Curvy swimsuit model cyberbullied over revealing Instagram photo

Plus size model Alexa Phelece routinely uses her Instagram to post body positive shots of herself in swimsuits and curve-hugging fashions.

Through her posts and uplifting messages, Phelece has grown her following to nearly 80K. However, her largely supportive fans weren’t as encouraging when the model posted a picture of herself and a much thinner woman wearing the same swimsuit – a $40 khaki monokini from Fashion Nova.

“So here we have two girls in the same swimsuit. Let me just point out a few things,” Phelece captioned the splitscreen photo.


“One girl is in size Sm (I looked online) and one is in 3x- different skin colors,” she continued. “– one may be considered privileged- one is more commonly seen as healthy based on size – one is more commonly recognized as beautiful on tv or media,” Phelece said.

However, it was the similarities the Instagram influencer listed that whipped her followers into a frenzy.

“Both [women] are models – both are wearing the same swimsuit,” Phelece said. “LETS NOT FORGET: BOTH are beauty – BOTH should be treated equally – both should be able to love their bodies – BOTH should be judged on the content of their character NOT their skin color and definitely NOT their size – Both women are equally capable and worthy.”

Her empowering speech is in line with other captions the Every Body Deserves Love founder has posted. This time, though, her fans were not feeling the love.

“At first I was getting a lot of love and encouragement to continue my self love journey but it quickly got very negative,” she told Yahoo Style. “I received a lot of comments mentioning the status of my health and how I am promoting obesity.”

On the photo, which received over 8,000 likes, one woman commented, “Girl from the right picture represents- laziness, obesity, and this type of post is just an excuse for fat persons, to continue leaving unhealthy life.”


And another person wrote, “’Fat but Fit’ is a myth. There are a myriad of studies out there that all come to the same conclusion. Being overweight, especially obese (yes, she IS obese), increases your risk of heart disease. Love yourself all you want, but you can’t deny reality that your weight puts you at risk for an early death. Period.”

Phelece, who told Yahoo Style that she was “heartbroken” to see the amount of hate her photo received, feels that women need to build each other up more rather than attack each other over physical differences.

Still, she is addressing the hate head on in her follow-up posts calling out those who have “fat shamed” and accused her of “promoting obesity,” and posting the ways she stays healthy like exercising and embracing her curves.

Read more:

A Cup Of Coffee Before The Gym Can Make Your Workout More Enjoyable, But There’s A Catch

If you’re a frequent gym-goer, I’m willing to bet that you’ve probably seen that chick who strolls into the weight room with her giant Starbucks cup in hand, or the dude with the hefty coffee mug sitting alongside him as he slays on the rowing machine. While we can all agree that coffee is, indeed, a serious blessing that shouldn’t just be limited to a morning wake-up call, is it really all that safe to drink coffee before a workout?

Anyone who’s looking for a little extra pep in their step before hitting the gym will likely opt for something like a pre-workout energy drink or supplement. But if you’ve ever tried that stuff, you know damn well just how expensive it is, not to mention the fact that it’s not exactly healthy for you and your hard-working bod

Of course, this only makes a quality cup of glorious java that much more tempting to indulge in before a tough sweat sesh.

If you’re out here dreaming of a nice cup of joe before the gym, science says you, my friend, are in luck.

A cup of coffee before your ab circuit can reap results such as an increased metabolism, improved circulation, muscle preservation, and extra endurance.

Plus, in a study from Coventry University, sports scientists found that caffeine helps fight decreased muscle strength that often occurs as the body ages.

I’m sure you didn’t need me to tell you how amazing coffee is in general, but who knew it could do so much good for the body when it comes to exercising?

But on the real, before you start ordering five cups of your favorite caffeinated beverage at Dunkin’ Donuts on your way to the gym, there’s a bit of a catch that you should know about.

Despite some of these reported benefits, some personal trainers say drinking coffee before a workout has a few downsides.

For example, while personal trainer Greer Rothermel loves her caffeine as much as the next girl, she knows what to avoid when it comes to her own energizing cup of pre-workout joe.

In terms of the benefits, Rothermel tells Elite Daily,

I have coffee before almost every workout.

It has many benefits which could help you during your next workout, including increasing your alertness, improving focus, and enhancing performance.

Though a couple shots of espresso can help you push through a rough workout and make it easier to exercise at a greater intensity, the catch you need to know about is what you put into your coffee: the creamer, the sugar, the artificial flavors — all that stuff.

Rothermel reveals,

Coffee can become unhealthy quickly, so make sure your coffee is good for you.

Make sure you skip out on the artificial sweeteners, artificial flavoring, and highly processed creamers.

If you’re just not about that black coffee lifestyle, though, personal trainer Rebecca Kennedy has you covered.

Kennedy uses healthy additives in her java to replace the processed crap that hinders the #gains, and your health.

Here’s what you can find in Kennedy’s cup of brew:

I start every day with a Moka (stove-top espresso) with three pumps of Promix medium chain triglyceride (MCT) oil, and two scoops of collagen peptides.

The MCT breaks down fast like a carb and is great to help sustain energy levels without experiencing spikes.

Additionally, the collagen peptides I add have a banging 20 grams of protein.

Kennedy stresses the fact that she never adds sugar to her coffee anymore because of its detrimental negative health effects. However, she says the MCT she adds to her coffee give the drink a smooth, butter-like quality that she used to turn to milk and creams for.

So, yes, you can totally mix your coffee with your cardio — just take it easy on the sugary artificial crap you pour into it to make it taste good. Try reaching for a banana to wash down some black coffee, or sprinkle some cinnamon in your cup when you’re craving that sweet little something.

Read more:

Dallas preps ‘mega-shelter’ as Texas braces for more rain

Houston (CNN)Harvey is no longer a hurricane, but life-threatening flooding continued in and around Houston on Sunday night as citizens with boats assisted authorities in search and rescue efforts.

Flooding from Tropical Storm Harvey is overburdening resources in the country’s fourth-largest city, prompting authorities to call on volunteers with watercraft for help in rescuing those trapped in homes and buildings.
An immediate respite from Harvey’s wrath seems unlikely to come. The National Weather Service calls the flooding “unprecedented,” and warns things may become more dire if a forecasted record-breaking 50 inches of rain does fall on parts of Texas in coming days. In anticipation of a worsening situation, Dallas is turning its main convention center into a “mega-shelter” that can host 5,000 evacuees.
    The rainfall threatens to exacerbate an already dangerous situation, as Harvey’s rains have left many east Texas rivers and bayous swollen to their banks or beyond.
    “The breadth and intensity of this rainfall are beyond anything experienced before,” the weather service said. “Catastrophic flooding is now underway and expected to continue for days.”
    The storm killed two people in Texas, authorities said, and the death toll will likely rise. More than 1,000 people were rescued overnight, and Houston Mayor Sylvester Turner warned that some 911 calls are going unanswered as operators “give preference to life-threatening calls.”
    Here are the latest developments:
    • A woman who drove her vehicle into high water in Houston was killed, and fire killed a man in Rockport.
    • Several states and the US military are sending emergency workers and equipment to Texas. In Harris County, though, authorities are having issues mobilizing those resources. “We’ve requested boats, all the things that would normally happen in a well-planned response to an event like this, but they can’t get here,” Harris County Judge Ed Emmett said.
    • Dallas announced its plans to open a “mega-shelter” capable of accommodating 5,000 evacuees at the Kay Bailey Hutchison Convention Center. County officials, charitable groups and local hospitals are working to open the shelter by Tuesday morning.
    • While Turner warned the rain could exacerbate flooding for “four to five days,” Federal Emergency Management Agency Director Brock Long said he expects his agency “is going to be there for years.”
    • The Houston Independent School District has canceled school for the week.
    • Houston’s George Bush Intercontinental and William P. Hobby airports are closed until further notice, officials said. Corpus Christi International reopened at 4 p.m. Sunday, officials said. Jack Brooks Regional Airport in Beaumont, Ellington Airport in Houston, Mustang Beach Airport in Port Aransas and McCampbell-Porter Airport in Aransas Pass are also temporarily closed, the Federal Aviation Administration says.
    • Ben Taub Hospital, which houses a Level I trauma center, is being evacuated after flooding in the basement “disrupted the power source,” Emmet said.
    • 316,000 customers have lost electricity, Gov. Greg Abbott said.
    • The Red Cross is serving about 130,000 meals a day, the governor said.
    • President Donald Trump will travel to Texas on Tuesday, press secretary Sarah Huckabee Sanders said.


      Woman trapped in home: 911 told us not to call

    Among those stranded by the storm is Ify Echetebu, 30, who spoke to CNN from her aunt’s house in Dickinson, not far from Galveston Bay. Along with her fiancé, grandparents, a friend and several teenagers, Echetebu is trapped on the second floor of the house as floodwaters creep up the staircase. She can see the rooftops of submerged cars in driveways, she said.
    On the first floor, the water is up to her waist, she said. Emergency services know she and 10 others are holed up in the home, she said, but because emergencies take priority, she doesn’t expect to be rescued until tomorrow, Echetebu said.

    The severity of the situation just hit me. I’m overcome with grief due to how helpless I feel in all of this. This is truly devestating. #PrayForTexas #PrayForGalvestonCounty #TropicalStormHarvey #HurricaneHarvey

    A post shared by Lotenné I. E. (@1whitenigerian) on

    “We’re nervous to stay here, but we are sleeping in shifts,” she said. “Now we’re having to deal with sewage in the water, river water, bayou water, water moccasins, snakes, gators.”
    Not far away, a rescue operation saved 20 to 25 residents of La Vita Bella assisted-living facility in Dickinson.
    “They were up to their waist,” Galveston County Commissioner Ken Clark said. “If they were in a wheelchair, they could have been up to their neck.”
    After a record 22 inches fell on the county in one day, rescuers set out before dawn Sunday to save those who braved the storm. Officials quickly realized they did not have enough boats for the rescue operations and asked private boat owners to help, said County Judge Mark Henry, responsible for disaster response in the county.
    As of Sunday evening, between 800 and 1,200 people had been rescued from their homes in Galveston County, Henry said.
    As authorities warned people not to take shelter in attics, unless they have axes handy to break through their roofs, several residents provided CNN with their accounts of riding out the storm.
    “We are still stranded in our home with little kids and the water keeps rising,” Houston resident Janet Castillo said Sunday morning. “We have (tried calling several numbers), but their lines are all busy or they don’t answer.”
    Jake Lewis of New Braunfels, Texas, said he woke up to ankle-deep water in the Houston hotel where he is staying.
    “We have nowhere to go,” he said. “I have a 2016 Chevy Silverado and the water is up to the door panels. The water keeps rising.”
    One of two confirmed fatalities happened in Houston when a woman drove her vehicle into high water and couldn’t make it across, city police said. She got out of her vehicle, was overtaken by floodwaters and drowned.

    Many roads impassable

    In a Sunday news conference, Abbott said, “We want to stress when there is heavy rainfall and flooding, the importance of staying off the road. If you drive into water, you’re taking your life into your own hands.”
    Portions of major highways, including Interstates 10, 45 and 610, were submerged and unnavigable. Houston resident Dion Laurent said the White Oak Bayou flooded I-10 and I-45.

    White Oak Bayou flooding I-10 and I-45 #Harvey from Quitman St. Bridge

    A post shared by dion laurent (@dionrlaurent) on

    Harris County Sheriff Ed Gonzalez said he understands the compulsion to find safer ground, but urged people to think twice before venturing out into high water and to consider unforeseen dangers, such as manhole covers being lifted from their holes.
    Lt. Craig Cummings of the Texas Department of Public Safety said attempts to drive to safety may be futile anyway, as it took him two and a half hours to drive 20 miles in Houston on Sunday.
    “There’s 60 barricaded locations as of midnight. Most thoroughfares are impassable. Several hundred structures are flooded, and we are expecting that number to rise,” he said.
    In Brazoria County, south of Houston, officials set up an evacuation route for all residents living west of State Highway 288 and south of State Highway 6, ordering them to “LEAVE NOW!” under a mandatory evacuation order. Those in need of shelter can take refuge in the Bell County Expo Center in Belton, officials said.
    The 911 dispatchers in the nation’s fourth-most populous city have received 2,000 requests for rescue, Mayor Turner said. Houston Fire Chief Samuel Peña said his department had responded to 2,500 calls and have about 1,000 more waiting to be serviced.
    Gonzalez tweeted that many high-water rescues were performed overnight in Houston, some involving children or residents with medical issues, including one person suffering from cardiac arrest. Stranded residents were saved from vehicles on the highway. Airboats were employed in some instances, he said.
    People are taking to social media to announce their locations and ask for help.
    One person, whose mom is diabetic and dad has heart disease, tweeted, “We need help!! My house is flooded.”

    24 inches of rain in 24 hours

      Slow moving storm Harvey drenching Texas

    Harvey blasted ashore as a Category 4 hurricane just north of Corpus Christi. It brought with it 132-mph winds but was quickly downgraded to a tropical storm. Still, it continued to spawn tornadoes and lightning.
    A flash flood emergency was declared for sections of Houston, where more than 24 inches of rain fell in 24 hours, the National Weather Service said.
    The weather service said maximum sustained winds Sunday would be near 45 mph. While Harvey could become a tropical depression by Sunday night, residents are warned to remain vigilant.
    The slow-moving storm is expected to drop 15 to 25 inches of rain over the Texas coast through Thursday. Isolated storms could drop up to 50 inches of rain, the weather service said.
    “What is unique in Harvey is that as the storm moved inland, a large high pressure built in to the north and, basically, the steering currents, which guide Harvey, collapsed,” said CNN senior meterologist Dave Hennen. “This has caused the extremely slow movement of the storm, moving only around 60 miles, less than 2 miles per hour. This has allowed the bands of storms to move over the same areas over and over.”
    The weather service says rainfall of this magnitude “will cause catastrophic and life-threatening flooding.”
    Some residents are comparing Harvey to Allison, a storm that struck the Texas coast in 2001 and killed 23 people.
    “Allison was bad — really, really bad,” Houston resident Pat Napolio said, “but if (the water) creeps up anymore, Harvey will surpass (Allison).”

    Rockport hit hard

    Another fatality was reported in the battered coastal city of Rockport. A person died in a house fire during the storm, Aransas County Judge Burt Mills said Saturday.
    Warnings of tornadoes, torrential downpours and potentially historic flooding means extra bad news for broad swaths of southeast Texas, already littered with uprooted trees, toppled signs, flagpoles snapped like toothpicks and homes missing rooftops and patches of brick walls.
    Additional fatalities were feared in Rockport, where an estimated 5,000 residents rode out the storm, Aransas County Sheriff Bill Mills said.
    Brock Long, director of the Federal Emergency Management Agency, said that Harvey would leave areas “uninhabitable for weeks or months,” echoing language last heard ahead of Hurricane Katrina in 2005.
    “FEMA is going to be there for years,” Long said.

    Read more:

    Read the Fine Print on the $475,000 Price of a Cancer Breakthrough

    It's been an historic week for cancer treatment. 

    Kicking it off, Gilead Sciences Inc. bought Kite Pharma Inc., a pioneer in "CAR-T" cell therapy, which uses a patient's immune cells to potentially eradicate blood cancers with just one treatment. And on Wednesday, Novartis AG's entry in this field, Kymriah, became the first such treatment to get FDA approval — a month ahead of schedule, to boot. 

    Making this even more interesting, Novartis priced the drug at $475,000 for one treatment. That is eye-popping, but well below even higher expectations of up to $700,000. And Novartis said it would offer ways to make the price even lower for some patients.  

    Kymriah will still be one of the most-expensive drugs ever, and its list price doesn't include the other costs of administering a complicated treatment with major side effects. But if CAR-T drugs are to become more than just niche medicines, then drugmakers will have to be flexible on pricing. It is encouraging that Novartis is building such flexibility in from the start. 

    Novartis hopes to use "indication-based" pricing, meaning it would charge patients differently depending on what sort of cancer they have. Kymriah's initial FDA approval is for a narrow group of patients: children and young adults with a specific blood cancer. These patients will likely be charged the highest prices. Not only is this a niche population, but the drug works particularly well in this group, with remissions achieved in 83 percent of patients within 3 months.

    But in clinical trials for older patients with a different cancer, Kymriah hasn't worked as well. So Novartis will likely charge that larger group less for the drug, if it is approved for those patients in the future. This would not be an entirely altruistic move on the drugmaker's part. A discount may be necessary to get doctors to prescribe, and payers to pay for, a drug in a larger population that will see less benefit. If Kymriah is to meet Wall Street's sales expectations, then it will need to move well beyond its initial approved use. Variable pricing may help.  

    Novartis is also working with the Centers for Medicare and Medicaid Services on a novel plan where it won't charge for Kymriah if it isn't working after a month. There's room for the drugmaker to do much more here. In the narrow group of patients for which Kymriah has initial approval, the response rate after a month is very high. Relapses tend to occur later. That means discounts tied to long-term success would be more meaningful. But Novartis will end up eating the cost for some treatments — and that's a big deal for a drug that is expensively manufactured for each individual patient rather than in large batches. 

    Novartis may still take some heat for its price tag, but it could have been much worse. A U.K cost-benefit analysis of CAR-T drugs suggested a $750,000 price could be justified. Novartis is notably scrapping the typical pharma playbook, which is to start high and privately give discounts to insurers. That would have been the wrong approach in this case, optically and strategically, inviting a fiercer backlash and slowing uptake of the drug.

    Novartis knows how that movie goes. It thought its heart drug Entresto, approved in 2015, could be a blockbuster with $5 billion in annual sales. But pharmacy benefit managers and insurers afraid of such spending threw up roadblocks to the drug's broader use — it only costs about $4,500 a year, but heart disease is a huge market — that have badly hurt sales growth and expectations. Analysts once expected Entresto to hit $1 billion in sales this year; now they expect that milestone to come in 2018, and just barely. By adding extra pricing levers for Kymriah, Novartis will be better at adapting to an even more complicated market than Entresto's. 

    The fact that a $475,000 price looks something like restraint says a lot about the state of drug pricing in the U.S. But in this case, the fine print matters. 

    This column does not necessarily reflect the opinion of Bloomberg LP and its owners.

      Read more:

      Use neuroscience to convince your boss to let you nap at work

      Image: Orlova Kristina/mashable

       A nap can be a beautiful thing when we feel our brain slowly grinding to a halt. Whether it’s a siesta to shake off a food coma, a daytime doze on a lazy Sunday, or an all-out nap orgy with friends or loved ones, we arise feeling replenished, recharged, and ready to take action.
      Unfortunately, not very many bosses see any correlation between snoring and success. Only a handful of organization—Ben & Jerry’s, Nike, Zappos, Google, and The Huffington Post, to name a few—currently see naps as smart business. They’ve invested in nap pods and massage chairs because they know that, when it comes to boosting productivity and creativity in the workplace, naps can be just what the doctor ordered.

      If you aren’t among the lucky few who work for nap-friendly bosses, you’ve come to the right place for advice. I’m a Harvard Medical School neuroscientist who firmly believes in the power of the unfocused mind, and my goal is to have every business on Earth — including your employer — embrace naps as a vital part of the workday.  

      The neurology of naps

      First, allow me to clarify a few things and offer a bit of a disclaimer. 

      Not all naps are equal, and not all brains are equal. Everyone will respond differently to napping, as some brains are more energy-efficient than others. For instance, a 15-minute catnap might give Sally the salesperson three extra hours of battery life, but it will only provide Mary the marketer with one extra hour of productivity. 
      Science also offers us some words of caution. Unhealthy napping habits may increase the risk of diabetesmuscle aches, and heart disease. People who use long, frequent naps as a substitute for sleep, for example, seem to get ill more often. 

      On the other hand, strategic napping is scientifically proven to provide countless benefits. To get your boss on board, approach him or her with these three compelling science-backed arguments: 

      1. Naps will re-engage our team

      Employee disengagement has officially become an epidemic in America, with Gallup’s 2017 State of the American Workplace Report revealing that 51 percent of today’s workforce members are disengaged from their jobs. Chances are good that your employer’s no exception to this trend. 

      Your boss is probably trying to re-engage the team by preaching (and rewarding) immense focus and tireless, around-the-clock hard work. However, you need to explain to him or her that the human brain operates at its best when it’s encouraged to oscillate between focus and unfocus. 

      Though naps may not seem very engaging, brain science tells us a vastly different story. While you’re asleep, your brain’s focus circuits get some much-needed rest, but believe it or not, other parts of your brain kick into overdrive. In fact, the brain consumes more energy during a nap than it does while you’re awake — and the bulk of this energy is devoted toward regions that promote self-awareness and emotional control. Therefore, naps don’t just help us think better; they help us feel better (especially morning naps). 

      A well-rested focus circuit, paired with a greater sense of self, is a recipe for engagement in the workplace. All it takes is five to 15 minutes per day.  

      2. Naps will help us innovate

      In today’s ever-changing business world, innovation is what keeps companies afloat. Creative energy must flow through every department, and it’s up to your boss to foster an atmosphere that encourages this. 

      Perhaps he or she bought beanbag chairs, ping-pong tables, and colorful artwork in an attempt to stimulate creative thought, but few things come close to sparking creativity like a nap does. Explain to your boss that naps will help your team navigate complex taskssharpen its thinking, and keep a keen eye on its competition. Naps drop drawbridges between seemingly disconnected thoughts and allow for new insights to emerge.

      Keep in mind, however, that in order to reap the full creative benefits of napping, it’s best to devote 90 minutes to each snooze. This may require a rejiggering of the workday; perhaps your company could lengthen its lunch break to promote midday napping, and then extend its office hours a bit to make up for it. 

      Napping helps people freshen up their ideas and gain sudden, unexpected insights. On a companywide basis, they can give a business just the creative edge it needs to thrive.  

      3. All the cool kids are napping

      It’s no coincidence that some of the world’s most endearing and innovative companies were among the first to embrace napping as a viable business strategy. This is the wave of the future, and your boss will be in great company if he or she hops aboard today. Current and prospective employees will be thrilled by the idea of working in a progressive environment that mirrors the likes of Google. 

      But it also goes beyond business. Some of the world’s most inspiring minds were also known nappers. Salvador Dalí, Ludwig van Beethoven, Aristotle, Albert Einstein, and Thomas Edison power-napped their way to universal reverence, and even presidents Kennedy, Reagan, and Clinton were fans of the practice. 

      If your boss still doesn’t see napping as legit, sign and circulate this nap petition amongst your co-workers. It will give your group even more cred, and your boss may be more open to listening.

      Strategic napping is productivity in disguise — and it’s time for your boss to recognize this fact. Thanks to science, we can now unmask the hidden benefits of naps and bring a whole new meaning to “sleeping on the job.” 

      Srini Pillay, M.D., is the CEO of NeuroBusiness Group and the award-winning author of numerous books, including the upcoming book “Tinker Dabble Doodle Try: Unlock the Power of the Unfocused Mind,” available for preorder wherever books are sold, “Life Unlocked: 7 Revolutionary Lessons to Overcome Fear,” and “Your Brain and Business: The Neuroscience of Great Leaders.” He also serves as an assistant professor of psychiatry at Harvard Medical School and teaches in the Executive Education Program at Harvard Business School. 

      Read more:

      Pediatricians say Florida hurt sick kids to help big GOP donors

      St. Augustine, Florida (CNN)When he was 11 years old, LJ Stroud of St. Augustine, Florida, had a tooth emerge in a place where no tooth belongs: the roof of his mouth.

      With her son in terrible pain, Meredith Stroud arranged for surgeries to fix his problems.
      But just days before the procedures were to take place, the surgeons’ office called to cancel them.
      Like nearly half of all children in Florida, LJ is on Medicaid, which has several types of insurance plans. The state had switched LJ to a new plan, and his surgeons didn’t take it.

        Doctors: ‘Trick question’ hurt sick kids

      LJ wasn’t alone. In the spring and summer of 2015, the state switched more than 13,000 children out of a highly respected program called Children’s Medical Services, or CMS, a part of Florida Medicaid. Children on this plan have serious health problems including birth defects, heart disease, diabetes and blindness.
      The state moved the children to other Medicaid insurance plans that don’t specialize in caring for very sick children.
      Stroud says that for her son, the consequences were devastating. Despite hours of phone calls, she says, she couldn’t find surgeons on his new insurance plan willing to do the highly specialized procedures he needed. Over the next seven months, her son lost 10 pounds, quit the football team and often missed school.
      “He was in pain every day,” Stroud said. “I just felt so helpless. It’s such a horrible feeling where you can’t help your kid.”
      LJ filed a lawsuit against the state of Florida, and he was eventually placed back on Children’s Medical Services and received the care he needed. But some Florida pediatricians worry about other children with special health care needs who, two years later, are still off the program.
      The doctors aren’t just worried; they’re angry.
      First, the data analysis the state used to justify switching the children is “inaccurate” and “bizarre,” according to the researcher who wrote the software used in that analysis.
      Second, the screening tool the state used to select which children would be kicked off the program has been called “completely invalid” and “a perversion of science” by top experts in children with special health care needs.
      Third, in fall 2015, a state administrative law judge ruled that the Department of Health should stop using the screening tool because it was unlawful. However, even after the judge issued his decision, the department didn’t automatically re-enroll the children or even reach out to the families directly to let them know that re-enrollment was a possibility.
      Finally, parents and Florida pediatricians raise questions about the true reasons why Florida’s Republican administration switched the children’s health plans. They question whether it was to financially reward insurance companies that had donated millions of dollars to the Republican Party of Florida.
      “This was a way for the politicians to repay the entities that had contributed to their political campaigns and their political success, and it’s the children who suffered,” said Dr. Louis St. Petery, former executive vice president of the Florida chapter of the American Academy of Pediatrics.
      Experts outside Florida are also disturbed that the children were switched out of CMS, a program that’s served as a model for other states for more than 40 years.
      “CMS is well-known and well-respected,” said Dr. James Perrin, professor of pediatrics at Harvard Medical School. “It’s one of the earlier programs to build in assurances that these kids get the kind of care they need.”
      “These are the sickest and most vulnerable kids, and (changing their insurance) can mean life or death for them,” said Joan Alker, executive director of the Center for Children and Families at Georgetown University. “This is really very troubling.”
      Dr. Rishi Agrawal, an associate professor of pediatrics at Northwestern University’s Feinberg School of Medicine, agreed, adding that Florida should have more carefully considered how the insurance switch would affect the children’s health care.
      “The process in Florida was particularly abrupt and poorly executed,” he said.
      Mara Gambineri, a spokeswoman for the Florida Department of Health, said that “at no time (during the insurance switch) did children go without medically necessary services.”
      State officials, including a spokesman for Governor Rick Scott’s office, initially declined to comment directly on the pediatricians’ and parents’ concerns that the children might have been switched to benefit contributors to the Republican Party of Florida. On Friday, after this story was published, the Florida Department of Health released a statement asserting that such a claim “is 100 percent false.”
      “The department’s number one priority is protecting the health and well-being of all Florida residents, especially children with special health care needs,” Gambineri wrote in an earlier email. “The department remains committed to providing quality health care services to Florida’s children with special health care needs.”

      A mother’s anguish

      In spring 2015, LJ’s mother received a phone call from a nurse at the Florida Department of Health.
      Stroud had no idea that one word she would say to that nurse — just one single word — would cause her son months of pain and suffering.
      The nurse asked Stroud a series of questions, including whether LJ was limited in his ability to do things other children could do.
      Despite his birth defect, LJ goes to school and plays with friends, so she answered no.
      Stroud says that because of that answer, LJ lost his insurance with CMS, the program that has cared for children with special health care needs in Florida for 40 years, and was put on a different Medicaid insurance plan.
      LJ was one of 13,074 Florida children kicked off CMS — that’s about one in five children in the program — as a result of the telephone survey, according to a presentation, testimony and a letter from Florida’s top health officials.
        Stroud thinks back to her answer to the nurse’s question about limitations.
        “That question’s not fair,” Stroud said of the one that got her child kicked off CMS. “What [the Florida Department of Health] did was totally wrong.”
        “It was a trick question,” she added.

        Pediatrician: ‘A truly duplicitous question’

        Experts agree with her.
        “I personally find it pretty astonishing that they can take a survey question like that and use it to justify the de-enrolling of these kids,” said Dr. Jay Berry, an assistant professor of pediatrics at Harvard Medical School who studies policies for children with special health care needs.
        What Florida did was “completely invalid,” added Dr. John Neff, professor emeritus of pediatrics at the University of Washington, another expert on children with special health care needs.
        The pediatricians explained that many children with serious and chronic medical conditions — such as cleft lip and palate, HIV, diabetes and cystic fibrosis — are often able to do things other children can do. However, they still require extensive and highly specialized medical care.
        The question the Florida Department of Health nurses asked — “Is your child limited or prevented in any way in his or her ability to do the things most children of the same age can do?” — would lead to disqualifying children who truly have special medical needs from a program designed for them, said Stephen Blumberg, associate director for science at the National Center for Health Statistics and one of the world’s leading experts on the epidemiology of children with special health care needs.

        “Is your child limited or prevented in any way in his or her ability to do the things most children of the same age can do?”

        “You would get false negatives. Your conclusion would be that a child does not have special health care needs when, in fact, the child does,” he added.
        The Department of Health no longer uses the same screening method that resulted in 13,074 children being removed from CMS.
        “It is unfortunate the negativity surrounding this issue is a continued topic of inquiry, as the department and our stakeholders have put in a significant amount of time and effort to move past this issue for the benefit of the children we serve,” wrote Gambineri, the Department of Health spokeswoman.
        But pediatricians in Florida point out that many children who were removed from Children’s Medical Services using the controversial questionnaire were never put back on.
        “This was a truly duplicitous question,” said Dr. Philip Colaizzo, a pediatrician in Jupiter, Florida, who said that many of his patients with special health care needs were taken off CMS. “It was a trick question.”
        “It’s a perversion of science,” said Dr. Jeffrey Goldhagen, professor of pediatrics at the University of Florida College of Medicine and medical director of the Bower Lyman Center for Medically Complex Children at Wolfson Children’s Hospital.
        Goldhagen added that he was speaking for himself and not the institutions where he works.
        “It was a scam job,” added Dr. Nancy Wright, a pediatric endocrinologist in Tallahassee who said that dozens of her patients with diabetes were removed from the program.
        “They really tried their darnedest to kick the kids out of CMS,” added Dr. Carrol Fenn, an orthodontist in West Palm Beach. “They’ve messed up kids’ lives.”
        “They’re the most vulnerable of our population, and that they can be booted off the plan that was designed to help them is just amazing. How can someone in an office make a decision like that?” asked Dr. John Obi, an adjunct clinical professor in plastic surgery at the University of Florida, who operates on children with cleft lip and palate.
        “I congratulate whoever came up with that question,” he added wryly. “If you want to exclude virtually anybody, that’s the way to do it.”

        Johns Hopkins expert: ‘I’m speechless’

        Christina Bethell’s team came up with that question — and she’s furious.
        Bethell is a professor at the Johns Hopkins Bloomberg School of Public Health. She and her team spent many years and millions of dollars coming up with the right questions to accurately identify children across the United States who might have special health care needs.
        The list of questions — known as the Children with Special Health Care Needs Screener — is publicly available on the Hopkins website. Many state and federal agencies use it to help decide which children might benefit from special health services.
        The Florida Department of Health, however, used the questions to do something completely different: to kick children out of a program.
        That’s scientifically invalid, Bethell said. Using the questions that way — especially the question about limitations — would lead to denying children with special health care needs the services they require.
        “I’m speechless,” she said.
        To make matters worse, Bethell said, Florida repeatedly and publicly cited research done by her group at Hopkins — the Children and Adolescent Health Measurement Initiative — to support the children’s removal from CMS.
        “I feel really manipulated,” she said.
        She thinks of the children who were taken off CMS and fumes that the tool used to remove them was her own work.
        “I’m angry,” she said. “And I’m crestfallen for these families.”

        Grave consequences for Florida children

        The Shabanehs in Tallahassee are one of those families.
        Aref Shabaneh, 8, is blind, and his sister, Yasmeen, 11, is severely visually impaired. Their mother, Reema Shabaneh, says they were kicked off CMS in 2015.
        Shabaneh says she told the Florida Department of Health nurse that they didn’t have limitations.
        “Aref wants to do everything by himself,” she said. “He can play ball with friends. The ball has a bell, so he can hear it coming.”
        After they were kicked off CMS, Shabaneh said, she couldn’t find an ophthalmologist on the new insurance plan willing to care for her children.
          “I was so scared,” she said.
          When Jennifer Rodriguez received the phone call from the Department of Health nurse, she said, she told the nurse she didn’t know how to answer the question about limitations. Her son, Alejandro, suffers from a congenital heart defect, asthma and kidney problems. Sometimes, his heart races and he has trouble breathing, but other times, he feels up to playing soccer with his friends.
          “When I tried to explain the answer, she cut me off and said she was just doing her job and needed a yes or a no,” she said.
          Rodriguez says she answered that her son, who was 10 at the time, did not have limitations. He then lost his CMS coverage.
          “It makes me angry, because you would think that since he’s seeing a cardiologist, a nephrologist, a urologist and an asthma doctor, they would see he’s not your average child,” she said.
          LJ, Alejandro and the Shabaneh children filed lawsuits and were put back on CMS. They were represented by the Public Interest Law Center at Florida State University.
          Many Florida pediatricians say their patients also suffered when they were taken off CMS and put on other Medicaid plans. The doctors say those other plans typically have fewer pediatric specialists than CMS, which specializes in caring for very sick children.
          Dr. Lisa Cosgrove, a pediatrician in Merritt Island, Florida, said she had a difficult time finding an orthopedist to treat a 6-year-old with a broken elbow who had been taken off CMS. The girl ended up having surgery later than she should have and now can’t extend her elbow all the way.
          She said a baby born with a clubfoot also suffered because she couldn’t find an orthopedist willing to take the baby’s plan. The baby couldn’t have the necessary casts to twist the foot back into place and may need surgery, Cosgrove said.
          Dr. Elizabeth Curry, a pediatrician in Port St. Joe, Florida, said that last year, she took care of a baby whose eye wiggled back and forth involuntarily, which can be a sign of a brain tumor.
          Curry said it took her more than a month to find an ophthalmologist willing to take the baby’s Medicaid plan — and the doctor she finally found was three hours away, in Pensacola.
          Fortunately, the baby turned out to be fine.
          “This child could have had cancer. That’s a kid who should have seen a doctor right away,” Curry said. “I feel terrible for these children. It makes me so angry.”
          Because of problems like these, switching the children’s insurance “was a complete dereliction of Florida’s responsibility to children,” said Goldhagen, the professor of pediatrics at the University of Florida College of Medicine.
          Gambineri, the spokeswoman for the Florida Department of Health, said the children didn’t suffer as a result of the switch, because the insurance plans they were moved to were “more than capable” of caring for them. She added that even before the 13,074 children were switched, those plans cared for tens of thousands of children with special health needs.
          Other pediatricians agree that plans besides CMS have done a good job of caring for these very sick children.
          The other plans “do a pretty good job with our families,” said Dr. Karalee Kulek-Luzey, medical director of the Pediatric Health Care Alliance, a group practice with multiple locations in the Tampa area. “They’re working really hard.”
          “For the most part, they do a good job,” said Dr. Michael Freimark, a pediatrician in Plantation, Florida.
          “We have a good relationship with the plans,” said Dr. Michael Gervasi, president and chief executive officer of the Florida Community Health Centers, a large medical practice with offices in several counties. Most of the time, he said, the plans take care of the children’s needs, but if there’s ever a problem, his practice contacts the plan, and they fix it.

          Florida’s ‘outreach’ to experts

          In January 2016, about eight months after the Florida Department of Health started to move the 13,074 children out of CMS, Jennifer Tschetter, then the department’s chief operating officer, testified before the state legislature. She said that the decision to use the Hopkins screening tool was made “in consultation with … national experts.”
          But it remains unclear who those experts were.
          Tschetter, who has since left state government, did not respond to phone calls and emails seeking comment.
          Gambineri, the Florida health department spokeswoman, said the department did “research” into what Louisiana, California, Texas and New York “were doing and experiences they had in regard to clinical eligibility for children with special health care needs.”
          When asked for the names of individuals Florida consulted in those states, Gambineri didn’t respond.
          Gambineri added that “outreach” was made to the federal Health Resources and Services Administration.
          An official at that agency said she spoke with a Florida health official.
          Dr. Marie Mann, senior medical adviser in the Division of Services for Children with Special Health Needs at the federal agency’s Maternal and Child Health Bureau, said she spoke with Kelli Stannard, then interim chief, bureau of network operations, at CMS.
          Mann says she told Stannard she couldn’t give her any guidance.
          “I told her I was not in a position to provide advice,” Mann said.
          Mann said she suggested that Florida health officials reach out to Daniel Armstrong and Dr. Jeffrey Brosco, director and associate director respectively of the Mailman Center for Child Development at the University of Miami Miller School of Medicine.
          “We will make sure they’re both involved in this review process,” Stannard wrote back to Mann in an email obtained by CNN under the Freedom of Information Act.
          CNN asked Gambineri, the department spokeswoman, whether the department ever reached out to Armstrong to review and make recommendations on using the telephone survey to screen children out of CMS.
          “Not to our knowledge,” Gambineri answered.
          “I played no role in the decision-making process related to the use of the tool for the Children’s Medical Services program,” Armstrong wrote in an email to CNN.
          Brosco said he told the Department of Health that in his opinion, a child should not be kicked off CMS based on a parent’s answer to the question about the child’s limitations.
          “I gave them my feedback, and they said, ‘thank you for your work,’ ” Brosco said.
          In July, Brosco was named the Florida Department of Health’s deputy secretary for CMS.

            Christmas shopping at the Florida Mall

            Despite the lack of support from the very experts they’d consulted, Florida health officials forged ahead with using the phone survey to disqualify children from CMS.
            They had a schedule to stick to.
            In November 2014, state officials set out to “go live” with the phone survey in six months, according to a timeline developed by the state and obtained by CNN under the Freedom of Information Act.
            Before implementing the surveys, the officials gave themselves 21 days to “solicit feedback from the field” about the questions they would ask the parents.
            One of the first things they did was to ask one of the state’s most experienced pediatricians to leave a meeting.
            It was St. Petery, who at the time was the executive vice president of the Florida chapter of the American Academy of Pediatrics and who has an encyclopedic knowledge of Medicaid rules and regulations. He’d served as interim director of CMS for six months during the mid-1970s.
            He’d also been a thorn in the side of the state Department of Health for years. He’d been instrumental in a lawsuit that accused the state of failing to reimburse doctors properly in the Medicaid program and to ensure that children receive adequate care.
            His side eventually won that lawsuit, and the American Academy of Pediatrics gave him a prestigious award for being “a tireless advocate for children’s health and well-being.”
            On December 13, 2014, St. Petery showed up at the Department of Health meeting. It was for the regional medical directors of CMS, the group of pediatricians who help run the program. St. Petery wasn’t one of the directors, but he’d been attending their meetings for many years in his role with the Florida chapter of the American Academy of Pediatrics.
            St. Petery said that just before the meeting started, Tschetter, then the department’s chief operating officer, approached him.
            “She said, didn’t I want to go Christmas shopping at the Florida Mall?” St. Petery remembered. The mall was adjacent to the conference center in Orlando where the meeting was taking place.
            St. Petery said he told Tschetter that he hates shopping, especially around the holidays, and wanted to stay at the meeting.
            “I protested. I asked her, is this meeting not in the sunshine?” he said, referring to Florida’s Sunshine Law, which gives the public the right to access most government meetings.
            “After she told me for the third time to leave, I decided not to create a scene,” he said.
            St. Petery got up and left.
            Other doctors watched the action, stunned.
            “We were all kind of shaking,” said Dr. Barbara Rumberger, one of the CMS regional medical directors who attended the meeting.
            After St. Petery departed, health officials explained that they would start screening children off of CMS. Their justification: a new analysis showing that half the children on CMS might not belong there.
            There are no minutes for this meeting, according to Department of Health officials, but a year later, Tschetter presented similar data to the Florida Legislature.

            A ‘totally inaccurate’ analysis

            By Florida law, a child can be in CMS only if he or she has a “chronic and serious” condition requiring health care “of a type or amount beyond that which is generally required by children.”
            The analysis Tschetter presented showed that about half of the children on CMS had lower than average risk scores, an assessment of how much a patient uses health care services.
            Tschetter called these results “surprising.” By legislative mandate, children on CMS are supposed to have health needs greater those of other children.
            “The analysis made clear, certainly to the department, that we were not meeting legislative direction: (that) the children in the plan have both chronic and serious health care conditions,” Tschetter told legislators. “It was clear to the department that something had to be done, because complying with legislative direction is certainly not optional.”
            But an expert who developed the software Florida used to make that data analysis said the state did its calculations incorrectly.
            “It’s totally inaccurate,” said Todd Gilmer, co-developer of the Chronic Illness and Disability Payment System and chief of the division of health policy at the University of California, San Diego.
            Gilmer’s software, which is used by dozens of state Medicaid programs, tracks patients’ diagnoses and their prescription drug use to calculate risk scores for each individual.
            After viewing Florida officials’ analysis of the data, he said they made two errors when they calculated that half the children on CMS had below-average risk scores.
            First, he explained that his software relies on doctors’ diagnoses, and Florida failed to account for the fact that doctors frequently don’t document a child’s full diagnosis in the medical record. For example, if a quadriplegic child goes to the doctor because of bedsores, doctors often write down the reason the child came in — the bedsores — instead of the more serious diagnosis of quadriplegia.
            Second, he said, Florida did the wrong calculation for disabled children, who represent 40% of the patients on CMS, according to Mallory McManus, a spokeswoman for Florida’s Agency for Health Care Administration.
            He said his software compares disabled children with each other. Even the ones who fall in the lower half of the risk-score spectrum still have serious and chronic illnesses, he said, such as HIV or heart failure.
            He said that what Florida did was akin to assembling a group of people who are over 7 feet tall and calling the bottom half of that group short.
            Gilmer called Florida’s analysis “kind of bizarre” and said he was disappointed to see his software “misapplied” by the Florida Department of Health.
            Spokeswomen for the Florida Department of Health and the Agency for Health Care Administration did not respond directly to Gilmer’s criticism.
              Gambineri, the health department spokeswoman, said that the department no longer uses the screening method that it used in 2015 and that parents can ask to have their children re-screened at any time.
              “Our mission is now and has always been to provide the best health care possible to the populations that we serve,” McManus wrote in an email.

              Pediatrician: ‘We were just irrelevant’

              Pediatricians say that by the time the Department of Health meeting was held at the Orlando conference center at the end of 2014, they felt like Florida was dead-set on screening a large number of children off CMS.
              They said state officials didn’t listen to their concerns, even though they were stated repeatedly, both in person and in writing.
              At the meeting, health officials asked the pediatricians to tell them what was on their minds, according to Rumberger, one of the doctors who was there.
              She said she and her colleagues brought up concerns that children might be taken off CMS inappropriately.
              The Department of Health official wrote down what the doctors said on pieces of paper taped to the wall, Rumberger said. The official then told the doctors that these were issues to discuss at another time.
              “She said, ‘We’re going to park these. We’re putting these ideas in the parking lot for some time, and we’re not talking about these things today,’ ” Rumberger remembered, adding that she was speaking on behalf of herself and not in her role as a CMS regional medical director.
              “We were all amazed at what they did,” she added.
              A few months later, the state held a series of telephone conference calls with the same CMS regional medical directors.
              “They didn’t ask us ‘What do you think?’ or ‘Do you have any suggestions?’ ” Rumberger said. “It was just ‘This is how we’re going to do it.’ It was clear they didn’t want to have a free discussion.”
              “It appears to be a very conscious decision to not get input and not receive any dissension,” said Goldhagen, the professor of pediatrics at the University of Florida. “We were just irrelevant.”
              Dr. Rex Northup, another CMS regional medical director and associate professor of pediatrics at the University of Florida College of Medicine, agrees.
              “It was like, ‘When we want your opinion on a given topic, we’ll let you know, and we’ll provide that opinion to you,’ ” Northup said, adding that he speaks for himself and not the university or any other institution.
              Several doctors present on those conference calls said they voiced their concerns anyway.
              There’s no record of these concerns. According to the Florida Department of Health, no minutes were taken of these phone conferences.
              CNN asked the Florida Department of Health about the meeting where St. Petery was asked to leave and about doctors’ complaints that the state steamrolled through a screening tool that would harm sick children.
              “When CMS began the process of implementing a new screening tool in 2014, the department may have underestimated the need for stakeholder input and the time required to obtain feedback and ensure our community was comfortable with the mechanisms for determining clinical eligibility,” responded Gambineri, the Department of Health spokeswoman.
              She added that the department has “engaged our stakeholders using several methods” including public meetings to solicit input from patients, parents and providers and “remains open to feedback and input in order to best serve children with serious and chronic medical conditions.”
              True to its schedule, the state started screening children off CMS in May 2015.
              Florida pediatricians repeatedly told the state that it was hurting sick, vulnerable children.
              In August 2015, Goldhagen, Rumberger, Northup and 11 other doctors with positions at CMS wrote a letter to a Department of Health official saying the screening process was “flawed” and was removing too many children.
              The doctors did not receive a response, Goldhagen said.
              Two months later, St. Petery wrote to Department of Health officials, sharply criticizing the use of the screening tool.
              He said he never received a response, either.
              Curry, the Port Saint Joe pediatrician who practices in a rural area of the Florida Panhandle, said she also complained to the state’s Agency for Health Care Administration about children being kicked off CMS, along with other issues affecting children on Medicaid.
              She said the agency worked with her on some of the other issues but didn’t respond to her complaints about the children being taken off CMS.
              “Our Agency has been in contact with the provider and is working with the health plan to resolve what issues might be resolved,” wrote McManus, the agency spokeswoman.
              Curry said she took her complaints even higher.
              “I even called the governor’s office once and left a message,” she said. “I admit that I finally gave up. I’m just trying to take care of my patients.”
              Pediatricians interviewed for this story said they felt pressure from the state not to speak to the media about the removal of the children from CMS.
              On November 15, 2016, Dr. John Curran, then the Florida Department of Health’s deputy secretary for CMS, said on a conference call that a CNN reporter was working on this story, according to several doctors on the call.
              That evening, a department official wrote an email to the doctors who’d been on the call. It advised these pediatricians that prior to responding to media inquiries, they should contact the department’s communications director.
              “I’m going to be so fired for saying all these things,” Rumberger said.
              But she and other pediatricians say they’re speaking up because they feel that the Department of Health hurt children because they didn’t listen to their concerns.
              They say it could be because pediatricians don’t tend to have millions of dollars to donate to political campaigns.
              But insurance companies do.

              ‘Like a plot in a Carl Hiaasen novel’

              All of this — the telephone survey, the question about limitations, the analysis that’s been called flawed — leaves many Florida parents and pediatricians suspicious about why the state wanted to take 13,074 children off CMS and why it worked so hard and so quickly to do it.
              Switching the children from CMS to the other Medicaid plans didn’t save taxpayers money, according to McManus, the agency spokeswoman.
              The doctors wonder, then, whether the inspiration for the change was political: to send taxpayers’ dollars to generous donors to the Florida Republican Party.
              CMS is a public program; it’s not owned by a private insurance company.
              When the children were taken off CMS, they were switched to 11 insurance plans that are owned by private companies. The parent companies of nine of those 11 plans donated a total of more than $8 million to Florida Republican Party committees in the five years before the children were switched.
              “I knew it had to be about money,” said Wright, the pediatric endocrinologist in Tallahassee who said that dozens of her patients had their insurance switched. “This sounds very believable for Florida, and I’m from Florida.”
              “When this was all unfolding, I told my office manager, ‘I feel like we’re in a plot in a Carl Hiaasen novel,’ ” she added, referring to the Miami Herald columnist who writes about politics and corruption in Florida.
              The companies that own the nine insurance plans contributed $8.6 million to Florida Republican Party committees from 2010 to 2014, according to an analysis done for CNN by the National Institute on Money in State Politics, a nonpartisan nonprofit group.
              Here’s a breakdown of how much money each insurance company with a Medicaid contract contributed to Florida Republican Party committees from 2010 to 2014:
              • $5.9 million from Blue Cross and Blue Shield of Florida. Florida True Health is an affiliate of Blue Cross and Blue Shield of Florida. At the time the money was contributed, Florida True Health owned 40% of Prestige Health Choice, which has a Medicaid contract with the state of Florida. In 2015, Florida True Health purchased Prestige outright.
              • $90,000 from Simply Health, which owns a Medicaid plan called Better Health.
              • $849,433 from Miguel Fernandez, the former chairman of Simply Health. In addition, Fernandez donated about $1.3 million to Scott’s Let’s Get to Work political action committee from 2010 to 2014.

              Insurance companies’ outsize contributions to Florida Republicans

              Nearly all states pay insurance companies to insure some of their Medicaid patients; this is not unique to Florida.
              And insurance companies often contribute money to state political parties. That’s not unique to Florida, either.
              What is unusual is the size of the contributions, even for a large state.
              Take UnitedHealthcare, an insurance giant with business in all 50 states. From 2010 to 2014, United contributed $442,500 to Florida Republican Party committees, according to the National Institute on Money in State Politics.
              The company’s next largest contribution to any other state political party was $145,000 to California Democrats — less than half the Florida amount.
              Humana, another insurance company with a national reach, gave substantially more money to Florida Republican Party committees than to any other state political party committees.
              From 2010 to 2014, Humana donated $482,815 to Florida Republican Party committees. Its next largest contribution was $213,823 to Florida Democrats. The next largest contribution after that was $22,000 to the Illinois GOP, less than one-20th the size of the contribution to Florida Republicans.
              Blue Cross and Blue Shield of Florida gave Florida Republican Party committees $5.9 million from 2010 to 2014 and gave Florida Democrats $1.8 million. The next largest contribution after that from any other Blue Cross and Blue Shield company in the United States was $730,696 from Blue Shield of California to Democrats in that state — about one-eighth the size of the contribution to Florida Republicans.

              Florida’s payments to the insurance companies

              Nearly all states pay private insurance companies monthly premiums to insure Medicaid patients. It’s become big business.
              The Florida Department of Health declined to say how much it paid the private insurance companies to insure the 13,074 children when they were switched out of CMS.
              “If they got 13,000 new kids, (it’s) that times however many dollars per member per month,” St. Petery said. “I think that’s a lot of money when you start talking about that many kids.”
              These children came from CMS, a Medicaid program for sick children, and the state pays insurance companies more money to care for such children.
              This is how it works, according to McManus, the spokeswoman for the Florida Agency for Health Care Administration.
              Florida takes a look at all the people who’ve signed up with an insurance company and calculates a risk score for that group based on factors such as the age of the enrollees in the plan and their health conditions.
              A plan with the lowest risk score has a “typical population” and might be paid a rate of, for example, $320 per person per month, McManus said. A plan with sicker enrollees might have a risk score that’s twice as high and so would be paid $640 per person per month, she added.
              The numbers can get even higher from there.
              “The state will pay a pretty good rate for these children,” said Agrawal, the pediatrician at Northwestern who studies health care systems for children with special medical needs.
              “They could get paid thousands more per month for a child with serious medical needs,” said Steve Schramm, founder and managing director of Optumas, a health care consulting group.
              “The enhanced reimbursement may be 10 times what the insurance companies get for a well child,” said Goldhagen, former director of Florida’s Duval County Health Department.
              Sick children are, of course, also costlier for insurance companies because they need more care. But insurance plans monitor that care to manage costs.
              “Plans have gotten very sophisticated in their ability to manage very sick kids, so their willingness to take very sick kids is great,” said Jeff Myers, president and CEO of Medicaid Health Plans of America, an industry group representing insurance companies.
              Pediatricians questioned whether such outsize political donations were an attempt to gain influence and favor with Florida’s Republican administration, which orchestrated the transfer of the children out of CMS and to the private companies.
              “It certainly raises a lot of suspicion and concern,” said Northup, the associate professor at the University of Florida College of Medicine.
              “Why would they make contributions in the hundreds of thousands and the millions to Florida Republicans? Why would they be so uniquely committed to Republicans in Florida? It gives one pause,” he added. “If you follow the money, at the very least, it’s worrisome.”
              “It’s the left-hand-washing-the-right-hand kind of business,” said Dr. Joseph Chiaro, who was Florida’s deputy secretary of health from 2005 to 2011. “It breaks my heart.”
              Six Florida pediatricians gathered in Orlando to tell CNN their concerns. They practice in rural, suburban and urban areas. Some of them are Republicans, and others are Democrats.
              They said they feared that big donors had influence on the state’s decision-making process and that in many cases, the children suffered as a result.
              “I don’t see this in writing anywhere, but my impression is, this was a way for political payback at the expense of the sickest of the Medicaid children,” St. Petery said.
              “It just comes back to money or power. It’s not about health care for the children,” said Wright, the pediatric endocrinologist in Tallahassee.
              “Just follow the money,” said Colaizzo, who runs a rural health care clinic in Pahokee, Florida.
              State leaders “don’t give a damn about the kids. They don’t give a damn about the families,” said Dr. Marcy Howard, a pediatrician in Crystal River, Florida.

              State officials and insurance companies respond

              McManus, the spokeswoman for the Florida Agency for Health Care Administration, wrote in an email.”The Statewide Medicaid Managed Care program was designed to provide comprehensive care to recipients through high quality health plans with a payment structure designed to ensure that plans paid an appropriate rate based on the health conditions of those enrolled in their plan.”
              “The program currently covers more than 2 million of Florida’s children, offers the strongest provider network and access standards in program history, and provides families with a choice of high quality, nationally accredited plans so that they can choose the plan that best suits their needs, including specialty plans for those who qualify,” she added.
              CNN reached out to officials at all nine insurance companies. Two responded.
              “WellCare contributes to a variety of organizations that shape health care policy, including the Florida Republican Party committees, the Democratic Party committees and those without political affiliation,” wrote Alissa Lawver, a spokeswoman for WellCare. “The company also discloses and publicly reports all political contributions on its website above and beyond the requirements of state and federal law. As a provider of managed care, WellCare is committed to partnering with the state of Florida to provide access to quality, affordable health care solutions for the state’s most vulnerable populations. We maintain a robust provider network and offer comprehensive care management services to create personalized, coordinated care plans to help improve and maintain the health of families and children across the state.”
              She added that WellCare has accountability to Florida’s Agency for Health Care Administration, “which provides careful oversight of the state’s Medicaid program to ensure all members, including children that transitioned from Children’s Medical Services, receive access to the right care, at the right time and in the most appropriate setting.”
              Ethan Slavin, a spokesman for Aetna, said the company makes “donations to campaigns for both major political parties to support and address issues that impact our customers and members.”
              He added that “we are required to meet state rules and regulations regarding our network of health care providers and are consistently compliant with those requirements” and that “we regularly work with our members, health care providers and the state of Florida to move children with special health care needs into the Children’s Medical Services program, when appropriate and in the best interest of our members. Our integrated care management program regularly identifies these children and assists in this process.”
              Miguel “Mike” Fernandez, founder and former chairman of Better Health, said he had contributed several million dollars to both Republicans and Democrats. He added that states move Medicaid patients into the care of private companies so they can “move the risk off their financial books.”

              A victory for Florida families

              Many pediatricians use strong language to describe their anger and frustration with the Florida Department of Health and what it did in 2015 to the 13,074 children.
              “This has just been a nightmare, and we’re still experiencing the fallout,” said Dr. Toni Richards-Rowley, treasurer of the Florida chapter of the American Academy of Pediatrics.
              “It’s disgusting,” said Cosgrove, the pediatrician in Merritt Island. “It’s all about money and not looking out for the children.”
              “Honestly, it makes me want to puke,” said Lida Sarnecky, nurse manager of the team at the University of Florida that takes care of children with cleft lip and palate.
              “In my heart, what I want to do is go down to Governor Scott’s office and ask him, ‘What if this were your child or grandchild who couldn’t receive the care they needed? How would you feel then?’ ” she said.
              By June 2015, some Florida parents had had enough.
              Five children, including Alejandro Rodriguez, and Yasmeen and Aref Shabaneh, sued the state Department of Health to get it to stop using the telephone questionnaire to take patients off CMS, claiming that the state Department of Health hadn’t gone through formal rulemaking procedures.
              The children won.
              The state didn’t fight the ruling. Instead, it came up with a new way to screen children for the program — one that doesn’t rely on a telephone surv

              Read more:

              Jimmy Kimmel Delivers Tear-Filled Plea for Obamacare After Infant Son Nearly Dies

              Jimmy Kimmel was crying before he even started talking.

              I have a story to tell about something that happened to our family last week, the late-night host said at the top of his show Monday night. Before I go into it, I want you to know it has a happy ending. Its a good thing he said that because otherwise, this 13-minute monologue would have been even more unbearable to endure.

              Kimmel went on to tell his audience and viewers that this past week, his wife gave birth to a baby boy named William John KimmelBilly for short. Everything seemed fine at first until a nurse noticed that his heart had a murmur and his coloring wasnt right.

              A cardiac specialist rushed in and discovered that the baby had a dangerous heart condition and needed surgery right away. They brought him from Cedars-Sinai to Childrens Hospital in Los Angeles, where they successfully performed the first of several open-heart surgeries he will likely need over the next several years of his life.

              As he told the story, thanking the doctors and nurses who diagnosed and treated his new son, along with the family members, coworkers, and friends who were there to support him, Kimmel regularly broke down in tears, struggling to get through the harrowing details.

              Finally, after about 10 minutes, Kimmel decided he wanted to make a larger point about how the American health-care system works. He is among the wealthiest people in the country, able to afford any treatment his baby may have needed to survive. But he is aware that others are not so lucky and are forced to make horrible choices about how to proceed when they or their families need medical help. This was especially true before the passage of the Affordable Care Act.

              Kimmel pointed out that just last month, President Trump proposed a $6 billion cut in funding to the National Institutes of Health. And thank God our congressmen made a deal last night to not go along with that, he said. Instead, they increased funding by $2 billion. And I applaud them for doing that, he added.

              We were brought up to believe that we live in the greatest country in the world, Kimmel continued. But until a few years ago, millions and millions of us had no access to health insurance at all. You know, before 2014, if you were born with congenital heart disease, like my son was, theres a good chance youd never be able to get health insurance, because you had a pre-existing condition. And if your parents didnt have insurance, he added, You may not even live long enough to get denied because of your pre-existing condition.

              If your baby is going to die and it doesnt have to, it shouldnt matter how much money you make, Kimmel said, his voice breaking again. I think thats something that whether youre a Republican or a Democrat or something else, we all agree on that, right? His audience roared with approval.

              Whatever party you belong to, Kimmel said, We need to make sure that the people who represent us, and people are meeting about this right now in Washington, understand that very clearly. Lets stop with the nonsense. This isnt football. There are no teams. We are the team. Its the United States. Dont let their partisan squabbles divide us on something every decent person wants.

              We need to take care of each other, Kimmel said through tears. No parent should ever have to decide if they can afford to save their childs life. It just shouldnt happen. Not here.

              It was the most personal, moving, and convincing case yet made by a public figure for keeping the Affordable Care Act intact. And it will be hard to ignore.

              Read more:

              Forget five a day, eat 10 portions of fruit and veg to cut risk of early death

              Scientists say even just 2.5 portions daily can lower chance of heart disease, stroke, cancer and premature death

              Five portions of fruit and veg a day is good for you, but 10 is much better and could prevent up to 7.8 million premature deaths worldwide every year, say scientists.

              The findings of the study led by Imperial College London may dismay the two in three adults who struggle to manage three or four portions perhaps some tomatoes in a sandwich at lunchtime, an apple and a few spoonfuls of peas at dinner.

              All of that is good because a daily intake of even 200g, or two and a half standard 80g portions, is associated with a 16% reduced risk of heart disease, an 18% reduced risk of stroke, a 13% reduced risk of cardiovascular disease, 4% reduced risk of cancer and a 15% reduction in the risk of premature death.

              But the study suggests we should be piling up platefuls of vegetables and raiding the fruit bowl every day if we want the best chance of avoiding chronic diseases or an early death.

              We wanted to investigate how much fruit and vegetables you need to eat to gain the maximum protection against disease, and premature death. Our results suggest that although five portions of fruit and vegetables is good, 10 a day is even better, said Dr Dagfinn Aune, lead author of the research from the School of Public Health at Imperial.

              Eating up to 800g of fruit and vegetables equivalent to 10 portions and double the recommended amount in the UK was associated with a 24% reduced risk of heart disease, a 33% reduced risk of stroke, a 28% reduced risk of cardiovascular disease, a 13% reduced risk of total cancer, and a 31% reduction in premature deaths.

              What does 800g look like?

              And not all fruit and veg are created equal. Apples and pears, citrus fruits, salads and green leafy vegetables such as spinach, lettuce and chicory, and cruciferous vegetables such as broccoli, cabbage and cauliflower were found to be best at preventing heart disease and stroke.

              To reduce the risk of cancer, however, the menu should include green vegetables, such as green beans; yellow and orange vegetables such as peppers and carrots; and cruciferous vegetables.

              The researchers did not find any difference between the protective effects of cooked and raw fruit and vegetables.

              Fruit and vegetables have been shown to reduce cholesterol levels, blood pressure, and to boost the health of our blood vessels and immune system, said Aune. This may be due to the complex network of nutrients they hold. For instance they contain many antioxidants, which may reduce DNA damage, and lead to a reduction in cancer risk.

              Compounds called glucosinolates in cruciferous vegetables, such as broccoli, activate enzymes that may help prevent cancer. Fruit and vegetables may also have a beneficial effect on the naturally occurring bacteria in our gut, he said.

              Most people struggle to eat three or four portions a day, the study shows. Photograph: Simon Masters/Getty Images/Vetta

              And it will not be possible to bottle the effects of fruit and vegetables or put them in a pill, he said. Forget the supplements. Most likely it is the whole package of beneficial nutrients you obtain by eating fruits and vegetables that is crucial to health, he said. This is why it is important to eat whole plant foods to get the benefit, instead of taking antioxidant or vitamin supplements (which have not been shown to reduce disease risk).

              The analysis in the International Journal of Epidemiology pooled the results from 95 different studies involving a total of approximately 2 million people. They assessed up to 43,000 cases of heart disease, 47,000 cases of stroke, 81,000 cases of cardiovascular disease, 112,000 cancer cases and 94,000 deaths.

              Aune said more research was needed, but it is clear from this work that a high intake of fruit and vegetables hold tremendous health benefits, and we should try to increase their intake in our diet.

              Sarah Toule, from the World Cancer Research Fund, said: This interesting research shows just how incredibly important vegetables and fruit are as part of a healthy diet. In fact, theyre essential for maintaining a healthy weight, which our own evidence has shown reduces the risk of 11 common cancers.

              People should aim to eat at least five portions of vegetables and fruit a day but the more the better. If people find this hard, why not start by adding an extra portion of fruit or veg a day to your lunch or try swapping one of your naughty snacks for a piece of fruit?

              Read more:

              US Surgeon General Says Drug Addiction Is A Disease And Should Be Treated As Any Other

              We know the War on drugs isnt working and we need a new approach. A new report from the US Surgeon General’s office urging the government and health bodies to recognize substance abuse as a mental health issue, not a criminal one, might just be the answer.

              Referring to the report as the first of its kind on this topic, the US Surgeon General Dr Vivek Murthy explained that his aim was to shift the way society thinks about substance abuse and substance use disorders and to take action to both prevent and treat these conditions.

              I am issuing a new call to action to end the public health crisis of addiction, he said.

              The report, Facing Addiction in America, states that 21 million Americans were directly affected by drug abuse in 2015, nearly the same figure as diabetes, but only one in 10 received treatment.

              “We would never tolerate a situation where only one in 10 people with cancer or diabetes gets treatment, and yet we do that with substance-abuse disorders,” Murthy toldThe Washington Post.

              Some of the facts and figures included in the report are startling. Of the 21 million Americans affected by substance use disorders, 12.5 million of those are due to abusing prescription painkillers. Opioid overdose deaths averaged 28,500 last year, four times what it was in 1999. And, sadly, only 10 percent of any of these people received the help they needed.

              The report states that for too long drug and alcohol abuse has been viewed as a moral failingand that the stigma of shame has made people suffering from substance use disorders less likely to come forward and seek help.

              There has been much evidence presented over the last year by health care experts, scientists, and politicians urging world leaders that in the face of the failing war on drugs, it is time to change direction and allow doctors and other medical professionals, rather than law enforcement, to take the lead on designing global drug policy. It seems the US sat up and took notice.

              The report called on substance abuse (referred to in the report as substance use disorders) and addiction to be recognized for what they are medical conditions and should be treated as any other traditionally recognized diseases such as cancer and heart disease.

              Science tells us clearly that addiction is a disease of the brain, Murthy said at a summit held in Los Angeles. It affects the circuitry of our brain that controls decision-making, impulse control and our stress and reward systems.

              To address the issue, the report recommends that substance-abuse services should be integrated into general health care rather than niche programs that only end up serving a tiny percentage of those suffering.

              As Murthy told the Huffington Post: Addiction is a chronic disease of the brain and its one that we have to treat the way we would any other chronic illness: with skill, with compassion and with urgency.

              Read more:

              A New Year resolution that’s good for you and the planet: stop eating meat

              Raising beef cattle requires 160 times more land and causes 11 times more greenhouse gas emissions when compared to crops like wheat, rice or potatoes

              Choosing to live a life with less in an eco-friendly way goes far beyond what you consume, what you drive or whether you use plastic bags. It can also be drastically affected by what you choose to eat or avoid eating, for that matter. Yep, you guessed it: Im talking about meat.

              In addition to being an unapologetic hippie, a toy denier and one step away from joining a commune and singing Kumbaya, I am also vegetarian just like 4 million others in the UK, 7.3 million in the US, and 1.3 million in my home and native land of Canada.

              As the rush of the Christmas season fades away and New Years Day rapidly looms, consider avoiding resolutions you wont keep (are you really going to the gym five times a week?) and try a meatless (or even meat-reduced) diet instead. You may find that the benefits work for you, just like they work for millions of others around the globe.

              Why? A meatless diet boasts improved overall health, reduces grocery bills and provides a helpful boost to our struggling ecosystem. Ill readily admit, however, that turning my back on hot dogs and chicken breasts wasnt initially an environmental choice for me, but an ethical one. As a curious 18-year-old, I researched how a pig becomes a pork chop and it turned my stomach. I couldnt face the true cost of my diet the unimaginable cruelty, suffering and loss of life simply so I could enjoy a hamburger.

              The horrifying conditions endured by the animals we eat is still the biggest motivating factor in my choice to be a vegetarian, but in the past few years the effects of a meatless diet have been shown to benefit far more than the collective consciences of bleeding hearts like me.

              It turns out that raising animals for slaughter isnt just bad for the unlucky cows, pigs, chickens and lambs; studies are increasingly shown that it takes a drastic toll on the environment too. As a result, someone who eats a diet high in meat accounts for almost double the climate-killing carbon dioxide emissions of a typical vegetarian.

              When you break it down further into environmental cost per calorie, the impact of beef, for example, is monstrous. Raising beef cattle requires 160 times more land and causes 11 times more greenhouse gas emissions when compared to crops like wheat, rice or potatoes (finally a reason to ditch the carb-free diet!).

              The environmental benefits of eliminating or even reducing meat from your diet are compelling, but dont think you have to ditch the bacon for purely altruistic motives the benefits will quickly kick back to you too.

              Numerous studies demonstrate that vegetarians have lower incidences of heart disease, lower BMI and lower blood pressure than their meat-eating counterparts. And according to the World Cancer Research Fund, if you stop eating red meat, youll also be avoiding the only convincing dietary association with colon cancer.

              Of course, I can sit here spouting statistics all day demonstrating the benefits of a vegetarian diet to the environment and to you they certainly exist in spades but is that really likely to change your mind? Are numbers and percentage points enough to change how your dinner table looks after 30, 40 or 50 years?

              Change can be terrifying, even when (or perhaps especially when) you know its good for you. For many, the idea of a table without meat simply looks like a whole lot of side dishes. Vegetables have long been relegated to boring lead-ups to the main event, middling sidekicks to beefy superheros delicious, maybe, but just not quite enough. And for men especially, giving up meat and labelling themselves a capital-V vegetarian feels so drastic, like adopting a whole new persona, or wearing a wild new wardrobe that doesnt quite fit.

              If the thought of giving up meat whole-hog overwhelms you, dont feel like you need to go all-in right from the start. Try just dipping your toe in at first. As with all environmental endeavors, it pays to start small and keep it sustainable. The online world is rich with hearty, filling and scrumptious recipes with nary an ounce of meat required, so try just one or two meatless meals a week to start. A few of my favourites are black bean and spinach enchiladas, spaghetti squash chow mein, and an Asian quinoa slaw dish that is easily 10 times as good as the name makes it sound.

              All of your tiny choices add up even decreasing your meat intake by just one less burger a week can result in the same environmental benefit as taking your car off the road for 320 miles.

              You dont need to make drastic change in your life in order to create change in the world around you, and lady magazines be damned, you dont need a whole new you as we enter the new year.

              Lets throw that nonsense out the window and settle for a few new traditions instead. A little less shopping here, a few more reusable bags there, a meatless meal on the table a few times a week and the knowledge that you are making a difference.

              Read more: