How much are hospitals marking up the price of medicines? The answer may surprise you . . . According to a report by Robert Zirkelbach on October 17, 2017 from http://catalyst.phrma.org "Hospitals mark up medicine prices, on average, nearly 500 percent, according to a new analysis from the Moran Company that was commissioned by the Pharmaceutical Research and Manufacturers of America (PhRMA). The analysis of 20 medicines also found the amount hospitals receive after negotiations with commercial payers is, on average, more than 250 percent what they paid to acquire the medicine. This means a hospital is paid two and a half times what the biopharmaceutical company, who brought the medicine to market, receives. This hidden threat to affordability is a driver of higher cost sharing and premiums for patients across the country. While hospital markups lead to higher costs for patients, employers and payers, these markups are often overlooked in conversations about medicine costs. As the provider market continues to become more concentrated and the number of medicines being administered in hospital-owned facilities is growing, the amount hospitals mark up medicine prices needs greater scrutiny. " We welcome conversations about costs, but we need to take into account the entire biopharmaceutical supply chain, including the impact hospital markups have on access and affordability of medicines. View the full analysis here. View the analysis infographics here. Learn more at www.LetsTalkAboutCost.org.
Discussions about costs are important. No patient should have to worry about whether they can afford the care they need. At the same time, it is important to look at costs across the health care system and not just the share going toward life changing medicines.Explore our graphics and videos below to learn more. http://www.phrma.org/media/cost-and-value-of-medicines
Before the General Election last year Mesa Mayor John Giles clearly said publicly that "It's the right thing to do" . . .
One year later that assertion and affoirmation is getting nowhere here in the most conservative in America, probably for good reason when LGBTQ rights are under challenge by certain alt-right Bible-Belt evangelicals together with persistent opposition from The Church of Jesus Christ of The Latter-Day Saints. The powers-that-be here in Mesa appear to be waiting for The State of Arizona to take a stand on all-inclusive civil rights guaranteed by the force-of-law while one issue part of that conversation is getting heard in front of the U.S. Supreme Court:
Nearly 1,300 Faith Leaders File SCOTUS Brief Saying Religious Beliefs Do Not Justify Discrimination
By Adam Polaski • October 31, 2017 • 7:07 pm
"Nearly 1,300 clergy and faith leaders representing 500,000 congregants from approximately 50 unique faith traditions across the U.S. joined together this week to send a clear message that businesses open to the public must serve all. The clergy filed a friend-of-the-court brief to the Supreme Court in the Masterpiece Cakeshop vs. Colorado Civil Rights Commission case.
More than 85 national religious leaders signed the brief including the leaders of the Christian Church (Disciples of Christ), the Unitarian Universalist Association, the Metropolitan Community Church, the Alliance of Baptists, Muslims for Progressive Values, and Reconstructionist Judaism. The presidents of ten seminaries and the leaders of 40 religious organizations also signed the brief.
The brief filed this week highlights the dangers of the exemptions being sought in this case and makes the argument that there should not be a license to discriminate based on faith. Source > https://www.freedomforallamericans.org The brief states, in part:
“It is both morally wrong and not constitutionally required to permit blanket discrimination in the public marketplace for goods and services based on the personal religious beliefs of merchants with respect to same-sex couples’ rights and relationships. Amici believe that, to the contrary, public accommodation laws should be applied on the basis of religiously neutral principles of equal protection under the law.”
According to the brief, its signers “represent traditions rooted in centuries of American history and who affirm religious liberty, human dignity, and equal rights.” Read the full brief here. The crux of the argument is that there is no conflict between freedom of religion and equality. Freedom for All Americans is proud to have worked with the Religious Institute, the National LGBTQ Task Force, and many state and local organizations on supporting outreach for the brief.
Both houses of Congress have more work to do. . . AFFORDABLE HOUSING FINANCE 31 Oct 2017
House Bill Seeks 50% Increase in LIHTCs
The latest legislation comes from Rep. Suzan DelBene.
U.S. Rep. Suzan DelBene (D-Wash.) introduced the Access to Affordable Housing Act to increase the low-income housing tax credit (LIHTC) by 50% today.
“Making sure that every American has a safe and affordable place to call home is a moral imperative that we must address,” DelBene said in a statement. "To help lift families out of poverty and expand access to affordable housing, we need to increase the low-income housing tax credit. Washington has seen it firsthand. Housing options are not keeping pace with demand, and my legislation would help ensure more families can find stable, affordable housing.”
Reps. Adam Smith and Pramila Jayapal are co-sponsors of DelBene’s bill—all of whom represent Washington’s King County, where housing demand and costs have sky rocketed in recent years. In their state, nearly 400,000 households pay half their income in rent.
Earlier this year, Sens. Maria Cantwell (D-Wash.) and Orrin Hatch (R-Utah) introduced the Affordable Housing Credit Improvement Act of 2017 (S. 548), which also seeks to increase the housing credit by 50% as well as make additional changes. The bipartisan bill has 20 co-sponsors.
A House bill (H.R. 1661) by Reps. Pat Tiberi (R-Ohio) and Richard Neal (D-Mass.) also seeks to strengthen the LIHTC but does not include the 50% increase sought in the Senate proposal. It has amassed 116 co-sponsors.
DelBene serves on the House Ways and Means Committee, which has jurisdiction over tax issues. She is also a cosponsor of H.R. 1661.
After much anticipation, the Senate Finance Committee released a tax reform bill that is significantly better for affordable housing than the House proposal.
Both versions retain the low-income housing tax credit (LIHTC), but the Senate legislation also preserves private-activity bonds (PABs). This is an important change from the bill passed by the House Ways and Means Committee this week, which eliminates the bonds.
Emily Cadik, director of public policy, Enterprise Community Partners
“We are very pleased that the Senate retained private-activity bonds and rejected the House proposal,” says Emily Cadik, director of public policy at Enterprise Community Partners.
In another move, the Senate proposes to lower the corporate tax rate from 35% to 20%. This is notable because without modifying the LIHTC program, this change would make the housing credit worth less and could diminish investor appetite.
“We are still working with Chairman Hatch and other Republican senators on the committee to see if there is an opportunity to add language to offset the impact on housing credit investment as the bill moves through the committee,” Cadik says.
Housing advocates are hopeful that changes can be made to the Senate bill over the weekend and early next week as the Senate Finance Committee begins its mark up of the legislation.
The Senate bill also proposes that the lower corporate tax credit begin in 2019, a year later than in the House plan. This could be a major point in negotiations and how that is resolved could factor into how much revenue is available for programs like the LIHTC and other tax credits.
Historic and NMTCs remain Unlike the House bill, the Senate plan retains the historic tax credit, but it reduces the percentage of qualified rehabilitation expenses eligible for the credit from 20% to 10%. Historic tax credits have often been used to preserve and adapt older buildings into affordable housing.
In another move, the Senate also seeks to keep the New Markets Tax Credit (NMTC) through 2019.
“We are very glad the New Markets Tax Credits was retained as currently authorized in the Senate bill,” Cadik says. “The credit is unfortunately only authorized through 2019. While we believe it should be a permanent part of the tax code, we are glad that the Senate rejected the House proposal to claw back two years of New Markets Tax Credit allocation authority that had already been authorized.”
What’s next? Both houses of Congress have more work to do. The full House is expected to vote on its bill next week. An early timeline had both the House and Senate voting on their tax bills before Thanksgiving, but it now appears the Senate may vote on its legislation after the holiday recess.
A question remains as to whether the House and Senate will take a conference committee approach to resolve the differences in their bills in December or try something similar to what they did with the 2018 budget resolution, according to Cadik. In the latter case, the Senate would approve a bill that it knows can also clear the House and then have the House pass that bill, a move that is more expedient.
Readers of this blog will notice the space at the beginning of this post is left empty on purpose . . . it's up to you and everyone with an interest to Re/Generate The New Urban DTMesa to help fill in the blanks, moving beyond imagination to real results like the recently opened El Rancho Del Sol by Community Development Partners.
We can surely do more to build on public-private community development partners as well as keeping our eyes open to new directions in urban planning [some are presented here] that can inform, guide and inspire all of us to heal the open scars in our shared urban landscape left by earlier 'bad urban planning' in large parcels of land - like the 25-acre Site 17 one block north of Main Street, an entire 10-acre city block recently cleared and cleaned-up by demolishing an 85-year auto dealer and car service operation at 100-200 E Main Street adjacent to the $100-Million investment in The Mesa Arts Center, as well as other sites using parking lots as land-banks, the rehab and adaptive-reuse of historic properties and city-owned properties that maintain what's unique about downtown.
This plan hopes to completely reimagine an area in Milwaukee
It was a mix of life,” Angelini says. “We lose a lot when we lose that kind of diversity and begin to think that people who aren’t just like us aren’t really as worthwhile as we are. I think one of the ways to get through that is to enable people of diverse backgrounds to have opportunities to live in the same communities.” http://www.housingfinance.com
AFFORDABLE HOUSING FINANCE Milwaukee Development Serves Diverse Population Greenwich Park provides affordable, supportive, and market-rate housing.
The 53-unit community has 36 affordable apartments, 14 permanent supportive housing units and 22 apartments that serve households earning no more than 60% of the area median income. The remaining 17 units are market-rate apartments. The affordable homes are identical to the market-rate units, and they’re distributed throughout the building. __________________________________________________________________________
This just 2 days ago:
Renderings and report on joint development proposed at Exposition and Crenshaw boulevards
Under the proposal, 73 (or 15 percent) of the 492 residential units, will be affordable units for households earning 50 percent or less of the area median income.
The community-serving space is envisioned toinclude a grocery store and restaurant space targeted for locally-owned and operated businesses.
A business incubator-type space would be part of the development, as well as a mobility hub to provide bicycle and carshare connections for Metro riders.
The proposal also includes nearly three acres of public open space that will also host community events.
>> During the six-month period, Watt Companies will offer opportunities to the community to provide feedback on the proposed project. Watt will also seek out a community-based organization who can add additional local participation on their team.
Blogger Note: The Watt Companies proposal was found to be the most responsive to the community priorities and vision expressed in the Guidelines.
Some quick background: Metro Joint Development is a program in which Metro partners with private developers to build transit-oriented development on Metro-owned properties. These are often parcels of land that were used for transit line construction. The idea is to createtransit-oriented communities(TOCs)that are more walkable and bikeable with easy access to transit. TOCs also aim to include high quality urban design and promote equity by providing a mix of uses that support housing at different income levels. To date, more than 2,000 residential units have been built as part of Metro joint developments.
_______________________________________________________________________________________________________________________________________________ Filling a void in the cityscape based on Transit-Oriented Development
A look at the mixed-use redevelopment planned for Chicago’s former Harold Ickes Homes
The CHA’s board recently voted in favor of a multi-phase plan to redevelop the vacant South Side parcel
KTGY Unveils Homeless Housing Development Made of Shipping Containers
KTGY Architecture + Planning has shared an initial rendering of Hope on Alvarado, a four-story, 84-unit homeless housing development constructed primarily out of shipping containers in downtown Los Angeles, reports Leah Demirjian, senior associate editor of design at Builder magazine. The firm attributes the project's accelerated construction time (it's slated to begin a six-month construction period in the first quarter of 2018) to the design's use of the shipping containers, which will be sourced locally in Los Angeles.
The developments in the city's Westlake District will be financed by LSA Capital in partnership with project sponsor Jerry Jacobs with Scott Baldridge and Leslie Weiss, working with the Foundation for Affordable Housing, and will be developed by Aedis Real Estate Group.
"The development climate of malls were driven less by demand and more by opportunity,". . . As new centers get built, anchor stores are lured away, and a cannibalization process begins ... Only so many consumers are going to malls, and they will flock to newer ones. If developers build a new mall, they are inevitably undercutting another property. So older properties have to get re-positioned every decade, or they will die." While everyone likes to point the finger at Amazon, the growing retail apocalypse in America can't be tied to just one catalyst.
Certainly, there is no doubt that Amazon is taking a toll on brick-and-mortar retailers but massive excess capacity, perpetually over-levered capital structures and a constant lack of capital investment have undoubtedly helped accelerate the decline. AsBloombergpoints out today, up until this year, struggling retailers have largely been able to avoid bankruptcy by refinancing to buy more time. Alas, as evidenced by the Toys "R" Us bankruptcy, investor demand for retail debt has waned of late resulting in a whole slew of recent retail failures. Now that boom is finally going bust. Through the third quarter of this year, 6,752 locations were scheduled to shutter in the U.S., excluding grocery stores and restaurants, according to the International Council of Shopping Centers. That's more than double the 2016 total and is close to surpassing the all-time high of 6,900 in 2008, during the depths of the financial crisis. Apparel chains have by far taken the biggest hit, with 2,500 locations closing. Department stores were hammered, too, with Macy’s Inc., Sears Holdings Corp. and J.C. Penney Co. downsizing. In all, about 550 department stores closed, equating to 43 million square feet, or about half the totalA Look At America's Retail Apocalypse In Charts
A Look At America's Retail Apocalypse In Charts | Zero Hedge
Info-graphic to left show delinquent loans > Notice Phoenix
Of course, the wave of retail failures is a direct hit to an industry that is the largest employer of young Americans and those at the low end of income scale
Meanwhile, investor distaste for retail debt comes just as the industry faces a massive wave of maturities over the next five years.
Making matters more difficult is the explosive amount of risky debt owed by retail coming due over the next five years.Several companies are like teen-jewelry chain Claire’s Stores Inc., a 2007 leveraged buyout owned by private-equity firm Apollo Global Management LLC, which has $2 billion in borrowings starting to mature in 2019 and still has 1,600 stores in North America.
Just $100 million of high-yield retail borrowings were set to mature this year, but that will increase to $1.9 billion in 2018, according to Fitch Ratings Inc.
And from 2019 to 2025, it will balloon to an annual average of almost $5 billion.
The amount of retail debt considered risky is also rising. Over the past year, high-yield bonds outstanding gained 20 percent, to $35 billion, and the industry’s leveraged loans are up 15 percent, to $152 billion, according to Bloomberg data. Even worse, this will hit as a record $1 trillion in high-yield debt for all industries comes due over the next five years, according to Moody’s. The surge in demand for refinancing is also likely to come just as credit markets tighten and become much less accommodating to distressed borrowers. So, who has been hit the hardest so far?
Malls of the future have an opportunity to fulfill other community needs besides commerce, June Williamson, a City College of New York architecture professor and the author of"Retrofitting Suburbia," tells Business Insider.
Here are what may become of the many failing malls of today:
Extracts from an article written by Leanne Garfield 13 May 2017 http://www.businessinsider.com > Closed department stores will likely become other businesses that can benefit from the large square-footage, like fitness centers, churches, offices, public libraries, and even medical clinics > Since most food courts have a lot of natural light, they could be used as gathering spaces for community groups or child daycare centers if they close down, Williamson says.
Most failing food courts, however, are redeveloping into clusters of high-priced restaurants right now, like the one at Miami's Aventura Mall, which will get rid of the cheap chains and open a revamped eatery this fall.Mall atriums are wide-open spaces that can allow for events, like concerts or fashion shows, or serve as showrooms for cars — all of which generate revenue, Williamson says. > Many dead retail spaces will likely morph into businesses that have community-based functions, like apartments, public libraries, indoor farms, and refrigerated spaces for processing food (for local restaurants or grocery stores), Williamson says. "You'll find DMVs, town halls, and libraries in malls increasingly, the type of place where the public government can interact with the public," Williamson says. > Some public spaces, like libraries, don't bring in much rent, so they mainly serve as a way to attract people to the mall, she says. "If the mall owners can't keep the place fully leased, this at least keeps people coming who could keep the other leasees from fleeing," she says. The 'Main Street' was killed by the mall, so developers are trying to build new downtowns inside the malls. > Malls may increasingly (and somewhat ironically) turn their surface parking lots into space that emphasizes walking over cars. This, in some ways, would be a nod to the original intended use of a "mall," Smiley says. Until the 1960s, shopping centers had green plazas called "malls," until it became a term for the enclosed center itself. "The genealogy of the word 'mall' is a landscape term — a pedestrian space. But we've co-opted that term and linked it to retail," Williamson says. In coming years, she predicts that many malls will downsize the amount of surface parking they offer, and turn it into public space that can benefit the surrounding community. > Ethnic malls are shopping centers that target a specific ethnic demographic in the community. She says this type of customized mall can thrive more than a traditional mall, because it better meets local shoppers' needs. > Unlike small suburban centers aimed at shoppers who live nearby, destination malls look to attract shoppers from the entire region.
Destination malls, also called "super-regional malls" or "lifestyle centers," use experiential attractions to subsidize regular retail shops. They usually include attractions like movie theaters, bars, casinos, restaurants, rock climbing walls, laser tag, and even roller coasters. "People will drive miles to these malls, because they will be destinations
"The emergence of entertainment as part of the shopping mall is becoming very important," Smiley says. "It keeps people in the center longer. And even if they weren't going to shop for something, they get lured in."
