Umeme Limited ( 2018 Abridged Report

first_imgUmeme Limited ( listed on the Uganda Securities Exchange under the Energy sector has released it’s 2018 abridged results.For more information about Umeme Limited ( reports, abridged reports, interim earnings results and earnings presentations, visit the Umeme Limited ( company page on AfricanFinancials.Document: Umeme Limited (  2018 abridged results.Company ProfileUmeme Limited supplies and distributes electricity in Uganda. It is the main electricity distribution company in the region; operating and maintaining a distribution network of some 31 790 kilometres of medium and low voltage electricity lines as well as providing after-sales services to its customers. Umeme Limited supplies electricity for domestic, commercial, industrial and public works usage, and is responsible for the purchase of electricity for Independent Power Producers. Umeme Limited is a subsidiary of Umeme Holdings; which is a subsidiary of Actis Infrastructure 2LP. Umeme Limited took over the supply and distribution of electricity in Uganda from UEDCL under a 20-year concession period. Umeme Limited is listed on the Uganda Securities Exchangelast_img read more

Wood Old House / Tadashi Yoshimura Architects

first_imgArchDaily CopyHouses•Japan ShareFacebookTwitterPinterestWhatsappMailOr Clipboard ShareFacebookTwitterPinterestWhatsappMailOr Clipboard Wood Old House / Tadashi Yoshimura ArchitectsSave this projectSaveWood Old House / Tadashi Yoshimura Architects Photographs:  Hitoshi Kawamoto    Save this picture!© Hitoshi KawamotoRecommended ProductsPorcelain StonewareGrespaniaPorcelain Tiles- CoverlamCeramicsTerrealTerracotta Baguettes in Vork CenterWoodHESS TIMBERTimber – GLT HybridPorcelain StonewareApariciPorcelain Tiles – BuildThis project is the renovation of a traditional wooden town house in Nara, Japan, built about 200 years ago, for a young couple and their children. Save this picture!© Hitoshi KawamotoThis old house consists of several small buildings, and there are several spot gardens, and passage gardens between buildings. Save this picture!© Hitoshi KawamotoHowever, taking no thought of interaction between buildings and gardens, repairs have been carried out on numerous occasions, and the interior has also been redecorated with new materials. Except for the main structure and façade, the original model can no longer be seen. Save this picture!© Hitoshi Kawamoto‘Void space’ carved out the old house, taking out new materials. Void space means the new large space turned into a porch by opening all sliding window panels, and the new small earthen floor space, connected existing spot gardens and passage gardens, facilitated lighting and ventilation. Making the new space, we reuse materials from old house, to the extent possible. Save this picture!© Hitoshi KawamotoBy inserting this void space, it connects the new with the old, and a revival is achieved through a skilful fusion between buildings and gardens. Save this picture!© Hitoshi KawamotoWe reuse structural members and old mud wall from old house as structural reinforcements and heat storage materials. Save this picture!© Hitoshi KawamotoAnd new outside materials are planned to be able to reuse in the future, binding with wedge.Project gallerySee allShow lessChina Mobile Building / SynarchitectsArticlesDisaster Prevention and Education Center / 109 ArchitectesArticles Share 2011 Year:  “COPY” Wood Old House / Tadashi Yoshimura Architectscenter_img Save this picture!© Hitoshi Kawamoto+ 18 Share Projects Photographs Architects: Tadashi Yoshimura Architects Year Completion year of this architecture project “COPY” Houses Japan CopyAbout this officeTadashi Yoshimura ArchitectsOfficeFollowProductWood#TagsProjectsBuilt ProjectsSelected ProjectsResidential ArchitectureHousesRefurbishmentHousesJapanPublished on December 20, 2011Cite: “Wood Old House / Tadashi Yoshimura Architects” 20 Dec 2011. ArchDaily. Accessed 11 Jun 2021. ISSN 0719-8884Read commentsBrowse the CatalogSinkshansgroheBathroom Mixers – Metropol ClassicVinyl Walls3MVinyl Finish – DI-NOC™ StonePartitionsSkyfoldVertically Folding Operable Walls – Zenith® SeriesPanels / Prefabricated AssembliesProdemaProdEx Wood Facade in the Aspen Art MuseumSealantsSikaRenovation of Zeitz MuseumSinksBradley Corporation USAVerge Coordinated Soap Dispenser and Faucet SetsWoodLunawoodThermo Timber and Industrial ThermowoodAcousticFabriTRAK®FabriFELT™ for Walls and CeilingsGlassDip-TechDigital Ceramic Etch PrintingWindowspanoramah!®ah! Ultra MinimalistEngineered Wood FlooringAustralian Sustainable Hardwoods (ASH)Australian Oak Engineered FlooringLouvers / ShuttersConstruction SpecialtiesSunshades – Airfoil LuxMore products »Read commentsSave世界上最受欢迎的建筑网站现已推出你的母语版本!想浏览ArchDaily中国吗?是否翻译成中文现有为你所在地区特制的网站?想浏览ArchDaily中国吗?Take me there »✖You’ve started following your first account!Did you know?You’ll now receive updates based on what you follow! Personalize your stream and start following your favorite authors, offices and users.Go to my streamlast_img read more

Lane End House / PAD studio

first_img Projects United Kingdom CopyHouses•United Kingdom CopyAbout this officePAD studioOfficeFollowProductWood#TagsProjectsBuilt ProjectsSelected ProjectsResidential ArchitectureHousesUnited KingdomPublished on July 28, 2019Cite: “Lane End House / PAD studio” 28 Jul 2019. ArchDaily. Accessed 11 Jun 2021. ISSN 0719-8884Browse the CatalogFaucets / SinkshansgroheKitchen SinksGlass3MSun Control Window Film in MarkthalPartitionsSkyfoldIntegrating Operable Walls in a SpaceRetractable StructuresShadeFXRetractable Canopies in Beverly HillsPanels / Prefabricated AssembliesIsland Exterior FabricatorsSpecialty Facade SystemsWoodSculptformTimber Tongue and Groove CladdingSkylightsVELUX CommercialLonglight 5-30° – Modular SkylightsBars / Wire / MeshJakobWebnet – Sports NetSuspension SystemsMetawellAluminum Panels for Ceiling SailsMineral / Organic PaintsKEIMTiO2-free Mineral Paint – Soldalit®-ArteHanging LampsLuminisPendant Lights – HollowcoreHandicap BathroomAamsco Lighting, Inc.Mirror-Lux LED Illuminated MirrorMore products »Save世界上最受欢迎的建筑网站现已推出你的母语版本!想浏览ArchDaily中国吗?是否翻译成中文现有为你所在地区特制的网站?想浏览ArchDaily中国吗?Take me there »✖You’ve started following your first account!Did you know?You’ll now receive updates based on what you follow! Personalize your stream and start following your favorite authors, offices and users.Go to my stream Save this picture!© Richard Chivers+ 27Curated by Paula Pintos Share Area:  185 m² Year Completion year of this architecture project Year:  Wendy Perring ArchDaily Architects: PAD studio Area Area of this architecture project Lane End House / PAD studioSave this projectSaveLane End House / PAD studio Engineering:McCarey SimmondsCost Consultants:APS AssociatesCountry:United KingdomMore SpecsLess SpecsSave this picture!© Richard ChiversRecommended ProductsMetallicsTECU®Copper Surface – Classic CoatedDoorsJansenDoors – Folding and SlidingEnclosures / Double Skin FacadesFranken-SchotterFacade System –  LINEAWoodAccoyaAccoya® Cladding, Siding & FacadesText description provided by the architects. Lane End is located on the edge of the South Downs on an elevated site surrounded by woodland and stunning views. It replaces a poorly constructed, inefficient home that didn’t engage with the location. The design creates a contemporary, energy-efficient home, incorporating natural materials to harmonize with the site, designed and built to very high standards but created to a modest budget without compromising the design integrity of the scheme. The ground floor has an open plan living space, separate music room, office, a strong connection with the outside with full height doors onto a large covered BBQ terrace.Save this picture!© Richard ChiversA separate living room for colder months, smaller and more intimate in scale with a feature fireplace crafted from locally sourced brick, the chimney rises through the home anchoring the house. Architecturally drawing upon local vernacular forms and materiality for inspiration, adopting an asymmetric pitched shingle roof wrapping down the northern face. The shingles are a reference to Arts and Crafts buildings locally, a lighter, textured finish that mellows. The entrance on the approach appears restrained, maintaining privacy, contrasting with the expressive and open south façade. Inside, double-height spaces are lined with limed Douglas Fir, exaggerating the feeling of light and reflective of the exterior.Save this picture!© Richard ChiversSave this picture!© Richard ChiversLarge windows located on the south create a fluid relationship with outside, flooding the interior with daylight. Bedrooms are located on the first floor either end of the house, separated by a bridge that doubles as a study. A balcony extends the full width, the form extrudes the house, emphasizing the horizontal also providing solar shading. Planters are incorporated its length, further connectivity to the landscape. An important requirement in the brief was for a ‘secret place’, somewhere where the clients could hide and relax in. On the first floor, a snug has been created, with a day bed and large picture windows to allow the owners to relax and enjoy the ever-changing views throughout the year.Save this picture!Ground Floor PlanSave this picture!SectionArranged to maximize the site and passive solar gain, the timber frame structure minimizes environmental impact reducing the embodied carbon of construction materials. Large overhangs provide solar control with, openings distributed to maximize natural cross ventilation. The client was extremely hands-on in their approach, getting involved in all aspects of the build including putting up the internal cladding and learning how to polish the concrete flooring. The landscaping, around the house and on the balcony, was also created by the client.  Save this picture!© Richard ChiversSave this picture!© Richard ChiversConnectivity to the landscape was also a key design driver, large windows located on the south elevation create a fluid relationship between inside and outside, offering spectacular views of the immediate planting by the house and the expansive views of the surrounding landscape. The first-floor balcony also incorporates a planted herb garden and a natural trellis of espalier Hornbeam along its length further enhances the connection to the landscape whilst also offering privacy for the bedrooms from walkers in the parkland beyond.Save this picture!© Richard ChiversProject gallerySee allShow lessStudio Regie / Delmulle Delmulle ArchitectenSelected ProjectsChristophe Benichou Architecture Designs Minimalist Desert ResidenceArticles Share ShareFacebookTwitterPinterestWhatsappMailOr Clipboardcenter_img ShareFacebookTwitterPinterestWhatsappMailOr Clipboard Photographs Photographs:  Richard Chivers Lead Architect: “COPY” Contractor: “COPY” Houses Object Assemble 2018 Lane End House / PAD studiolast_img read more

Dot com services for dot orgs

About Howard Lake Howard Lake is a digital fundraising entrepreneur. Publisher of UK Fundraising, the world’s first web resource for professional fundraisers, since 1994. Trainer and consultant in digital fundraising. Founder of Fundraising Camp and co-founder of Researching massive growth in giving. AddThis Sharing ButtonsShare to TwitterTwitterShare to FacebookFacebookShare to LinkedInLinkedInShare to EmailEmailShare to WhatsAppWhatsAppShare to MessengerMessengerShare to MoreAddThis Dot com services for dot orgs A number of US companies have designed Web-based services for non-profits. Find out about custom portals, issue-based portals, event planning sites, search engines, and online grants services in Monica Williams useful overview Using .coms to enhance your .org at the Benton Foundation.  19 total views,  1 views today AddThis Sharing ButtonsShare to TwitterTwitterShare to FacebookFacebookShare to LinkedInLinkedInShare to EmailEmailShare to WhatsAppWhatsAppShare to MessengerMessengerShare to MoreAddThis Howard Lake | 20 June 2000 | News read more

Cats Protection launches Fill a Dish appeal

first_img Cats Protection has launched its annual Fill a Dish appeal to raise funds to feed the thousands of cats that will be in the charity’s care during the festive season.The Fill a Dish appeal is a sponsorship activity whereby supporters are encouraged to persuade their friends, family and colleagues to fill one or more of 40 dishes on each sponsorship form by making a minimum 50p donation.Sponsorship forms can be obtained by telephone or by downloading them from the charity’s website. Cats Protection asks for all forms to be returned with the money by 31 January 2006. Advertisement Howard Lake | 8 December 2005 | News Cats Protection launches Fill a Dish appeal Tagged with: Individual giving  41 total views,  1 views today AddThis Sharing ButtonsShare to TwitterTwitterShare to FacebookFacebookShare to LinkedInLinkedInShare to EmailEmailShare to WhatsAppWhatsAppShare to MessengerMessengerShare to MoreAddThis About Howard Lake Howard Lake is a digital fundraising entrepreneur. Publisher of UK Fundraising, the world’s first web resource for professional fundraisers, since 1994. Trainer and consultant in digital fundraising. Founder of Fundraising Camp and co-founder of Researching massive growth in giving. AddThis Sharing ButtonsShare to TwitterTwitterShare to FacebookFacebookShare to LinkedInLinkedInShare to EmailEmailShare to WhatsAppWhatsAppShare to MessengerMessengerShare to MoreAddThislast_img read more

Tesco chooses Cancer Research UK as charity of the year 2012

first_img Howard Lake | 10 January 2012 | News Tagged with: charity of the year corporate  37 total views,  1 views today AddThis Sharing ButtonsShare to TwitterTwitterShare to FacebookFacebookShare to LinkedInLinkedInShare to EmailEmailShare to WhatsAppWhatsAppShare to MessengerMessengerShare to MoreAddThis About Howard Lake Howard Lake is a digital fundraising entrepreneur. Publisher of UK Fundraising, the world’s first web resource for professional fundraisers, since 1994. Trainer and consultant in digital fundraising. Founder of Fundraising Camp and co-founder of Researching massive growth in giving. Supermarket Tesco has chosen Cancer Research UK as its Charity of the Year for 2012 and aims to raise £10 million for the charity. The money will be raised by Tesco, its staff, customers and suppliers.Tesco has been the main sponsor of the cancer charity’s Race for Life for the last 10 years. Last year, however, it announced that it was ending that sponsorship but today it reports that it is “delighted to continue in this role for the next three years”. It aims to raise an additional £3 million through sponsorship, corporate donation and staff fundraising as part of the event series.Richard Brasher, Tesco UK CEO, said: “I’m delighted to announce our increased commitment to Cancer Research UK – an amazing organisation, which has saved so many lives already through its groundbreaking research.”He added: “I’m particularly pleased that the partnership builds on our continued support of Race for Life. During the past 10 years over two-thirds of Tesco staff have taken part or supported this great event, raising £7.5 million themselves and helping the Race for Life series as a whole to reach its overall total to date of £457 million.” Tesco chooses Cancer Research UK as charity of the year 2012 AddThis Sharing ButtonsShare to TwitterTwitterShare to FacebookFacebookShare to LinkedInLinkedInShare to EmailEmailShare to WhatsAppWhatsAppShare to MessengerMessengerShare to MoreAddThislast_img read more

Fannie Mae Sells More Delinquent Loans to Non-Profit

first_img About Author: Brian Honea Sign up for DS News Daily Servicers Navigate the Post-Pandemic World 2 days ago in Daily Dose, Featured, News, Secondary Market Data Provider Black Knight to Acquire Top of Mind 2 days ago The Best Markets For Residential Property Investors 2 days ago Deeply Delinquent Mortgage Loans Fannie Mae Non-Performing Loans Non-Profits 2016-05-26 Brian Honea Share Save The Week Ahead: Nearing the Forbearance Exit 2 days ago Previous: Servicers Remain Aggressive with Outreach Efforts Next: On the Fast Track at Last: Ohio Passes Foreclosure Bill Governmental Measures Target Expanded Access to Affordable Housing 2 days ago Demand Propels Home Prices Upward 2 days ago Home / Daily Dose / Fannie Mae Sells More Delinquent Loans to Non-Profit Demand Propels Home Prices Upward 2 days agocenter_img Data Provider Black Knight to Acquire Top of Mind 2 days ago Subscribe  Print This Post Governmental Measures Target Expanded Access to Affordable Housing 2 days ago Fannie Mae Sells More Delinquent Loans to Non-Profit The Best Markets For Residential Property Investors 2 days ago May 26, 2016 1,702 Views Servicers Navigate the Post-Pandemic World 2 days ago Government agencies have have taken a lot of heat from advocacy groups, civil rights groups, and lawmakers in the last few months over selling non-performing residential mortgage loans (NPLs) to private investors and Wall Street rather than non-profits or other community development organizations.On Thursday, however, Fannie Mae announced it has sold its third Community Impact Pool of NPLs to New Jersey Community Capital (NJCC), a non-profit Community Development Financial Institution (CDFI) that the was winner of Fannie Mae’s first two Community Impact Pool auctions.Fannie Mae’s sales of Community Impact Pools of NPLs are structured to attract participation from non-profits, smaller investors, and women- and minority-owned businesses.“We continue to seek buyers for our non-performing loans that will take actionable steps to help struggling homeowners avoid foreclosure and help stabilize neighborhoods,” said Joy Cianci, SVP, Single-Family Credit Portfolio Management, Fannie Mae. “We actively work with non-profit organizations across the country to address the needs of borrowers in hard hit communities, and we are happy to award our Community Impact Pool to NJCC.”The Community Impact Pool just sold contains 83 loans on properties in the Miami, Florida, area with an aggregate unpaid principal balance of approximately $19.7 million. The transaction is expected to close on July 25, 2016. Fannie Mae began marketing the Community Impact Pool to potential bidders (in collaboration with Bank of America Merrill Lynch and First Financial Network) on April 12.The loans in the Community Impact Pool were delinquent by an average of 51 months, the average loan size was $237,672, the average note rate was 5.07 percent, and the average BPO LTV ratio was 105 percent. The sale price was in the high 60s as a percentage of UPB, according to Fannie Mae.At the same time Fannie Mae announced the winners of the latest NPL sale, the GSE also announced the sale of an additional pool of NPLs in conjunction with its fifth NPL sale. The winning bidder in this pool was Goldman Sachs, and the pool includes 1,760 loans with an aggregate unpaid principal balance of $329,788,631, an average loan size of $187,380, an average note rate of 5.41 percent, average delinquency of 49 months, and an average BPO LTV ratio of 83 percent. Tagged with: Deeply Delinquent Mortgage Loans Fannie Mae Non-Performing Loans Non-Profits Related Articles Brian Honea’s writing and editing career spans nearly two decades across many forms of media. He served as sports editor for two suburban newspaper chains in the DFW area and has freelanced for such publications as the Yahoo! Contributor Network, Dallas Home Improvement magazine, and the Dallas Morning News. He has written four non-fiction sports books, the latest of which, The Life of Coach Chuck Curtis, was published by the TCU Press in December 2014. A lifelong Texan, Brian received his master’s degree from Amberton University in Garland. last_img read more

Salvation Army Sues Neighboring Children’s Museum Over Expansion

first_img Salvation Army Sues Neighboring Children’s Museum Over ExpansionScott Olson for www.theindianalawyer.comThe Salvation Army is suing the Children’s Museum of Indianapolis, claiming its neighbor’s $35 million outdoor expansion project intrudes on its easements and restricts its access to Illinois Street.The Children’s Museum is building its attraction, called the Riley Children’s Health Legends Sports Experience, directly to the north of the museum. The project is bounded North Illinois Street on the east and will wrap around the west and north sides of the Salvation Army’s Indiana divisional headquarters at 3100 N. Meridian St.In its lawsuit filed Thursday morning in Marion Superior Court, the Salvation Army says it has easement rights on the property owned by the museum that allow it access to Illinois Street and give it overflow parking rights.The Salvation Army asserts in the suit that it acquired the easement rights through a 1993 land swap with the museum. The suit says those easement rights not only give the charity direct access to Illinois Street but allow it to use portions of the parking lots for overflow parking during special events hosted by the headquarters.Construction of the museum’s project is preventing the Salvation Army from using the easements and, if the project is completed as planned, will permanently deprive the organization of its property rights, the Salvation Army says in its complaint.The Salvation Army said it would have preferred to resolve the situation without a lawsuit but has received little cooperation from the museum.“We’re hoping that by going through the courts we can find some resolution to restore our rights,” Maj. Robert Webster, commander of the Salvation Army’s Indiana division, told the Indianapolis Business Journal. “[The project] has made it very difficult for us to continue to safely conduct our business at the Salvation Army headquarters.”Children’s Museum officials issued a statement to IBJ early Thursday afternoon saying President and CEO Jeffrey Patchen contacted the Salvation Army immediately after it received the lawsuit to express a desire to work out the dispute.“We have been engaged in discussions with the Salvation Army about this matter for several months, and have been following in good faith a process that the Salvation Army proposed for gathering data before meeting again to discuss a resolution,” the statement read. “Despite having multiple communications with the Salvation Army, we had no notice that they were going to file a lawsuit until this morning.”The easements are west of the Salvation Army’s headquarters and run from the building’s parking lot directly to Illinois Street, Webster said.In its site plan for the new project, Webster said, the Children’s Museum provides the Salvation Army access to Illinois Street via an unpaved path that meanders through the outdoor sports experience.“It goes through hedges and winds around a couple of paths and next to an attraction,” he said. “It takes us into additional parcels that aren’t even ours. It clearly doesn’t make it possible for us to have vehicular traffic going to Illinois Street.”The Children’s Museum is building the sports park on 7.5 acres. The indoor/outdoor attraction will include activities from a variety of sports, including basketball, football, golf, running, tennis, soccer and motorsports.IBJ reported the museum’s expansion plans in May 2016 and the museum formally announced the project the following month, as it neared its $35 million fundraising goal.The Children’s Museum didn’t inform the Salvation Army of its expansion plans until the public announcement, the charity said in its suit. The Salvation Army since has made several attempts to resolve the issue privately, it said, but the concerns have gone unresolved.“We’ve had a great relationship with the Children’s Museum,” Webster said, “but they’re asking us to do stuff now that is unsafe.”The Salvation Army still has access to busy Meridian Street, but the restrictions to Illinois Street create an inconvenience that encroaches on its easement rights, Webster said.The sports park is set to open in the spring of 2018. Plans had been in the works since at least 2012, when the museum purchased both The Drake and The Whitestone apartment buildings to the north of the museum from Indianapolis-based Zender Family Limited Partnership for $1 million each. The Whitestone has been torn down to make way for the expansion.The Children’s Museum of Indianapolis was created in 1925 and moved to its current location at 3000 N. Meridian St. in 1946. The facility, which is the nation’s largest children’s museum, encompasses 472,900 square feet under roof and houses 120,000 artifacts.FacebookTwitterCopy LinkEmailSharelast_img read more

Tom Hamilton & Holly Bowling Lead Acoustic Grateful Dead Tribute At The Cap [Pro-Shot Video/Photos]

first_imgTom Hamilton and Holly Bowling teamed up for a special night at Port Chester, NY’s Capitol Theatre on Friday, June 1st. The pair—who recently kicked off their first tour with their new Ghost Light project—treated fans to an acoustic tribute to the Grateful Dead.EXCLUSIVE: Tom Hamilton & Holly Bowling Talk New Band, Ghost Light, & The Grateful DeadHamilton and Bowling both have plenty of experience with the Grateful Dead catalog. In addition to playing Dead tunes with Ghost Light, Hamilton has been a member of popular Grateful Dead tribute act Joe Russo’s Almost Dead since the band’s inception. Bowling, on the other hand, released a full album of Grateful Dead covers titled Better Left Unsung and rose to fame in the jam scene for her creative solo piano reimaginings of Phish and the Dead. Both artists have performed with original members of the Grateful Dead at various times. For a full list of upcoming Ghost Light tour dates, head to their website.Watch pro-shot video of Tom Hamilton and Holly Bowling’s Acoustic Explorations of the Grateful Dead below, courtesy of Relix.[Video: Relix]Check out photos from Hamilton and Bowling’s Acoustic Explorations of the Grateful Dead below, courtesy of photographer Andrew Blackstein.Tom Hamilton & Holly Bowling | Acoustic Explorations of the Grateful Dead | The Capitol Theatre | Port Chester, NY | 6/1/18 Load remaining images Photo: Andrew Blacksteinlast_img read more

Again, Obamacare under siege

first_imgThe U.S. Supreme Court is hearing oral arguments on Wednesday in the case of King v. Burwell, a suit challenging implementation of the Affordable Care Act (ACA), President Obama’s signature program to expand health insurance coverage to all Americans. The case revolves around federal subsidies that decrease insurance costs for low- and middle-income Americans who buy through federal health insurance exchanges in the 34 states that declined to set up state-run health insurance exchanges. Plaintiffs in the case argue that the law’s wording should limit the subsidies only to those getting insurance in the 16 states that did set up exchanges.The Gazette spoke about the case with John McDonough, professor of the practice of public health at the Harvard T.H. Chan School of Public Health and an authority on health care reform.GAZETTE: Can you tell us about the case and describe the issues involved?McDONOUGH: This lawsuit has been advanced by the Cato Institute, a libertarian think tank in Washington that wants to invalidate the provision of federal health insurance tax credits to consumers under the Affordable Care Act because of a narrow interpretation of the law. That [interpretation] suggests that the law was written in a way that does not permit tax credits/subsidies to flow to the consumers who obtain their insurance through the federal health insurance exchanges as opposed to state exchanges.GAZETTE: It seems like this split between federal and state exchanges is at the center of this case. Can you explain what the exchanges are and why there may be more federal exchanges than originally anticipated?McDONOUGH: An exchange is a creation of the Affordable Care Act that is now spreading across the country, in the ACA variety and in other forms as well. An exchange is a marketplace where consumers who can’t get health insurance anyplace else can go and buy individual insurance, sometimes referred to as non-group insurance.The exchange runs the website where people can go online and make their purchases. The exchange is responsible for making sure that the website only sells insurance policies that meet the requirements — the protection and the benefits — of the Affordable Care Act.The way the law was written, states were given the right of first refusal to set up their own exchanges. Then, if they either deliberately chose not to set up an exchange or didn’t make a decision, the establishment of “such exchange” is given to the U.S. Department of Health and Human Services.GAZETTE: What do those behind this lawsuit hope to accomplish?McDONOUGH: The folks behind this lawsuit, in particular the Cato Institute, have been vociferous opponents of health reform, [and have been] very much enemies of the Affordable Care Act since before the ACA was signed into law by President Obama in March of 2010. They have been parties to multiple lawsuits and have a strategy of doing anything and everything they can to repeal or undermine and bring down the Affordable Care Act. And I don’t think I’m saying anything they would disagree with at all.They are determined to see the law repealed, to see it fail, because their values, their ideology is completely opposed to any level of government providing this kind of protection to citizens.GAZETTE: What are possible ramifications if the Supreme Court agrees with them?McDONOUGH: There have been evaluations done by the Urban Institute, by the RAND [Corp.], by the Commonwealth Fund, and by others. The most credible estimates that I’ve seen suggest that if the decision were to go in the plaintiffs’ direction, between 9.3 and 9.6 million lower- and moderate-income working Americans who are obtaining subsidies right now would find their health insurance unaffordable, and most of them would drop coverage.The number of uninsured, with an adverse decision, would increase by about 8.2 million. We’ve seen the number of uninsured over the past year drop by more than 10 million. So this would erase a very large proportion of the progress that has been made over the last 18 months in expanding coverage.Importantly, we know from research that the lack of health insurance actually is a cause of death among Americans. One estimate suggests that — and this is pre-ACA — as many as 45,000 Americans every year have a premature death principally because they didn’t have health insurance.So one of the many amicus briefs that was filed in this case was filed by about 22 deans of U.S. schools of public health, and includes an estimate that if 8.2 million folks became uninsured, that would translate into approximately 9,800 premature deaths annually.There will also be significant disruption in the U.S. health sector. The people who would be most immediately and directly damaged would be people who currently have a subsidy. But there are also millions of folks who buy unsubsidized health insurance, both inside and outside exchanges, who would be adversely impacted by this as well.That’s because many of those people getting subsidized coverage are younger and healthier people. They would dive out of the market and there would be an adverse selection phenomenon in the markets in these 34 states. That would result in extraordinary health insurance premium increases to the non-subsidized folks as well. The estimate — again from Urban and Rand — suggests that premiums would increase anywhere between 35 and 47 percent. That would lead many, many, many of these unsubsidized, non-group enrollees also to drop coverage.GAZETTE: So it wouldn’t just be the hit from losing the subsidy. In addition, the rates would go up?McDONOUGH: It would be the market impact as well that would lead to another significant number of folks dropping coverage. Really what you would be seeing — and this is not an exaggeration — is the destruction of the non-group insurance markets in all of these states, these 34 states.The estimate of the loss in revenues to various parts of the health care sector annually is about $9.3 billion … and about $6.3 billion of that would be losses that would affect hospitals. And many of these hospitals provide disproportionate care to lower-income folks. So some of the safety-net hospitals would take some of the biggest hits and biggest pain as a result of an adverse rule.GAZETTE: If the government loses, is there a chance it will kill the law, or, if it just damages the law, is there any chance Congress might “fix” it?McDONOUGH: Those are all questions without answers. Massachusetts has its own state exchange, New York is another — there are about 16 states where it’s pretty clear things would continue.Massachusetts started in 2007 through its own reform law, and I don’t think there was any adverse impact in Massachusetts because other states did not have this structure. So I think that, in states that have their own state-based exchanges, things would continue without significant disruption.Would Congress find a way to come in and undo the damage? There’s a political game going on in Congress and in Washington, D.C., right now. Republicans are saying that they will come in and undo the damage. However, they have not put anything down concretely, and the pattern has been whenever the Republican-controlled chambers have attempted to do something, they can’t even agree among themselves what to do. For example, the House of Representatives voted more than 55 times now to repeal all or part of the ACA and has never advanced — even as a proposal — a significant replacement. So the notion that they would come together and advance an alternative framework is a speculative proposition.GAZETTE: What happens if the government prevails? Any changes at all, or just go back to business as usual?McDONOUGH: If the government prevails, which I suspect is going to be the case, then the last significant obstacle to full and secure and long-lasting implementation is discarded.Though Republicans came in promising to do significant damage to the ACA, they have not been able to agree on anything at this point other than minor changes around the 30-40 hour workweek rule. When the Supreme Court announced that it was going to consider this case, last December, it provided a reprieve for Republicans. It allowed them to kick any kind of replacement structure down the road. They used King v. Burwell to say: Whatever happens, we’re going to get to something in the fall after we see what the Supreme Court does.GAZETTE: Are there other legal challenges? You seemed to indicate this is the last big one.McDONOUGH: I stand to be corrected, but after this one there are just cats and dogs left.GAZETTE: What are the next big milestones for the law?McDONOUGH: We’re in the middle of the next big milestone right now. For the first time, people are filing their taxes and feeling the individual-mandate penalty.It is at a low rate this year: $95 or 1 percent of your household income, whichever is higher, if you didn’t have valid coverage in 2014. Next year, it will go higher, and the year after that, in 2016, it will go higher, and that’s where it will stay. So right now, people are facing the individual-mandate penalty, and there are also people who got subsidized coverage last year and didn’t correctly estimate what their household income would be.People who got subsidies larger than they were entitled to have to pay the excess back. People who got lower subsidies than entitled actually get an advantage. So all of this is swirling around right now as the Supreme Court is hearing the oral arguments.GAZETTE: Sounds like we’re at a phase in the implementation where the carrots are switching to sticks?McDONOUGH: Yes, but understand that the single most important day of implementation was Jan. 1, 2014. That was the day when the systemic insurance reform, elimination of medical underwriting and pre-existing condition exclusions, and putting in its place something called guaranteed issue, became law in all 50 states. That was the day that the individual mandate became real. That was the day the subsidies began to flow, the day that Medicaid expansion became activated under the provisions of the ACA in all of the states that have accepted the expansion.That is why, in the fall of 2013, there was a federal government shutdown. That really was the last major effort by Republicans to kill or undermine the law before it took full effect, because they understood how consequential that date was. On that date, the benefits of the law changed from being hypothetical to being real.GAZETTE: The kids are now covered, the pre-existing conditions are covered, and these are things people are not going to want to go back on. McDONOUGH: Right now, any changes that you make to any of those key elements affect real people who are getting benefits today. And that is a completely different dynamic. In terms of the implementation game, if you’re going to call it that, we’re way into the fourth quarter. GAZETTE: Once we get through the implementation and 2016, aren’t there still provisions for experimental programs and other ongoing changes, so it won’t be a situation where it’ll be done and that’s it?McDONOUGH: No, this is like Social Security, this is like Medicare, this is like Medicaid. The passage of the original law sets a new framework, and is the end of the initial legislative process. [But] it only opens a new era, of what I like to refer to as continuous policy improvement.Medicare and Medicaid were both established in 1965. That was the end of the initial journey by President Lyndon Johnson to pass a law. It was only the start of an endless change, evaluation, and improvement process. When Medicaid, for example, was established in 1965, the only people who could get any benefits from Medicaid were poor, low-income mothers and their children who were collecting public assistance.Shortly thereafter, states started experimenting, Congress started experimenting, expanding the scope of who could get benefits. It has grown and grown and grown and, obviously, took a major, historic leap forward with the Affordable Care Act as well.But many of these [new] programs will not succeed and will be repealed, gone and forgotten. Others will become an enduring part of our health system landscape for decades and longer. We won’t know for some time the durability of any of these, but it’s fairly certain that the essential, important ones will stay, although they will be — as has been the case with Medicare and Medicaid — changed, improved, cut back many, many times in the years and decades to come. That’s how it goes.It’s never over until you die, and then it goes on without you. That’s what I tell my students every year. It always gets a good laugh, but it’s true.last_img read more