Philadelphia Daily News/Inquirer. September 7, 2023

Editorial: Fracking is making Pennsylvanians sick. Lawmakers must act.

Studies have repeatedly found the negative health impacts of fracking. Instead of safeguarding their constituents, legislators have ensured the fallout continues.

You didn’t need to be a geologist or any other kind of expert to know from the start that hydraulic fracking was fraught with a host of health and safety questions in Pennsylvania.

Just consider what goes into using the controversial process. Up to 6 million gallons of water treated with toxic chemicals and sand are used to blast through a rock formation known as the Marcellus Shale to extract natural gas. Since the state embraced fracking in 2008, more than 13,000 such wells have been drilled thousands of feet underground.

The gas industry has long claimed fracking is safe but refused to disclose precisely which toxic chemicals are used in the process. It was a risky gambit of trust with no verification.

So, it’s been no surprise that study after study has found one health problem after another. Three recent reports by the state government and the University of Pittsburgh found increased incidences of childhood cancerasthma and low birth weight among those living within 10 miles of natural gas wells.

The studies bolster past research that raised red flags about fracking soon after then-Gov. Ed Rendell unleashed a gas drilling gold rush in 2008 by opening 2.2 million acres of state forests to Big Oil and touting the jobs and revenue that would pour into state coffers.

Within a year, a series of water-contamination problems, including methane leaks, affecting drinking water in seven counties were linked to gas drilling in Pennsylvania.

In 2010, an HBO documentary titled Gasland detailed the health and environmental dangers from fracking, including the alarming image of a woman in the small town of Dimock, Pa. — about an hour’s drive north of Scranton — lighting tap water from her faucet on fire because it contained so much methane.

Despite the health concerns, Pennsylvania lawmakers looked the other way as the gas industry spent more than $60 million on lobbying and campaign contributions over a seven-year stretch. The flow of money kept lawmakers from imposing a severance tax on gas drilling, making Pennsylvania the only state without such a tax.

Harrisburg’s embrace of fracking is a shameful study in contrast to what happened when lobbyists came knocking in New York. In 2010, the New York State Assembly approved a temporary moratorium on fracking. Four years later, then-Gov. Andrew Cuomo issued an executive order that banned fracking because of health concerns. State lawmakers in Albany codified the ban in 2020.

What did New York know that Pennsylvania lawmakers either didn’t or willfully ignored?

Instead of safeguarding their constituents, legislators ensured that the fallout from fracking continues to impact Pennsylvanians. A 2015 study by researchers at Johns Hopkins University found that pregnant women living near fracking wells experienced more premature births and high-risk pregnancies.

A 2016 study, also by Johns Hopkins, found that people living near active gas wells were up to four times likelier to have asthma attacks. A 2020 study tied air pollution from fracking to deaths in Pennsylvania.

And what about the unnamed toxic chemicals used in the fracking process?

In 2021, it was disclosed that the Environmental Protection Agency long ago approved the use of so-called forever chemicals in fracking, which have been linked to a variety of cancers as well as asthma, low birth weight, and other health problems.

And what became of the residents in Dimock who could light their water on fire?

After long denying responsibility, Houston-based Coterra Energy Inc. pleaded no contest last year to criminal charges of drilling faulty gas wells that leaked flammable methane into residential water supplies. Coterra agreed to pay more than $16 million to build a new public water system and pay the impacted residents’ water bills for the next 75 years.

That plea deal was the result of criminal charges filed in 2020 against Coterra’s corporate predecessor, Cabot Oil & Gas Corp., by then-Attorney General Josh Shapiro. But in a shameless and irresponsible twist, the day after announcing the deal, the state Department of Environmental Protection lifted a 12-year ban and agreed to allow Coterra to resume drilling in Dimock.

At the time, Shapiro said the gas driller “damaged our environment, harming our water supplies and endangering Pennsylvanians.” The same could be said of the lawmakers and environmental officials who continue to enable the fracking industry.

Now that Shapiro is the governor of Pennsylvania, will he protect residents or the fracking industry?

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Pittsburgh Post-Gazette. September 12, 2023

Editorial: Pa. should ban insurance practice that shifts costs onto vulnerable patients

If there’s one constant in the American health care system, it’s that the patients never win. And in the case of so-called “copay accumulator” programs, the victims are generally the most vulnerable patients of all: those with rare and chronic diseases who require specialty drugs.

The reason copay accumulators exist, however, is to defend against a drug manufacturer practice that unilaterally, and arguably unfairly, shifts costs onto insurers. It’s all part of the shell game that is the American health care system.

A 2020 decision by the Centers for Medicare and Medicaid Services permitted these programs, which moves some of the cost of expensive treatments back onto patients. Since then, 19 states have banned them on state-regulated plans.

Pennsylvania should join them. But copay accumulators didn’t arise out of nowhere: They are a response to the complicated and perverse incentives built into American health care. And they shouldn’t be understood as an attack by health insurers on their customers, but as those customers getting caught in the crossfire between insurers and drug manufacturers.

Copay accumulators are insurers’ response to a drug manufacturer practice called “copay assistance.” These assistance programs offer patients, especially those with rare and chronic conditions that require expensive ongoing treatment, discount coupons that defray much of the annual cost of their drugs.

This makes the manufacturers look generous, but those manufacturers then turn around and bill insurers for the full sticker price. A time-consuming negotiation ensues — the kind of tedium that makes American health care so convoluted and expensive — and insurers often end up on the hook for more than they would have been otherwise, raising their costs and the cost of insurance generally.

Copay accumulators undercut copay assistance by not counting the value of the coupons against a patient’s annual deductible or out-of-pocket maximum. Therefore, when the coupons run out for the year, the patient still has, usually, thousands of dollars to pay until coinsurance — the health plan’s share of cost-sharing — kicks in. Every organization in the country that advocates for patients with unusual or chronic conditions, from AIDS to cancer to immune deficiency syndromes, strongly opposes copay accumulators, because they shift costs back to those who can least afford them: the patients themselves.

Banning copay accumulators, by requiring that all copay assistance count toward deductibles, essentially rewards drug manufacturers and punishes insurers: It allows the manufacturers the upper hand in the cost-shifting shell game. But it protects vulnerable patients from getting caught in the crossfire, and so is the right thing to do. Of patients in states that have not banned the practice, around 80% are on copay-accumulator plans.

Nearly three years ago, state Sen. Judy Ward, R-Blair, and now-former Sen. John P. Blake, D-Lackawanna, introduced a bill that would bring Pennsylvania in line with the growing number of states banning copay accumulators. We hope Ms. Ward will reintroduce this bipartisan bill this session.

But it’s important to remember that arcane practices like copay accumulators are a symptom of a much more extensive condition: a convoluted health care system that lacks all compassion and good sense, and in which patients are always the losers.

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Pittsburgh Tribune-Review. September 9, 2023

Editorial: Why are prisoners escaping county jails?

What’s up with all the prison escapes?

Pennsylvania has seen a number of high-profile incidents in 2023 when someone in custody has gotten free and gone on the lam.

As of Friday, one was still ongoing. Danelo Cavalcante, 34, is a Brazilian native convicted of murdering his ex-girlfriend. He was given a life sentence in August and was waiting to be transferred to a state correctional facility when he broke out of Chester County Prison. The hunt for Cavalcante — who is also wanted in Brazil in connection to another killing — has gone on for more than a week, blocking roads and swarming the suburban Philadelphia area with police.

But these things happen. You can’t predict that someone might shimmy up a wall like a Cirque du Soleil acrobat.

Well, actually, you can when it happened at the same prison just three months earlier. Another inmate, Igor Bolte, did the same spider-like climb in May. His escape didn’t go as easily, and he was back in custody within hours.

Then, there were the two inmates who cut their way out of Philadelphia Industrial Correctional Facility — also in May. Ameen Hurst was missing for more than a week. Nasir Grant was back behind bars in days.

It doesn’t just happen in the Greater Philadelphia area. In July, Michael Burham spent more than a week in the woods after escaping Warren County Prison in the most cliched way possible — with a rope made of sheets.

Maybe part of the problem is the terminology. The word “prison” is usually associated with state or federal facilities that may have more layers of security than a county jail. Pennsylvania prisons aren’t called prisons, but “state correctional institutions.” More county lock-ups are using the prison moniker. It can’t be ignored that these notable manhunts have all involved county inmates.

But manpower seems like the obvious countermeasure. State and county corrections operations have been noting the need for more staff for years. Both Allegheny and Westmoreland counties have noted low numbers, as has the union representing state corrections workers.

In 2022, John Eckenrode, president of the Pennsylvania State Corrections Officers Association, called the low numbers a crisis, as well as a danger to both employees and communities.

With four such conspicuous escapes of five prisoners in three months, that seems prescient. It also seems like only a matter of time before another such incident — and before there is a serious consequence.

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Scranton Times-Tribune. September 12, 2023

Editorial: Commission must focus on fairness

In approving the new state budget, lawmakers and Gov. Josh Shapiro took a pass on complying with the historic Commonwealth Court decision earlier this year, which found that the government’s distribution of education funding shortchanges poorer districts and is unconstitutional.

But today in Allentown, the 15-member Basic Education Funding Commission will conduct the first of 10 scheduled public hearings on how to fix the flaws cited by the court.

The Legislature adopted a “fair funding formula” in 2015 but immediately rendered it unfair. It also decided to apply the formula only to money appropriated above the 2015 baseline, so that today only about 14% of state basic education funding is distributed according to the fair formula.

The consequences are profound. The Scranton School District alone, for example, would receive an estimated $30 million more every year if the formula applied to all state education funding.

It is encouraging that the first witness will be Matthew Kelly, a Penn State University professor and public school funding expert whose analysis was instrumental in the Commonwealth Court decision. He plans to present a new study of the funding disparities.

The commission comprises 12 legislators — six of each party from both houses — and three members appointed by the governor. Its schedule is to complete its work by November, which is ambitious, but its true target is February so that Shapiro would be able to include proposed solutions in next year’s budget proposal.

Plaintiffs who brought the Commonwealth Court case contended that the state would have to come up with about $4.5 billion a year to meet the fair funding mandate. This year the budget includes a $567 million increase in basic education funds and some additional money in “level-up” funding for poorer districts.

Democratic Rep. Mike Sturla of Lancaster, a commission member, had it right when he said the most important issue for the commission should be truly fair distribution of whatever the budget makes available, rather than a focus on any particular number. The Legislature can increase funding over time, but the distribution issue should be the immediate focus for the next budget.

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Uniontown Herald-Standard. September 9, 2023

Editorial: Suicide prevention more urgent than ever

Sunday marks the beginning of National Suicide Prevention Week, and the need to stop individuals from taking their own lives is more urgent than ever.

In August, the Centers for Disease Control and Prevention released preliminary data on suicides in the United States in 2022, and the agency found that close to 50,000 people died by their own hand last year – the highest number on record. That’s 15 people per 100,000, making it the 11th leading cause of death in the United States, just ahead of influenza and pneumonia. Generally, suicide rates in the United States have been steadily increasing for the last 15 years.

The data indicated that the old were more likely to take their own lives than the young, with suicide among those aged 65 or older seeing the greatest increase. And more than half of the suicides in 2022 were carried out with guns. The Center for Gun Violence Solutions at Johns Hopkins University has reported that the number of suicides where guns were used increased by 10% between 2019 and 2021, just as the number of suicides that did not involve guns fell by 8%. Thousands and thousands of Americans die every year from gun-related injuries, and usually more than half of those are self-inflicted.

What is the reason for the increase? Experts point to such eternal problems as loneliness, substance abuse, and economic uncertainty, the latter of which was exacerbated as a result of COVID-19. It’s been said that the United States is in the midst of a mental health crisis, and a recent survey by the Kaiser Family Foundation found that 20% of adults in the country described their mental health as being just “fair” or “poor.”

Robin Lee, an epidemiologist with the National Center for Injury Prevention and Control, told The New York Times, “Suicide is complex and is rarely caused by a single issue.”

When someone you know or love dies as a result of suicide, it’s perhaps inevitable to look back and see what clues there might have been in the weeks and months beforehand. Experts say that warning signs to look out for include out-of-the-ordinary behavior like giving away valued possessions, flashes of anger or agitation, mood swings, not sleeping well or sleeping too much, talking about being a burden or straightforwardly talking about suicide. A family history of suicide can also increase the chance that someone will try to take their own life.

Last year, a simple, three-digit suicide and crisis national hotline – 988 – was put in place. If people who are feeling suicidal dial text those three numbers, they can be connected to a licensed counselor who can offer help and guidance. Resources are also available at SpeakingOfSuicide.com.

And while the week ahead is National Suicide Prevention Week, trying to reduce the suicide rate is something that requires care and vigilance every week of the year.

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