second at the time to transition off the city’s aging mainframe system. The continued use of the mainframe system in the treasurer’s office was another concern cited by city leaders before City Council voted to strip the office of certain duties.

“And we want to also assess what we believe the effectiveness of our acting auditor has been,” West added.

It’s unclear whether Padilla is among the candidates being interviewed.

West said the process up to this point has been “a little sloppy” due to different ideas among council about how to move forward, but that council is working together and “getting there.”

Natalie Anderson, 757-732-1133, [email protected]

Oliver Anthony says he’s “still in a state of shock” over the viral success of “Rich Men North of Richmond,” a country song that has been dubbed an ode to the working class, but also an “alt-right anthem” that’s “offensive” and “fatphobic.”

“Rich Men North of Richmond has been uploaded to all major streaming platforms and will show up there in a few days,” the Virginia country-folk singer tweeted last week as his admonition about taxes and working “overtime hours for b— pay” picked up steam online.

“Im still in a state of shock at the outpouring of love I’ve seen in the comments, messages and emails. I’m working to respond to everyone as quickly as possible,” he wrote, sharing a video of himself performing the song.

The Farmville singer — said to be a farmer living off the grid with his three dogs — has quickly racked up 1.9 million streams on Spotify. A video of him performing it that was posted on YouTube by a local indie channel has amassed more than 13 million views in less than a week. The song also hit No. 1 on the all-genre iTunes chart. Anthony’s other songs, “Ain’t Gotta Dollar” and “I’ve Got to Get Sober” have even relegated Jason Aldean’s controversial ballad “Try That in a Small Town” to the No. 4 position on the chart.

Anthony did not immediately respond Tuesday to The Times’ request for comment.

The musician told Rolling Stone, which branded the country song a new favorite for “right-wing influencers,” that he’s a relatively new songwriter who only began to write in 2021 after he “wasted a lot of nights getting high and getting drunk.” In a YouTube monologue he posted days before releasing “Rich Men,” Anthony described himself as nonpartisan, sitting “pretty dead center down the aisle on politics.”

“I remember as a kid the conservatives wanting war, and me not understanding that. And I remember a lot of the controversies when the left took office, and it seems like, you know, both sides serve the same master. And that master is not someone of any good to the people of this country,” he said.

Richmond’s history as a Confederate capital and Anthony’s reproachful lyrics have influenced listeners’ hot takes on the song and on Anthony himself, categorizing the red-bearded musician as a conservative too. However, it’s no surprise that the song’s arrival on the heels of “Try That in a Small Town” and its displacement of Aldean’s song on the charts further steeps the up-and-coming musician in the brewing culture war and the politicization of country music.

“Livin’ in the new world / With an old soul,” Anthony sings. “These rich men north of Richmond / Lord knows they all just wanna have total control / Wanna know what you think, wanna know what you do / And they don’t think you know, but I know that you do / ‘Cause your dollar ain’t s— and it’s taxed to no end / ‘Cause of rich men north of Richmond.”

Prominent conservative figures, including podcaster Dan Bongino and singer John Rich, have lauded the song, joining the voices of those hailing Anthony as an independent phenomenon. “What is a Woman?” documentarian Matt Walsh of the Daily Wire described “Rich Men North of Richmond” as “the protest song of our generation.”

“The main reason this song resonates with so many people isn’t political. It’s because the song is raw and authentic. We are suffocated by artificiality,” Walsh tweeted, vowing to promote any album Anthony releases on all his platforms.

On Sunday, Anthony performed a free show at Morris Farm Market in Barco, N.C., that reportedly generated enough interest to fill 25 acres with cars. (He was also joined onstage by singer-songwriter Jamey Johnson for a duet of Johnson’s 2008 hit “In Color.”) He has repeatedly taken to social media to marvel at the response to the song.

But the fanfare around his single and its viral ascent is being tempered by detractors calling him out for harboring right-wing attitudes, criticizing his take on the so-called elites and, in more extreme cases, accusing him of being an “industry plant” despite appearing to have no music industry backing.

“I wish politicians would look out for miners / And not just minors on an island somewhere / Lord, we got folks in the street, ain’t got nothin’ to eat / And the obese milkin’ welfare,” Anthony sings.

“Well, God, if you’re 5-foot-3 and you’re 300 pounds / Taxes ought not to pay for your bags of fudge rounds /

Young men are puttin’ themselves 6 feet in the ground / ‘Cause all this damn country does is keep on kickin’ them down.”

Others took issue with specific lyrics in the song, some of which allude to convicted sex trafficker Jeffrey Epstein and others that shame people living on welfare.

“This dude Oliver Anthony doesn’t know if he’s mad at the rich men north of Richmond or fat people on welfare. Make up your mind bro,” one user tweeted.

“Nothing says class consciousness like a song where the entire middle verse is about how the poor can’t eat because of obese welfare recipients,” another wrote.

Here are some of the wide-ranging responses:

This story originally appeared in Los Angeles Times.

©2023 Los Angeles Times. Visit latimes.com. Distributed by Tribune Content Agency, LLC.