Fact Sheet: Affordable Care Act Repeal

Despite the fact that only 26 percent of Americans support repealing the Affordable Care Act, or ACA, congressional Republicans currently plan to repeal much of the ACA early next year.1 In addition, they plan to delay the implementation of this repeal by three years since they do not yet have a specific replacement.2

ACA repeal and delay would cause chaos

Congressional Republicans can do this with a majority vote through the budget reconciliation process. This reconciliation bill would repeal the ACA’s premium tax credits, Medicaid expansion, the penalties associated with the individual mandate and employer mandate, and many other smaller provisions.

  • The Congressional Budget Office, or CBO, estimates that in the absence of a replacement, this bill would result in 22 million people becoming uninsured.3
  • The CBO also writes:

Repealing the subsidies and mandate penalties established by the ACA while leaving in place the insurance market reforms would result in a less healthy population in the nongroup market and correspondingly higher average premiums. In addition, the market for nongroup insurance, particularly in smaller states, could become unstable, leading to very low to no participation by insurers and consumers.4

  • The Urban Institute estimates that this near market collapse would cause an additional 7.3 million people to become uninsured, for a total of 29.8 million people losing coverage.5
  • The bill would also include a massive tax cut for the rich by cutting taxes on people earning more than $200,000 per year by $346 billion.6
  • Only 26 percent of Americans support ACA repeal.7 Furthermore, 42 percent of these repeal supporters oppose the repeal-and-delay approach and want congressional Republicans to wait until they have a replacement plan before they repeal the ACA. Only 5 percent of all Americans specifically prefer the repeal-and-delay approach.

Instead of a smooth transition, repeal and delay would quickly cause chaos in the marketplace and potentially lead to a market collapse.8 This is because insurers must make decisions soon on their proposed premium rates and marketplace participation in 2018. If they do not have certainty this spring about the state of the marketplace in 2018, many will exit the marketplace after 2017.

Many experts warn that this will cause market chaos sooner than congressional Republicans think:

  • Robert Laszewski, health insurance consultant: “Insurers have got to put their products together this spring, and we’re right in the middle of killing Obamacare. Are they going to submit proposals to sell in 2018? Why would they stay in the pool?”9
  • Philip Klein, Washington Examiner: “There’s no guarantee that insurance companies will continue to participate in Obamacare over the next several years knowing that the law is going to be repealed.”10
  • Topher Spiro, Center for American Progress: “A repeal that kicks the can on replace would put the market in serious jeopardy, and the American people will hold them accountable for the results.”11
  • Larry Levitt, Kaiser Family Foundation: “Think of ACA repeal first, replace later like musical chairs. When the music stops, no insurer wants to be the one with the sick enrollees.”12

Massive cuts to Medicaid

In addition to repealing Medicaid expansion, congressional Republicans have signaled their interest in massively cutting Medicaid spending by converting it to a block grant.13

  • Currently, the federal government matches a certain share of states’ Medicaid costs, with states covering the rest. Under a block grant, federal funding for Medicaid for each state would be capped and reduced significantly over time, pushing states to cut eligibility, reduce benefits, and raise costs on beneficiaries.
  • By the 10th year of block grants under the House Republican budget plan, federal Medicaid funding would be slashed by one-third relative to current law.14
  • Ultimately, an estimated 14 million to 20 million Medicaid beneficiaries would lose coverage under block grants.15

Thomas Huelskoetter is a Research Associate for the Health Policy team at the Center for American Progress.


  1. Ashley Kirzinger, Elise Sugarman, and Mollyann Brodie, “Kaiser Health Tracking Poll: November 2016” (Menlo Park, CA: Henry J. Kaiser Family Foundation, 2016), available at http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-november-2016/.
  2. Robert Pear, Jennifer Steinhauer, and Thomas Kaplan, “G.O.P. Plans Immediate Repeal of Health Law, Then a Delay,” The New York Times, December 2, 2016, available at http://www.nytimes.com/2016/12/02/us/politics/obamacare-repeal.html.
  3. Congressional Budget Office, “Re: Budgetary Effects of H.R. 3762, the Restoring Americans’ Healthcare Freedom Reconciliation Act, as Passed by the Senate on December 3, 2015” (2015), available at https://www.cbo.gov/sites/default/files/114th-congress-2015-2016/costestimate/hr3762senatepassed.pdf.
  4. Ibid.
  5. Linda J. Blumberg, Matthew Buettgens, and John Holahan, “Implications of Partial Repeal of the ACA through Reconciliation” (Washington: The Urban Institute, 2016), available at http://www.urban.org/sites/default/files/publication/86236/2001013-the-implications-of-partial-repeal-of-the-aca-through-reconciliation.pdf.
  6. Nicholas Bagley, “The rich are about to get a big tax cut,” The Incidental Economist, December 6, 2016, available at http://theincidentaleconomist.com/wordpress/the-rich-are-about-to-get-a-big-tax-cut/.
  7. Kirzinger, Sugarman, and Brodie, “Kaiser Health Tracking Poll.”
  8. Topher Spiro and Thomas Huelskoetter, “Republican ACA Repeal Bill Would Unravel the Market Even Before It Goes into Effect” (Washington: Center for American Progress, 2016), available at https://www.americanprogress.org/issues/healthcare/reports/2016/11/16/292394/republican-aca-repeal-bill-would-unravel-the-market-even-before-it-goes-into-effect/.
  9. Sarah Kliff, “Obamacare ‘repeal and delay’ won’t work,” Vox, December 1, 2016, available at http://www.vox.com/2016/11/17/13665184/obamacare-repeal-delay.
  10. Philip Klein, “Repeal and delay won’t work,” Washington Examiner, December 1, 2016, available at http://www.washingtonexaminer.com/article/2608673.
  11. Adam Cancryn and Paul Demko, “Obamacare repeal plan stokes fears of market collapse,” Politico, November 21, 2016, available at http://www.politico.com/story/2016/11/obamacare-repeal-market-collapses-231653.
  12. Larry Levitt, “8:15 a.m., November 15, 2016,” Twitter, available at https://twitter.com/larry_levitt/status/798529807168536576.
  13. Edwin Park, “Medicaid Block Grant Would Slash Federal Funding, Shift Costs to States, and Leave Millions More Uninsured” (Washington: Center on Budget and Policy Priorities, 2016), available at http://www.cbpp.org/research/health/medicaid-block-grant-would-slash-federal-funding-shift-costs-to-states-and-leave.
  14. Ibid.
  15. John Holahan and others, “Medicaid and the Uninsured: National and State-by-State Impact of the 2012 House Republican Budget Plan for Medicaid” (Washington: The Henry J. Kaiser Family Foundation, 2012), available at https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8185-02.pdf.

The key to Your Health Could Be in Your ZIP Code

In January 2015, President Obama launched the Precision Medicine Initiative, a plan to support research into treatment and prevention strategies that take differences between people – especially genetics – into account.

However, precision medicine can’t just look gene-deep. Where we live – the air we breathe, the water we drink, the environments around us – has a huge impact on our health and even on our DNA.

As a professor of environmental health sciences, epidemiology and medicine and codirector of the Joint Geisinger-JHSPH Environmental Health Institute (EHI), I have been working with electronic health record data to link such environmental issues as animal feeding operations, agricultural practices, unconventional natural gas development and the built environment to such outcomes as drug-resistant infections, diabetes and asthma control, pregnancy outcomes and obesity. Working with Dr Annemarie Hirsch, an epidemiologist in the EHI, we are seeking to discover how to translate these findings into the delivery of more precise clinical care.

Understanding more how our environment and social conditions shape our health could lead to better treatments and better preventive care. But two problems stand in our way before we can do this. The first is that these data aren’t being collected. And if we were to start collecting them, health care providers wouldn’t know how to use them.

Biology isn’t the only thing that makes us different

We know that our genetics can shape our health, but so can three other important factors. These are social determinants of health and community social and physical environments.

Social determinants of health include income, poverty and inequality. The social environment includes things like crime rates and the affluence of your neighborhood. When we talk about physical environment, we’re talking about whether your neighborhood is designed to be walkable, has access to healthy foods or has heavy industry.

These factors can affect your health in direct and indirect ways. For instance, breathing in a poison from a factory can directly cause asthma or cancer. Living in a neighborhood with access to healthy food within walking distance of your house can indirectly benefit your health.

In fact, many studies have documented that these three factors have a more powerful impact on health than do the individual biologic differences between people. For instance, income and educational attainment are at least as strongly associated with hypoglycemia in patients with diabetes as known clinical risk factors. Individuals living in neighborhoods with limited healthy eating and physical activity resources have a higher risk of being diagnosed with type 2 diabetes.

Dr Risa Lavizzo-Mourey, president of the Robert Wood Johnson Foundation, has stated that: “We know that a child’s life expectancy is predicted more by his ZIP code than his genetic code.”

That’s not an overstatement. There are dramatic differences in life expectancy across the United States depending on where you are born. The highest-longevity places tend to be in the Northeast and West and the lowest in the South. While genetics and health care are critical, others have argued that “ZIP code, race, and class trump genetics and healthcare as predictors of health.”

Cracking the ZNA code

Dr Francis Collins, NIH director, recently tweeted that our ZIP code at birth is our “ZNA, “the blueprint for our behavioral and psychosocial make-up,” critical determinants of health.

Recent technological advances in geographic information systems (GIS), including digital software, maps and longitudinal data sets on socioeconomic and environmental factors, can be used to describe multiple aspects of an individual’s community and environment. Just like we can sequence a person’s DNA, we could use this data to sequence our “ZNA” from birth to death.

As electronic health records (EHR) become more common, it is possible to link new data collected about environment with patient medical records. And that link has relevance to clinical care and research, and perhaps most importantly, allows an increased focus on prevention.

We spend more on treating disease than on preventing it

In the US, health spending accounts for 17% of gross domestic product, among the highest of any country in the world. But US health outcomes rank in the middle of the pack for western industrialized economies. This disconnect between health care spending and outcomes has often been explained as the difference between clinical medicine and public health.

We spend much more on delivery of clinical services, often at the end of life to very sick patients, than we do on public health. Public health focuses on the health of a whole population, and often on preventing illness from happening in the first place. In trying to achieve its goals, public health considers social determinants of health and social and physical environments.

That’s because the causes of disease are often more strongly rooted in factors outside the health care system – like where we live, what we eat, the air we breathe. But the health care system and its providers do not know about these community, economic, environmental, behavioral and social causes of disease. Right now information is not typically collected nor sought about them.

These data are important, but we aren’t ready to collect them yet

Making sure this valuable information is collected and integrated into routine care could help solve that disconnect. But there are many hurdles to proposals for putting this information into use.

Right now health care providers don’t get paid for collecting, documenting or using these data. And medical training and clinical care guidelines do not yet teach providers how to incorporate these factors into care, so they would need instruction on what to do with this new social, environmental and community information.

And most clinical risk models do not include environmental, community or social determinants of health. Researchers have noted, for instance, that the Framingham Risk Score, which is used to predict risk of coronary heart disease, leads to underdiagnosis of cardiovascular disease in populations of low socioeconomic status (SES), because it doesn’t take SES into account. But integrating SES and other determinants of health in established risk calculators and clinical protocols will require investments by health care systems.

Policymakers and scientists are already meeting to develop a large-scale effort in response to the Precision Medicine Initiative. We believe that it is critical that community, economic, environmental, behavioral and social determinants of health are part of these discussions.

Mr. Freddie James Dice

Mr. Freddie James Dice

Mr. Freddie James Dice

Funeral services for Mr. Freddie James Dice of Americus, Georgia will be held on Saturday, November 28, 2015 at 11:00 A.M. at the Perry Grove Baptist Church in Leslie, Georgia with Evangelist Sara Dice officiating. Burial will follow at the Eastview Cemetery in Americus, Georgia.

Mr. Freddie (Frederick) James Dice affectionately known as Fred was born in Sumter County, Georgia on May 4, 1952 to the parentage of the late Willie Dice Sr. and Mattie B. Dice. He was educated in the Public school of Sumter County.  At an early age he joined the Perry Grove Baptist Church under the leadership of Rev. H. L. McGruder.  After graduating he enlisted in the Army in 1972, he served for twenty years.  He was married to Joyce Dice. “Fred” worked at the Country Club for ten years, and later went to Magnolia Manor and worked for twelve years in dietary. He was preceded in death by three brothers; Willie Dice Jr., Bobby Dice, and Robert Charles Dice. Fred died peacefully on Tuesday, November 24, 2015 at his home in Americus, Georgia.

He leaves to mourn his passing a wife, Joyce Dice; two brothers: Edward Dice of Americus, GA and Torryce Dice of Forest Park, GA; three sisters: Deborah Dice and friend Charles Gordon of Americus, GA, Melinda (Charles) Johnson of Forest Park, GA and Imogene Dice and friend Patrick of Forest Park, GA; an uncle, John L. Dice of Miami, FL; two aunts: Bertha Dice of Americus, GA and Bobbie Player of Miami, FL; four nieces: Valerie Dice, Koris K. Dice, Yasmine Gordon, and Niesha T. Johnson; six nephews: Corey Johnson, Nicholas Johnson, Mario Dice, Tarvaris Dice, Baraka Dice and Edward Dice Jr., and a host of other nieces, nephew, cousins, other relatives and sorrowing friends including a very devoted friend, Becky Dice.

Henry Lee Lusane, Jr.

Henry Lee Lusane, Jr.

Henry Lee Lusane, Jr.

Funeral services for Veteran Henry Lee Lusane, Jr. affectionately known as “PoPo” will be held on Saturday, November 21, 2015 at 11:00 A.M. at the Zion Hope Baptist Church with Rev. George F. Monts officiating. Burial will follow at the Eastview Cemetery.

Henry Lee Lusane, Jr. affectionately known as “PoPo” was born on October 23, 1963 in Sumter County, Georgia to the late Mrs. Doris Gray Lusane and Mr. Henry Lee Lusane, Sr. He was educated in the Sumter County School System. Henry was a long time employee at Cooper Lightning and a Master Barber at Mercer’s Barber Shop for twenty plus years. He was employed at Dorothea’s Beauty Salon.

He was a veteran of the Georgia National Guard C Co. 2nd BN 121st Infantry and served in Desert Storm. He was also a long time member of the American Legion Post #558. Veteran Henry Lusane, Jr. departed this life at home on Wednesday, November 18, 2015.

He was preceded in death by his daughter Erica Katrina Lusane and his son Clifton Leon Lusane. Veteran Lusane leaves to cherish his memory, his wife Angelia Denise Lusane (Johnn’Angelia); two daughters: Keandra Lusane (Christopher) and Octavia Lusane-Williams (Kahraccus); a son Henry Lee Lusane III; two grandsons Korneal “Kash” Barker and Kaden Williams; siblings: Dorothea Lusane-McKenzie (Ulysses), Mary Margaret Lusane Cross (Kenneth), Tracy Lusane Finch (Eric, Sr.), Monica Lusane (Tangalia), Marcus Wayne Lusane, Sr. (Tiffany) and Ann Lusane Smith (Ernest); a host of nieces, nephews, cousins, other relatives and friends also survive




Mrs. Mary Louise Walton was born on November 18, 1930 in Buena Vista, Marion County GA to the parentage of the late Mr. James Neal and the late Ms. Eula Mae Sampson. Sister Walton was employed with West Central Ga Headstart and retired after 40 years of service. Sister Walton love the Lord and believed in Jesus. She was not confined to building but believed in her Street Ministry and going to the people rather than the people coming to her.  She was the host of the Full Gospel of the Living Truth. For the past 40 years. She also held bible study in her home  every 2,4,5th for the past of 40 years and the prison ministry ministering the lest and the lost. She also ministered through out this community, Magnolia Village and other areas of the community and many ministers were saved in her home. She was active during the civil right movements and participated in marches in 1965. She was an avid donator to the St. Jude Children, Veterans Affairs, Americus Cancer Society and to other TV and radio ministries to keep the word going forth.  In additions to her parents 3 children preceded her in death, Willie James Sampson, Cynthia Davis Walton and Juanita Walton.

She leaves to mourn her passing one son, Leonard Walton, Jr. Americus, GA, three daughters, Margo Mitchell, Columbus GA, Karen Walton and Bernadine Brown, Americus, GA; her grandchildren, Michelle Sampson (William) Ellerby,  Latasha Brown, Taurus Sampson, Arailyus Kingdom, Nakia  Mitchell, Christopher Leonard Williams, Xavier Brown, Malik Brown, & Wellington Leonard Walton; her 5 great grandchildren, Christian Battle, Nickolas Battle, Darion Latrell Mitchell, Myrikal Mitchell and Willaim Mitchell Ellerby III and a host of nieces nephews cousins and other relatives also survive

Veteran McArthur Scott



Veteran McArthur Scott was born in Americus, GA on April 26, 1951 to the late Mr. Arthur Daniel Scott and Mrs. Ozie Scott, who survives.  As a child, he joined the Bethesda Baptist Church under the leadership of the late Rev. R. L. Freeman.  McArthur was graduated from Americus High School in the class of 1969, one of the first to integrate the public schools of Sumter County, GA.  He attended Georgia Southwestern State University before going on the United States Navy, where he devoted 20 years to the service of his country.  After traveling the world, he and his family returned to Georgia, making their home in Athens.  McArthur worked in the U S Postal Service in Athens for over 12 years where he served as the Union Steward.  He was married to his wife, Daisy for 42 years.  They were the proud parents of five children.  One infant son, Jonathan, precedes him in death.

In addition to his mother, Minister Ozie Scott, Americus, GA and his wife Daisy Scott of Athens, GA, McArthur is survived by 2 sons, Michael Scott, Hayward, GA and Adrian McArthur Scott of Athens, GA;  2 daughters, Danita Scott, Atlanta, GA and Regina Ginee’ Scott of Athens, GA;  1 sister, Ms. Ruth Gates, Palm Gardens, Fla.; 2 aunts, Mrs. Jeanette Statum, Americus, GA and Mrs. Deloris Berry, Gary, IND; 3 uncles, Mr. Lang Statum, Atlanta, GA, Mr. Willie H. (Fatima) Statum, San Antonio, TX and Mr. James Statum, Boston, MA;  1 sister-in-law, Ms. Cynthia Scott, Atlanta, GA;  5 brothers-in-law, Rev. Jimmy (Julia) Scott, Mr. Eddie Mitchell, Mr. Lorenzo (Wanda) Scott and Mr. Leon (Stephanie)Scott all of Atlanta, GA and Mr. Julius (Blanch) Scott, Winder, GA;  his best friend and cousin, Mr. Fred Williams, Americus, GA; The Scott, Cutts and Statum families; a host of lifelong friends and classmates; numerous other relatives and friends also survive.

Vanessa Michelle Mosley

Vanessa Michelle Mosley was born in Sumter County, Georgia on September 25, 1962, to the late Mary Amos and Arthur “AJ” Mosley. At the age of fourteen, she joined St. John Baptist Church. She attended Lee County High School and graduated in 1980. She continued her education at Albany Vocational Technical /College earning a Marketing Management diploma in 1992. She was devoted to the Lupus Chapter of Albany and Atlanta, GA and the Lee County High School Class of 1980. Her church and family were always her devotional daily guide. Ms. Mosley departed this life on December 5, 2015, at Emory St. Joseph Hospital, Atlanta, Georgia.

She leaves to cherish her memory, four brothers, Jessie (Gladys) Timmons, Willie Walker, Calvin (Rosemary) Jones, all of Leslie, GA, and Arthur Mosley of Bay Shore, NY; five sisters, Allena Allen of Bay Shore, NY, Annie Carter of Fayetteville, NC, Mary Lee (Leroy) Preston of Stone Mountain, GA, Sylvia Amos of Palmer Lake, CO and Veatrice Harvey of Leslie, GA; five aunts, Hilda Dozier, Pauline Henderson, Sally Mosley of Albany, GA, Kate (Marvin) Simmons of Leesburg, GA and Carrie Mae Mosley of Smithville, GA; and a host of nieces, nephews and friends.

Mr. Ernest James Griffin, Jr

Ernest James Griffin, Jr

Ernest James Griffin, Jr

Mr. Ernest James “Snook” Griffin, Jr., age 68, 259 Georgia Highway 49 South, Americus, Georgia passed Thursday morning, December 3, 2015 at Gentiva Hospice IPU, Columbus, Georgia.

The funeral service will be conducted at 1:00 P.M., Saturday, December 12, 2015 at Jerusalem Grove Baptist Church, Smithville, Georgia, where Reverend Ricky Cladd is pastor.  Bishop Dr.  Melvin McCluster of Friendship Missionary Baptist Church will officiate.  Interment will follow in Eastview Cemetery, Ashby Street, Americus, Georgia.

Mr. Ernest James Griffin, Jr., better known as “Snook,” was born in Sumter County, Georgia on April 7, 1947 to the parentage of Ernest Griffin, Sr. and the late Louise King Griffin.  Ernest was a people person, for he loved his family and was always telling jokes that kept you laughing.  He received his education in Sumter County School System.  He joined First Bronwood Baptist Church in Bronwood, Georgia at an early age.  He was preceded in death by his mother, Louise King Griffin, and a brother, Connie Will Griffin.  After 30 dedicated years of service, he retired from Davison Rubber Company as a press operator.

Ernest leaves to cherish his memories to his loving children, Marsha Griffin Robinson (Jamie), Karen Griffin Reddick, both of Americus, Georgia, and Courtney Griffin, Albany, Georgia; a father, Ernest Griffin, Sr., Americus, Georgia; seven grandchildren, Shawn Robinson, Jr., Fort Valley, Georgia, Larayshia Reddick, Johnisha Johnson, Naykhia Reddick, and Kanorris Reddick, all of Americus, Georgia, Elaysia Stewart, and Elysia Stewart, both of Albany, Georgia; four great grandchildren, Cedric Gatewood, Jr., Carlie Gatewood, Jayden Johnson, and Leah Gatewood, Americus, Georgia; four sisters, Peggy Patterson (Will), Akron, Ohio, Shirlean Adams, Americus, Georgia, Pearline G. Marlin (Harold), Albany, Georgia and Joyce A. Dice, Midland, Georgia; one brother, Albert D. Griffin, Americus, Georgia; a host of nieces, nephews, other relatives, cousins, and devoted friends.

Alvin Moses Baisden

Alvin Moses Baisden was born February 24, 1954 in Ellaville Schley County, Georgia to the late Charlie Alonzo Baisden and Cora Bell Hopkins Baisden. Three siblings, Charles Albert Baisden, Willie Chester Baisden, and Danny Gene Baisden, preceded him in death.

He was a 1975 graduate of John Lewis High School. He was a member of the Concorde Holiness Church of Ellaville under the leadership of Reverend William Blue.

Survivors are four siblings, Eddie James Baisden (Tawona) Ellaville, Georgia, Enoch Baisden, Atlanta, Georgia, John Baisden, Atlanta, Georgia and Evens Leon Baisden (Rose) Americus, Georgia; aunts and uncle, William Smith (Lorene) Ellaville, Georgia, Jessie Hospkin, Americus, Georgia, Anita Sellars, Macon, Georgia, and Mary Dean Smith, Brooklyn, New York; a host of nieces and nephews, including a devoted niece, Felisha Ann Mason.

Leonard Charles Spencer

Leonard Charles Spencer

Leonard Charles Spencer

Funeral services for Mr. Leonard Charles Spencer, affectionately known as “L.C.” will be held on Saturday, December 12, 2015 at 11:00 A.M. in the Chapel of West’s Mortuary in Americus, Georgia with Bishop Henry J. Moore, Jr. officiating. Burial will follow at the Eastview Cemetery.

Leonard Charles Spencer, affectionately known as “L.C.” was born on August 20, 1942 in Sumter County, Georgia to the late Edward Ford and the late Doshie Mae Spencer. “L.C.” attended the public schools of Sumter County, Georgia.  At an early age, he became a member of the Daniel Grove Baptist Church in Sumter County, Georgia. He was no stranger to hard work.  He has worked as a farmer and a burial vault worker. “L.C.” was united in holy matrimony to the former Helen Warren on December 31, 1963 and to this union four children were born.

“L.C.” departed his earthly life on Sunday, December 6, 2015 at Phoebe-Sumter Medical Center in Americus, GA.  In addition to his parents, he was preceded in death by a granddaughter, Kwamesia Paris White; a grandson, Trayvin Charles Spencer; and a great-grandson, Camron O’Neal Goshay.

He leaves to cherish his memories, his wife, Helen Warren Spencer; four children, Leonard C. (LaKia) Spencer, III; Jacob L. Spencer, Gwendolyn A. Spencer, Connie J. Spencer; four sisters, Elizabeth Mitchell Cobb, Beulah Barner, Dorothy (Walter) Bridges, and Sallie White; two brothers, Henry Spencer and Leonard (Barbara) Williams; two aunts, Emma Jones and Eddie Wise; nine grandchildren, Giovanni Spencer, Antwanette Spencer, DeAngelo Spencer, DeShone Watson, Rakeem (Keaunna) Spencer, DeJennea Spencer, Jada Spencer, Tia Spencer, and China Spencer; caregiver, Dianne Warren and a host of nieces, nephews, cousins and friends.

Mr. William Bowens, Jr.

Mr. William Bowens, Jr.

Mr. William Bowens, Jr.

Mr. William Bowens, Jr. was born January 2, 1947 in Sumter County, Georgia to the late Voncile Mann Bowens and the late William Bowens, Sr. At an early age, he joined Antioch Baptist Church. He graduated from Sumter High School in 1964 and furthered his education at South Georgia Technical College receiving a degree in Drafting. “Jr” entered the United States Army on March 3, 1967 and served his country faithfully until he was discharged on May 1, 1970. On August 29, 1968 he married the love of his life, Ms. Diane Dorsey and they spent 49 beautiful years together.

“Dude” was a kind, loving person that would help anyone in need. He served on several community boards including the Boys & Girls Club of Americus & Sumter County, New Horizons Habitat for Humanity and West Central GA Community Action Council. He was also very active in the Civil Rights Movement in Sumter County. He was employed as an Insurance Agent for many years with Delta Life Insurance Company and United Insurance Company. He also was a car salesman at Earl Snider Auto Sales. He passed away on Tuesday, December 8, 2015 at the Phoebe Putney Memorial Hospital in Albany, Georgia surrounded by his family.

Left to cherish his memory is his devoted wife of 49 years Diane Bowens; four children: Teresa Dorsey, Christopher (Sharon) Bowens, Karina (Anthony) Campbell and Monica Bowens all of Americus, Georgia; two devoted siblings: Myrtice Bowens of Americus, Georgia and Alvin (Carolyn) Bowens of McDonough, Georgia; in-laws: Maybell Bullard, Peggy Ann Dorsey, Daniel Dorsey, Patricia Dorsey, Emmett Dorsey and Joann Floyd; nine grandchildren: Akeha, Lakeisha, Marquis, Shamaya, Chelsey, Anthony, Christopher, Tameal and Tammie; five great-grandchildren, and a host of other relatives and friends also survive




Miss Shamona “Mona” Davis was born in Americus, GA on March 16, 1975 to the parentage of the late Mrs. Barbara Jean and Mr. Eddie James Davis, Sr.  Mona was educated in the Sumter County Public Schools, graduating 1994 Class of Sumter County Comprehensive High School.  For over 17 years, she worked for the school system as a para professional.  In addition to her parents, she is preceded in death by a brother, Infant Eddie James Davis, Jr.

She leaves to cherish her memories her parents, Mr. Floyd (Pastor Georgia) Deriso, DeSoto, GA; five brothers, Mr. Michael (Claudia) Davis, Koln, Germany, Mr. Reginald (Angela) Stevenson, St. Louis, MO, Mr. Anthony (Faye) Deriso, Plains, GA, Mr. Franza (Kenyada) Deriso, Albany, GA and Mr. Kelsey (Denise) Deriso, Williamsburg, VA; six sisters, Mrs. Alvina (Preston) Davis, Mrs. Diane (Joseph) Monts and Ms. Tammy Harper, Albany, GA, Ms. Shenequia (John) Trice, Columbus, GA, Ms. Jackie (Calvin) King and Ms. Lasondra (Alfonso) Swain, both of Americus, GA; two uncles, Mr. Eddie (Mary) Stevenson, Holyoke, MA and Mr. Lewis Davis, Albany, GA; five aunts, Ms. Francine Peterson, Ms. Mary Jane Goggins, Ms. Shirley Thaxton and Ms. Durenda Taft all of Holyoke, MA, Ms. Carolyn Jones, Americus, GA; one great aunt, Ms. Shirlene McCray, Albany, GA; devoted friends, Shervon Yancey, Terrence Mathis, Rose Dodson, Brittney Trice and Shell Lane; a host of nieces, nephews, cousins, other relatives and friends also survive.




Elder Theodore Roosevelt Wakefield, Jr. was born in Webster County, Georgia on June 16, 1932 to the parentage of the late Rev. Theodore Roosevelt Wakefield and the late Mrs. Arrena Raven Wakefield. He grew up in the Archery Community and attended the Johnson Institute in Webster County, Georgia. He worked for several years as a laborer before becoming a full time Minister in the AME Church. He pastured churches in the Albany-Valdosta District and the Southern District before being appointed as Presiding Elder of the Southern District. He retired from the ministry in 2001 after serving faithfully for 37 years. He is preceded in death by his wife, Mrs. Mary Nellie Polk Wakefield.

He leaves to cherish his memories: two sons, Mr. Arther James Wakefield, Norfolk, VA and Mr. Simeon (Gloria) Wakefield, Plains, GA: three daughters, Mrs. Erma (Donald) Jenkins, Swainsboro, GA, Mrs. Mary (Michael) Harden, Martinez, GA and Ms. Vivian Singleton, Palm Coast, FL: two brothers, Rev. Franklin (Roxie) Wakefield, Jacksonville, FL and Mr. Herman (Bobbie) Wakefield, Oakland, CA; two sisters, Mrs. Naomi (Bennie) Thomas, Americus, GA and Ms. Mary Minion, Plains, GA; ten grandchildren, six great grandchildren; and a host of nieces, nephews, cousins other relatives and friends also survive.




Veteran Charles Eugene Moss was born in Sumter County, Georgia on November 24, 1932 to the parentage of the late Mr. Wheeler Moss and the late Mrs. Annie Willis Nelms. He was the second child born to this union. Charles was a graduate of A.S. Staley High School in Americus, Georgia, where he played the trumpet in the band and participated in other activities. After high school, he joined the United States Navy and served his country for seven years, he received the National Defense Medal award. He was a lifetime member of the American Legion Post #558. Charles worked at Georgia Southwestern College in security for eight plus years. He was self-employed at Moss’s Café for many years. Later, along with his wife, Annie Bell Moss, Charles became co-owner of Chas’ Wig Hut until his health failed. He was a devoted member of the Big Bethel Missionary Baptist Church, where he served faithfully, he attended Sunday School and Bible Study, he was ordained as a deacon on September 12, 1999 under the pastorage of Rev. Calvin Rollins.

On Wednesday, November 18, 2015, Mr. Moss transitioned to his eternal home. Charles is preceded in death by two brothers, Leonard and Terrell Moss.

He leaves to cherish his memories, his wife of 48 years, Mrs. Annie Bell Moss, Americus, GA; one daughter, Mrs. Linda (Joe) White, Detroit, MI; one son, Mr. Charles (Joyce) Moss, Jr., Pensacola, FL; four grandchildren, Joey White, Kenneth (Berlin) White, Celestine, Detroit, MI and Najea Moss, Pensacola, FL; a brother, Mr. Andrew (Doris) Daniels, Sr., Smithville, GA; one brother-in-law, Mr. Ernest White, Americus, GA; one sister-in-law, Ms. Eunice White, Americus, GA and a host of nieces, nephews, cousins, including special cousins, Ms. Rosa Ash, Atlanta, GA, Ms. Fannie Butler, Americus, GA other relatives and friends, including devoted friends, Ms. Tellis Burts and Mr. Tommy Willis, Americus, GA also survive.

Mrs. Rena Quinn Paul



Mrs. Rena Quinn Paul was born in Sumter County, Georgia on June 14, 1914 to the parentage of the late Mr. David Quinn and the later Mrs. Emma Bivins Quinn. She received her education in the public schools of Sumter County. At an early aged she joined the Old Corinth Baptist Church and in 1995 she joined Love of Christ Outreach Ministry noe named Love of Christ Bright Light Ministry under the leadership of Overseer Josephine Weston. She was a faithful member and served as Mother of the Church. She was married to the late Mr. A.D. Paul. Mother Paul is also preceded on death by her children, Nellie Mann, Rena Asberry, Vera Dowdell and A.D. Paul, Jr.; her siblings Jodie Quinn, Decoley Quinn, David Quinn, Ola Mann, Julia Waters, Emma Quinn, Rosa Brown and Daisy Clark  She was loved by all, especially her family who shall forever remember her for her wisdom and impeccable understanding. She was an inspiration to her community and a joy to all who knew her. At 101 years old, she was very independent and alert to the end.

She leaves to cherish her memories: three daughters, Ms. Minnie Battle, Mrs. Hannah (Curtis) Brooks of Americus, GA and Mrs. Betty (Robert) Washington, Brooklyn, NY: two sons, Mr. George (Bobby) Paul and Mr. James Omar (Gloria) Moore of Americus, GA; 40 grand children, 78 great grandchildren and 38 great-great grandchildren; and a host of nieces, nephews, cousins and other relatives also survive

Solo Entrepreneurs: 4 Tips to Help You Thrive, Not Flop

Entrepreneur.steps_.300x232by Carolyn M. Brown

Becoming your own boss takes lots of time and diligent planning. It also takes great, mutually supportive relationships and contacts.

Most of all, it takes work, work and more work. You need to commit resources to learning exactly what it will require to take their venture from potential opportunity to profitable enterprise.  For some, becoming your own boss is a natural step.

If you already have a side hustle and are ready to transition into making it a full-time paying gig, take cues from the success playbook of celebrity stylist and designer, Ty Hunter  (Beyoncé, ServedFresh™) who transitioned from working in the healthcare industry before following his passion of fashion and styling.

Related Story: My Brother’s Keeper: Byonce Stylist Shares Star-Studded Journey

The U.S. has more individually owned businesses, or sole proprietorships, than corporations, the Tax Foundation reports. Today, there are 1.7 million traditional C corporations, compared to 7.4 million partnerships and S corporations, and 23 million sole proprietorships.

A sole proprietorship is the simplest and most common structure chosen to start a business. What’s more you do not have to take any formal action to form a sole proprietorship. As long as you are the only owner, this status automatically comes from your business activities, notes the U.S. Small Business Administration. In fact, you may already own one without knowing it. If you are a freelance writer, for example, you are a sole proprietor.

But like all businesses, you need to obtain the necessary licenses and permits. Regulations vary by industry, state and locality. Use the Licensing & Permits tool to find a listing of federal, state and local permits, licenses and registrations you’ll need to run a business. If you choose to operate under a name different than your own, such as Maxine’s Shea Butter, you will most likely have to file a fictitious name (also known as an assumed name, trade name, or DBA name, short for “doing business as”). You must choose an original name; it cannot already be claimed by another business.

There are pros and cons to having a sole proprietorship. The biggest advantage of course is that you are entitled to all profits and are responsible for all your business’s debts, losses and liabilities. To help you along your journey, here are four things that you need to know:

  1. Tax Implications: Because you and your business are one and the same, the business itself is not taxed separately, so the sole proprietorship income is your income. You report income and/or losses and expenses with a Schedule C and the standard Form 1040.  The “bottom-line amount” from Schedule C transfers to your personal tax return. It’s your responsibility to withhold and pay all income taxes, including self-employment and estimated taxes. You can find more information about sole proprietorship taxes and other forms at IRS.gov. You’re required to pay estimated taxes on a quarterly basis. Many sole proprietors get into the practice of setting aside a percentage with each payment received (think of this like a self-imposed tax withholding).
  2. Accessing Capital: Sole proprietors often face challenges when trying to raise money. Because you can’t sell stock in the business, investors won’t often invest. Banks are also hesitant to lend to a sole proprietorship because of a perceived lack of credibility when it comes to repayment if the business fails. However, some angel investors provide private equity to sole proprietors and other small businesses to fund startup operations or finance existing business ventures. Female entrepreneurs with innovative solutions-oriented products or services can check out the Pipeline Angels Network to pitch their businesses.
  3. Mixing Equipment and Supplies: Many sole proprietors get confused trying to figure out which business expenses are considered equipment vs. supplies. Supplies are things that get used during the year (i.e., printer ink, paper, envelopes, etc.) while equipment typically are higher-value things that last longer than a year such as computers, software and office furniture. Supplies are reported on Schedule C, but equipment needs to be reported on Form 4562. You have the option to write off the full amount on your tax return (there is a max limit), or you can write off a portion for each year it’s in use.

Changes In Franchising Model To Hit Minorities The Hardest

Franchising-300x1803yby Carolyn M. Brown

Iconic names such as McDonald’s, Burger King, Pizza Hut, and Jamba Juice have attracted nearly 800,000 small business owners, who employ more than 8 million workers. These franchise owners contribute to the economic life of communities around the country. Minorities make up 20% of all franchisees.

Now, minority small business owners have the most to lose if the Obama administration’s labor regulators do away with the franchise business model, according to a new report.  “Minority-owned franchise businesses succeed at a rate 46% higher than that for minority-owned non-franchise businesses,” the report states, according to the Washington  Press Free Beacon.

An upcoming ruling on the joint employer standard by the federal government’s top labor arbiter, the National Labor Relations Board (NLRB), could determine whether franchisors are joint employers and, therefore, liable for the actions of its franchisees. Meaning, a Dunkin’ Donuts owner in Manhattan could find himself/herself under legal attack for alleged workplace violations by a Dunkin Donuts owner in Los Angeles, or an allegation of unfair business practices leveled at Applebee’s International could impact all individual Applebee’s restaurants.

The current franchise model allows individuals to open their own businesses under larger corporate brands, such as McDonald’s, in exchange for an annual franchise fee. Those franchisees handle the day-to-day business operations with the national brand handling marketing and, in some cases, supply. An analysis of the nation’s franchisees conducted by Competitive Enterprise Institute, a free-market think tank, found that the business model has been a boon to immigrants and minority entrepreneurs.

[Related: Franchise Company of The Year Karim Webb Shares Savvy Business Lessons]

NLRB General Counsel Richard Griffin, a former union lawyer, penned an amicus brief endorsing that argument and, in July 2014, brought charges against McDonald’s for the business practices of small business owners under the company umbrella. The CEI report said that if the NLRB upholds Griffin’s opinion, it would harm the prospects of franchisees, as corporations seek to avoid legal troubles, according to the Free Beacon.

“The franchise system benefits business startups, especially minority entrepreneurs seeking to start their own businesses. Holding corporate headquarters responsible for a franchisee’s workforce would make franchising much less attractive as a business model,” the report states.

Franchise business owners will agree that corporate provides a brand: the logo, guidelines on products and services, advertising, software, and other tools, such as a hotel reservation system, according to the trade group the International Franchising Association. However, decisions about who to hire, fire, and promote, as well as wages, are solely at the discretion of the franchisee. These decisions make up most of the management duties, and up to two-thirds of the costs of operating a franchise business.

Black Women at the Bottom of Income Gap

(Image: Valerie Rawlston Wilson, Economic Policy Institute)

(Image: Valerie Rawlston Wilson, Economic Policy Institute)

by Stacey Tisdale

When it comes to female workers, African American women have seen the largest decline in earnings since 2009 (-3.6%), while earnings for white women (-0.2%) and Hispanic women (-0.8%) are down by less, according to data from the Census Bureau.

“This is a really troubling trend,” says Valerie Rawlston Wilson, director of the Economic Policy Institute’s Program on Race, Ethnicity, and the Economy.

“A lot of this has to do with how different workers responded to the recession. While other groups may have stayed out of work after a job loss, African American women had to maintain stronger attachment to the labor market because of their different levels of wealth and savings. There has been more job growth in lower paying occupations, and these are the jobs African American women have been forced to take.”

Overall, the Census Bureau study found that real median household incomes in the United States were not statistically different in 2014, $53,657, from 2013, $54,462. This is the third consecutive year incomes have not shown statistical changes, following two years of declines.

If you break down those numbers by race, median household income for blacks was $35,398 in 2014, versus $60,256 for whites.

“Looking back over an even longer period of time, this has really been a rough decade,” says Rawlston Wilson. She says some of the reason for the sluggish job growth is policy related, citing the lack of a minimum wage increase at the federal level, but she also points out that the income trend reflects the still struggling job market.

“Labor market tightness is one of the things that puts upward pressure on wages. We’re still not nearing full employment even though the numbers look so much better. There are a number of prime age workers outside of the job market who don’t show up in the data,” she adds.

The Census Bureau also found that like incomes, the poverty rate in the U.S. hasn’t budged. It stands at 14.8%, meaning 46.7 million Americans live in poverty.

One bright spot in the report: Healthcare. Nine million more people had healthcare coverage in 2014 than the year before, and just 10.4% of Americans are uninsured, versus 13.3% in 2013.

Rawlston Wilson calls this proof that the Affordable Care Act is working. “It’s doing its jobs of insuring more Americans. If you’re criticism was that it wouldn’t work, clearly the data show that that is not the case.”

Usher confirms he’s married to longtime girlfriend Grace Miguel

usher-graceby Carrie Healey | theGrio.com

During an appearance on The Ellen DeGeneres Show, Usher confirmed he’s a married man.

The 37-year-old told DeGeneres he married his longtime girlfriend Grace Miguel in Cuba this September. The newlyweds spent their honeymoon in Cuba as well, reports Entertainment Tonight.

“One thing that has come from having a great partner like Grace is being able to cherish the places that I’ve gone,” Usher told Billboard last fall. “We see the monumental sites, go to the museums, eat in the best restaurants. I’m that guy now! In the past I’d do what I have to do and get on the bus to the next city. Life has become a vacation.”

The new union marks Usher’s second marriage. He was previously married to Tameka Foster from 2007-2009. They have two sons together.

Congratulations to the newlyweds!

Fetty Wap publicly questions reality star’s paternity claims

at the 2015 iHeartRadio Music Festival at the MGM Grand Garden Arena on September 19, 2015 in Las Vegas, Nevada.

at the 2015 iHeartRadio Music Festival at the MGM Grand Garden Arena on September 19, 2015 in Las Vegas, Nevada.

Masika-Kalysha-Pregnant-Fetty-Wap-Denies-He-s-The-Father-Of-Love-Hip-Hop-Star-s-Child-Wants-Paternity-TestBy theGrio.com

Fetty Wap isn’t denying that he occasionally hooked up with Masika Kalysha, but he doesn’t think that makes him the father of herunborn child.

Kalysha posted on Instagram announcing that she was pregnant, and when she did, she tagged Fetty in the post. But he denied the insinuation that he was a father, tweeting out, “Bi****s posting pics now the world going crazy. She need a come up I understand that career lookin bad.”

Although the post was later deleted, Fetty also tweeted a quieter message: “Just sit back n watch lol.”

He later tweeted out another comment, saying, “It gotta be my money cause I sho ain’t handsome.”

The same day, a representative for Fetty told Us Weekly, “I didn’t see Fetty or a paternity test confirm this allegation. Masika is known for being an industry jump-off and her little announcement was very calculated.”

Fetty has now been referring to Kalysha as a “groupie” and refuses to accept the child as his until there has been a paternity test. What’s more, after hearing about the marriage rumors that Kalysha had been hinting at, he vehemently responded with, “The whole situation about a ring is a bunch of s**t!”

NeNe Leakes calls out Raven-Symoné, says ‘The View’ co-hosts ‘were very shady’

nene-ravenby theGrio |

On Sunday, NeNe Leakes appeared on Watch What Happens Live, and when host Andy Cohen asked her to dish about her appearance on The View, she was more than happy to oblige.

“Oh, yes, honey. Let’s read The View. What do you need to know? Tell me all about it,” Leakes said, reports E! News. “Well, I didn’t see any of those ladies that’s on the panel until I actually walked on the panel. And I felt like they were not kind to me. I just…honestly, they weren’t kind. It’s not even ‘felt like.’”

“Was it a Joy thing?” Cohen asked. “Was it more than Joy?”

“It was more than Joy,” she said. “Now, Joy was definitely throwing a lot of shade, but there was someone else on the panel that threw shade as well, as far as looking me up and down. Now, we were live, so as far as what the cameras shot or showed, I don’t know. It didn’t show everything. But I could tell you that there were a couple of people on that panel who were very shady. Now, they welcomed me to their home­—”

Cohen clarified, “You’re talking about Raven-Symoné.”

“Probably,” Leakes responded.

She then went on to called out Raven-Symoné in particular, saying Raven looked her up and down “real nasty-like.” But, she said, the whole crew of The View was like that.

“I didn’t like that, because look, first of all, I was invited to their show. I was there to promote Chicagoand other things. They asked me to bring pictures of my home there, and I brought the pictures they asked me to bring. And they just weren’t kind. They did not have nice manners. I know all of them are tired: their hairstyles are tired, their makeup is tired. Whatever.”

Will Smith, Queen Latifah, Taraji P. Henson, Viola Davis land Golden Globe nominations

Taraji P. Henson in 'Empire' (left), Uzo Aduba on 'Orange is the New Black; (center) and Will Smith in 'Concussion,' (right).

Taraji P. Henson in ‘Empire’ (left), Uzo Aduba on ‘Orange is the New Black; (center) and Will Smith in ‘Concussion,’ (right).

Thursday morning Angela Bassett, America Ferrera, Dennis Quaid, announced the 2016 Golden Globe nominees, and there were plenty of surprises all around.

Will Smith got a nomination in Best Performance by an Actor in a Motion Picture Drama for Concussion, joining the likes of Bryan Cranston, Leonardo DiCaprio, Michael Fassbender and Eddie Redmayne.

Uzo Aduba and Regina King saw nominations for Best Performance by an Actress in a Supporting Role in a Series, Miniseries, or Motion Picture Made for Television.

Idris Elba received a Supporting Actor in a Feature Film nomination for Netflix’s Beast of No Nation,  and also earned a nom for his role in the BBC TV series, Luther.

Queen Latifah and Lady Gaga were nominated for Best Performance By an Actress in a Miniseries or Motion Picture Made for Television for their performances in “Bessie” and “American Horror Story: Hotel,” respectively.

But the nominations that came as no surprise to anyone were for Taraji P. Henson and Viola Davis (of Empire and How to Get Away with Murder fame). They were both nominated Best Performance By an Actress in a Television Series – Drama.

Serena Williams named ‘Sports Illustrated’s 2015 Sportsperson of the Year

CWMDDmeWIAAQ9jpby Carrie Healey |theGrio.com,

Tennis superstar Serena Williams was named Sport Illustrated’s2015 Sportsperson of the Year Monday morning, following an incredible year. Williams won 53 of her 56 matches this year, including three Grand Slam titles.

The 34-year-old has been ranked No. 1 every week for the past two years. Williams, despite multiple injuries and illnesses, still achieved her second “Serena Slam,” though devastating upset loss at the U.S. Open in early September dashed hopes of the first calendar year Grand Slam. Williams is one Grand Slam away from tying Steffi Graf’s singles title record at 22.

SI noted it wasn’t only Williams’ athletic prowess that earned her their top honor. It was her dominance on the court, combined with how she uses her far-reaching voice to be a proponent of racial justice, education and gender equality.

In 2015, Williams returned to Indian Wells for the first time since 2001. The last time she played there, Williams and her family reported facing racial slurs and boos from fans in attendance.

“Everyone always asked, ‘What was your greatest moment in tennis?’ and I always said it hasn’t happened,” Serena told SI. “But I think it has happened now, and that was going back to Indian Wells and playing. It released a lot of feelings that I didn’t even know I had. I was really surprised at how emotional I got—and how relieved I felt after everything was said and done.”

Williams is the first female individual to earn the honor since Mary Decker in 1983. SI even renamed the award to Sportsperson of the Year from the original Sportsman of the Year.

“This year was spectacular,” Williams said in a statement. “For Sports Illustrated to recognize my hard work, dedication and sheer determination with this award gives me hope to continue on and do better.”

Another Worry About Energy Drinks In Kids

Energy-DrinksBy: M. ALEXANDER OTTO, Family Practice News Digital Network

VANCOUVER – At least one of the commercially available energy drinks plays havoc with blood sugar and insulin levels in teen users, according to research from the University of Calgary (Alta.).

Ten teenage boys and ten girls were randomized to one regular “5-hour energy” drink, or, as a control, the decaffeinated version of the product, and then given an oral glucose tolerance test 40 minutes later.

In the second phase, the kids switched over to the drink they didn’t get in the first go-round, and the tolerance testing was repeated. Blood testing was done at baseline and throughout the study.

Investigator Jane Shearer, Ph.D., of the university’s department of biochemistry and molecular biology, explained the results, and why she’s worried about them, in an interview at the World Diabetes Congress.

Five-hour energy is a sugar-free 2-ounce drink containing about 200 mg of caffeine in its regular-strength formulation.

The findings raise another red flag about energy drinks in kids, especially if they are prone to diabetes. Dr. Shearer also shared her thoughts on what to do to address the issue.

Long Working Hours Raised Stroke Risk

RTEmagicC_1958984_working.jpgBy: AMY KARON,

Individuals who worked at least 55 hours a week were about 33% more likely to have a stroke than were those who worked 35-40 hours, according to a large meta-analysis of prospective studies.

The finding is “robust,” wrote Mika Kivimäki, Ph.D., of University College London and his associates. “There was no evidence of between-study heterogeneity, reverse causation bias, or confounding. Furthermore, the association did not vary between men and women or by geographical region, and was independent of the method of stroke ascertainment” (Lancet 2015;386[10005]:1739-46).

“Long working hours were also associated with incident coronary heart disease, but this association was weaker than that for stroke,” they noted.

Past studies have linked long working hours to cardiovascular disease, but prospective data are “scarce, imprecise, and mostly limited to coronary heart disease,” the researchers wrote. To assess relationships between working hours, incident CHD, and stroke, they searched Medline and Embase for studies published through August 2014, and also acquired unpublished data from 20 cohort studies through the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium and open-access databases. These efforts yielded 25 total studies of 24 cohorts in the United States, Europe, and Australia, comprising CHD risk data for almost 604,000 individuals and stroke risk data for almost 529,000, the researchers said.

The studies reported 1,722 strokes and 4,768 new episodes of CHD after an average of 7.2 and 8.5 years of follow-up, respectively, the investigators determined. After accounting for age, sex, and socioeconomic status, individuals who averaged a 55-hour work week were 33% more likely to have a stroke (relative risk, 1.33; 95% confidence interval, 1.11-1.61; P = .002) and a 13% greater risk of CHD (RR, 1.13; 95% CI, 1.02-1.26; P = .02) than were those who worked 35-40 hours per week.

“We recorded a dose-response association for stroke, with RR estimates of 1.10 (95% CI, 0.94 to 1.28; P = .24) for 41 to 48 working hours; 1.27 (1.03 to 1.56; P = .03) for 49 to 54 working hour; and 1.33 (1.11 to 1.61; P = .002) for 55 working hours or more per week, compared with standard working hours (P less than .0001),” the researchers wrote. Based on the findings, “more attention should be paid to the management of vascular risk factors in individuals who work long hours,” they concluded.

The study was funded by the U.K. Medical Research Council, the Economic and Social Research Council, the European Union New and Emerging Risks in Occupational Safety and Health research program, the Finnish Work Environment Fund, the Swedish Research Council for Working Life and Social Research, German Social Accident Insurance, the Danish National Research Centre for the Working Environment, the Academy of Finland, the Ministry of Social Affairs and Employment (Netherlands), the U.S. National Institutes of Health, and the British Heart Foundation. The investigators reported having no conflicts of interest.

Medicolegal Aspects Of Sleep Apnea

By: S.Y. TAN, M.D., J.D.

Question: A patient who is a commercial truck driver has a long history of snoring and daytime sleepiness. His physical exam was remarkable for obesity, prominent extremities, a large tongue, and a prominent jaw. The treating doctor did not pursue additional work-up or treatment.

One day, the patient fell asleep while driving his truck and hit an on-coming vehicle, resulting in injuries to both patient and the other driver.

In this hypothetical scenario, which of the following statements is best?

A. The doctor may be found negligent for missing the diagnosis of acromegaly and accompanying sleep apnea, and for failing to treat and warn about driving risks.

B. The doctor may be liable to both his patient and the other injured driver.

C. The patient may be terminated from his job as a commercial truck driver, because he poses a danger to himself and the public.


D. Both A and B are correct.

E. All are correct.

Answer: D. Sleep apnea, an underdiagnosed and undertreated disabling condition, places the patient at substantial risk for injuries, chronic hypoxemia, and respiratory arrest. Excessive daytime sleepiness and fatigue may prove hazardous, particularly in those whose undivided attention is a requirement of their jobs, such as with truck drivers.

Diagnosis is established with a formal sleep study (polysomnography), and treatment with a continuous positive airway pressure device is usually effective. In severe or recalcitrant cases, surgical intervention (that is, uvulopalatopharyngoplasty) may be needed.

In a recent study, Dr. Peter F. Svider of Rutgers New Jersey Medical School, Newark, and his colleagues analyzed 54 litigated sleep apnea cases, of which 33 (61%) were resolved in favor of the defendants (Otolaryngol Head Neck Surg. 2013 Dec;149[6]:947-53). Most of the cases (47) stemmed from patients who underwent surgery with perioperative complications, including death. Inadequate informed consent and monitoring, as well as inappropriate medications, were other findings.

Obstructive sleep apnea is a well-recognized complication of acromegaly with its bony and soft-tissue hypertrophy. The hypothetical situation described above is substantially modified from an actual case in which a 39-year-old man with acromegaly and sleep apnea died from cardiorespiratory arrest (Cornett v. W.O. Moss Regional Hospital, 614 So.2d 189 [La. 1993]). He had presented over the course of several years with repeated complaints of daytime sleepiness and sleeping while driving.

The Surprising News About Soda Sales


Per-capita soda consumption rates have fallen to their lowest levels since about 1986, a sign that continued attacks by public health groups over the potential health risks posed by these products may be working.

At least, to a point: Data released this week by the trade publication Beverage Digest shows that some of the leading full-calorie beverages made by industry leaders Coca-Cola (KO) and PepsiCo. (PEP) outperformed their diet counterparts.

Market leader Coke posted a volume gain of 0.1 percent in 2014, its first increase in many years. Pepsi, which dethroned Diet Coke for the number two spot, saw a 1.8 percent decline. Diet Coke, which finished fourth, fell 6.6 percent while Diet Pepsi was seventh with a 5.2 percent decline.

The data surprised Michael Jacobson, the head of the Center for Science in the Public Interest, a leading critic of the soda industry, who told CBS MoneyWatch that it shows that people who quit drinking regular soda are taking a pass on the diet varieties as well.

“You would think that would be the easiest change to make,” he said in an interview. “Over the last few years, sales of Diet Coke and Diet Pepsi have seriously eroded.”

One reason for the decline in diet soda consumption has been the growing concern about the potential health effects of the commonly used sweetener aspartame. Beverage Digest Editor and Publisher John Sicher told CBS MoneyWatch that those concerns about the chemical, which is sold under the brands Equal and NutriSweet, are without justification.

“Aspartame in fact is a safe and good sweetener,” Sicher said, adding that the Food & Drug Administration and its regulators in Europe have given the sweetener as clean bill of health.

The CSPI’s Jacobson isn’t sold on aspartame, and accused the U.S. government of “sticking its head in the sand” by disputing studies that showed a link between the sweetener and cancer. Nonetheless, he noted that there has been far less negative press about the health effects of diet soda compared with regular soda, where a plethora of studies have documented its potential health effects.

For instance, scientists have found that people who consume sugar-sweetened soft drinks regularly have a 26 percent greater chance of developing diabetes. Another study found that men who guzzled down these beverages had a 20 percent higher risk of having a heart attack or dying of one compared with their counterparts who avoided the stuff.

Coca-Cola, PepsiCo and other carbonated beverage companies are trying to develop alternative sweeteners using stevia, a plant found in the jungles of Paraguay and are hoping to find what Bloomberg News described as the “industry’s holy grail — a soda that tastes as good as the iconic colas, is sweetened naturally, and has zero calories.”

Both Coca-Cola and PepsiCo. introduced mid-calorie drinks sweetened with stevia, called Coke Life and Pepsi True. They are mixed with cane sugar since stevia can leave a bitter after taste, a problem that is hampering its wider use. According to Sicher, these products are too new to have a statistically significant impact on the market.

Jacobson wants more testing of stevia, though he considers it to be safer than artificial sweeteners and urges consumers to avoid drinking all soda.

“Health officials, legislators, and other policy makers should escalate their efforts to further drive down consumption by supporting policies that decrease availability in public places, raising new taxes, requiring warning labels, and otherwise promoting water as the default drink,” he said in a recent press release.

Officials from Coca-Cola and PepsiCo didn’t immediately respond to requests for comment.

Health Reform Lives!

Paul Krugman

Paul Krugman

To the right’s dismay, scare tactics — remember death panels? — and spurious legal challenges failed to protect the nation from the scourge of guaranteed health coverage. Still, Obamacare’s opponents insisted that it would implode in a “death spiral” of low enrollment and rising costs.

But the law’s first two years of full implementation went remarkably well. The number of uninsured Americans dropped sharply, roughly in line with projections, while costs came in well below expectations. Opponents of reform could have reconsidered their position — but that hardly ever happens in modern politics. Instead, they doubled down on their forecasts of doom, and hyped every hint of bad news.

How the Gun Control Debate Ignores Black Lives

Michael McBride is the Lead Pastor at the Way Christian Center in Berkeley, California where he is being photographed.

Michael McBride is the Lead Pastor at the Way Christian Center in Berkeley, California where he is being photographed.

ON A DRIZZLY AFTERNOON in January 2013, almost a month after the school shooting in Newtown, Connecticut, that left 20 first-graders dead, more than a dozen religious leaders assembled in Washington, D.C.

They had been invited by the Obama administration to talk about what the country should do to address gun violence. Vice President Joe Biden had been meeting with victims and advocates all day, and he arrived so late that some in the room wondered whether he would come at all. When he finally walked in, the clergy started sharing their advice, full of pain, some of it personal. “The incidents of Newtown are very tragic,” Michael McBride, a 37-year-old pastor from Berkeley, California, recalled telling Biden. “But any meaningful conversation about addressing gun violence has to include urban gun violence.”

McBride supported universal background checks. He supported an assault weapons ban. But he also wanted something else: a national push to save the lives of black men. In 2012, 90 people were killed in shootings like the ones in Newtown and Aurora, Colorado. That same year, nearly 6,000 black men were murdered with guns.

Many people viewed inner-city shootings as an intractable problem. But for two years, McBride had been spreading awareness about Ceasefire, a nearly two-decades-old strategy that had upended how police departments dealt with gang violence. Under Ceasefire, police teamed up with community leaders to identify the young men most at risk of shooting someone or being shot, talked to them directly about the risks they faced, offered them support, and promised a tough crackdown on the groups that continued shooting. In Boston, the city that developed Ceasefire, the average monthly number of youth homicides dropped by 63 percent in the two years after it was launched. The U.S. Department of Justice’s “what works” website for crime policy had a green check marknext to Ceasefire, labeling it “effective” — the highest rating and one few programs received.

McBride wanted President Obama to make Ceasefire and similar programs part of his post-Newtown push to reduce gun violence. He had brought a short memo to give to White House staffers, outlining a plan to devote $500 million over five years to scaling such programs nationwide. His pitch to Biden that day was even simpler: Don’t ignore that black children are dying too.

In response, the vice president agreed urban violence was very important, McBride said. But it was clear that “there was not a lot of appetite for that conversation by folks in the meeting,” McBride recalled.

Later, other ministers who worked with McBride would get an even blunter assessment from a White House staffer: There was no political will in the country to address inner-city violence.

When McBride spoke to administration staffers again about dramatically increasing money for programs like Ceasefire, he said, “People were kind of looking at me like, ‘Are you crazy?’ No, I’m not crazy. This is your own recommendation. You should do it!”

Mass shootings, unsurprisingly, drive the national debate on gun violence. But as horrific as these massacres are, by most counts they represent less than 1 percent of all gun homicides. America’s high rate of gun murders isn’t caused by events like Sandy Hook or the shootings this fall at a community college in Oregon. It’s fueled by a relentless drumbeat of deaths of black men.

Gun control advocates and politicians frequently cite the statistic that more than 30 Americans are murdered with guns every day. What’s rarely mentioned is that roughly 15 of the 30 are black men.

Avoiding that fact has consequences. Twenty years of government-funded research has shown there are several promising strategies to prevent murders of black men, including Ceasefire. They don’t require passing new gun laws, or an epic fight with the National Rifle Association. What they need — and often struggle to get — is political support and a bit of money.

A week after McBride and the other faith leaders met with Biden, Obama announced his national gun violence agenda. He called for universal background checks, which experts say could prevent some shootings. Other key elements of his plan — a ban on assault weapons and funding to put police officers in schools — were unlikely to save a significant number of lives.

At the press conference where Obama announced the plan, a diverse group of four children sat on the podium with him: two girls and two boys who had written letters begging the president to do something about gun violence. “Hinna, a third-grader — you can go ahead and wave, Hinna—that’s you — Hinna wrote, I feel terrible for the parents who lost their children. I love my country, and I want everybody to be happy and safe,” the president said.

Obama went over the litany of school shootings — Columbine, Virginia Tech, Newtown — and made a brief nod to the deaths of “kids on street corners in Chicago.” But his plan included no money for the urban violence strategies his Justice Department described as effective. His platform didn’t refer to them at all.

McBride, who was in the audience, said he was not surprised. He supported the president’s other proposals, and, when it came to urban violence, he had “realistic expectations.” In his fight to save the lives of black men, McBride has kept running up against the same assumption: that “urban violence is a problem with black folk. It’s not a problem for this country to solve.”

un violence in America is largely a story of race and geography. Almost two-thirds of America’s more than 30,000 annual gun deaths are suicides, most of them committed by white men. In 2009, the gun homicide rate for white Americans was 2 per 100,000 — about seven times as high as the rate for residents of Denmark, but a fraction of the rate for black Americans. In 2009, black Americans faced a gun homicide rate of nearly 15 per 100,000. That’s higher than the gun homicide rate in Mexico.

To liberals, gun violence among African-Americans is rooted in economic disadvantage and inequality, as well as America’s gun culture and lax gun laws. Conservatives, meanwhile, often focus on black “culture.” “The problem is not our gun laws,” a member of the Wall Street Journal editorial board wrote last year about Chicago’s murder rate. “Nor is it our drug laws, or racist cops, prosecutors and judges. The problem is black criminality, which is a function of black pathology, which ultimately stems from the breakdown of the black family.”

Lost in the debate is that even in high-crime cities, the risk of gun violence is mostly concentrated among a small number of men. In Oakland, for instance, crime experts working with the police department a few years ago found that about 1,000 active members of a few dozen street groups drove most homicides. That’s .3 percent of Oakland’s population. And even within this subgroup, risk fluctuated according to feuds and other beefs. In practical terms, the experts found that over a given stretch of several months only about 50 to 100 men are at the highest risk of shooting someone or getting shot.

Since Ferguson, A Rise In Charges Against Police Officers

Demonstrators march through downtown Chicago on Tuesday following the release of a video showing Jason Van Dyke, a police officer, shooting and killing Laquan McDonald. Van Dyke is charged with first-degree murder for the October 2014 shooting in which McDonald was hit with 16 bullets. So far this year, 15 officers have been charged with murder or manslaughter resulting from an on-duty shooting.

Demonstrators march through downtown Chicago on Tuesday following the release of a video showing Jason Van Dyke, a police officer, shooting and killing Laquan McDonald. Van Dyke is charged with first-degree murder for the October 2014 shooting in which McDonald was hit with 16 bullets. So far this year, 15 officers have been charged with murder or manslaughter resulting from an on-duty shooting.

A question some in Chicago are asking after the release of a video that shows a police officer fatally shooting a black teen: Did prosecutors charge the officer who killed Laquan McDonald only because they had to — because the video was about to come out?

Cook County State’s Attorney Anita Alvarez rejected that notion Tuesday.

“Pressure? This is no pressure! Why — I would never be pressured into making any kind of decision, quickly,” she said.

But across the country, prosecutors do seem to be under more pressure to charge police — especially in the year since police killed Michael Brown in Ferguson, Mo.

Homicide charges against police are pretty rare; they average about five cases a year. That number comes from Phil Stinson, a former-cop-turned-academic who collects statistics like this at Bowling Green State University in Ohio.

Stinson says the average is actually slightly less than five cases a year — but that’s the average for the past decade. This year is looking a little different.

“As of today, we now have 15 officers who’ve been charged with murder or manslaughter resulting from an on-duty shooting where they’ve shot and killed somebody,” he says.

It’s an interesting jump — but Stinson’s not ready to draw any conclusions yet.

“It’s hard to say if we’re seeing a pattern, a change in prosecutorial behavior, anything like that, because we’re dealing with such small numbers,” Stinson says. “We’re dealing with outliers.”

Statistics aside, though, he does think the justice system is giving police less benefit of the doubt than it did when he was a young cop.

“That’s being chipped away,” he says. “I think that now we’re not taking officers at their word, and that people are looking a little bit closer. And I think that goes for prosecutors as well.”

Still, there’s a lot of skepticism about whether prosecutors can be objective about the police, whom they work with every day.

That skepticism grows when the decision to charge them seems to drag out, as it did in McDonald’s case in Chicago, until the video came out — or in Cleveland, where it’s been a year since a police officer shot 12-year-old Tamir Rice.

Jonathan Abady is one of the lawyers representing Rice’s mother; he believes prosecutors there have been using that time to weaken their own case against the officer.

“It seems to us that it’s taking a year because this prosecutor is more interested in protecting the police, and what they’ve been doing for that year is searching for people who would be willing to call what is clearly in our view an unreasonable police shooting justified,” Abady says.

The prosecutor in Cleveland calls that theory “baseless,” and in fact, legal experts say it really isn’t fair to assume that the fix is in, just because a charging decision is taking a long time.

“It’s not a race,” says Laurie Levenson, a law professor at Loyola Law School and a former federal prosecutor in Los Angeles.

“There are good strategic reasons for a prosecutor actually not to bring the charges just because they can bring the charges so quickly,” she says.

Once you’ve file charges, Levenson says, it gets harder to collect evidence against an officer.

And people don’t realize how hard it is to make a case against cops; they usually have great lawyers, and they still get more sympathy from juries than the average murder defendant. Prosecutors have their work cut out for them, she says, even when there is a video.