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►  Appalachian poor, left out of health debate, seek free care

They arrived at a fairground in a deep corner of Appalachia before daybreak, hundreds of people with throbbing teeth, failing eyes, wheezing lungs. They took a number, sat in the bleachers and waited in the summer heat for their name to be called so they could receive the medical help they can’t get anywhere else.

Among the visitors at the free, once-a-year medical clinic was Lisa Kantsos, whose first stop was the dental tent, a sprawl of tables and chairs where volunteer dentists and students performed cleanings, filled cavities and pulled teeth. After getting a cleaning, she made a stop at a mammography van. Last year, it was free glasses.

“It’s a blessing. It really is,” said Kantsos, a 52-year-old diabetic, “because I don’t have to worry about these things.”

Kantsos and many of the estimated 2,000 others who turned out at the Wise County Fairgrounds in late July are the health care debate’s forgotten.

Even with the passage of “Obamacare” in 2010, they have no insurance because they exist in a desperate in-between zone, unable to afford coverage but ineligible for Medicaid. And because they haven’t benefited from the Affordable Care Act, the debate on Capitol Hill over repealing it has been all but irrelevant to them.

“Whether there was an Affordable Care Act or not, it really hasn’t made any difference for these people,” said Stan Brock, who founded the free traveling Remote Area Medical Clinic in the 1980s.

The need for better, more affordable care around here is undeniable.

The central Appalachian area that includes eastern Kentucky, southern West Virginia and western Virginia has long been one of the sickest and poorest regions in the country. More recently, it has been ravaged by the decline of coal mining.

“Everything revolved around coal,” said Matt Sutherland, a frequent visitor to the clinic from Castlewood, Virginia. “Now there’s not a lot of work, not a lot for people to do.”

People in central Appalachia are 41 percent more likely to get diabetes and 42 percent more likely to die of heart disease than the rest of the nation, according to a study released in August by the Appalachian Regional Commission and other groups. The study also found that the region’s supply of specialty doctors per 100,000 people is 65 percent lower than in the rest of the nation.

And people from southwestern Virginia die on average 10 years sooner than those from wealthier counties close to Washington, said August Wallmeyer, an author who lobbies the Virginia legislature on health issues.

Opioids are also taking their toll in Appalachia. In Virginia in 2014, drug overdoses became the No. 1 cause of accidental death, according to Wallmeyer’s 2016 book, “The Extremes of Virginia.”

But Virginia was among 19 states that chose not to expand Medicaid as part of the Affordable Care Act. Many states cited the cost, even though Washington pledged to pick up nearly the entire expense. An expansion in Virginia would have covered an additional 400,000 people.

“A lot of people, when the Affordable Care Act was first enacted and went into effect, had the mistaken belief that it was going to help the very poor people, particularly in Appalachia and other parts of Virginia,” Wallmeyer said. “And it’s just not true.”

Wallmeyer said the clinic in Wise County doesn’t see as many patients as it once did from Kentucky, a state that expanded Medicaid under the ACA.

Teresa Gardner Tyson, executive director of Virginia’s Health Wagon, a free clinic that takes part in the Wise event, lamented that the politicians “forget at the end of the day that they’re our servants.”

“They can’t get away from the partisan politics, but here we’re faced with people dying on a daily basis,” she said.

Among the patients at the free clinic was Joey Johnson, who shot himself in the head while playing with a gun when he was a teenager and has been in a wheelchair for 25 years.

No longer receiving health benefits from his stepfather’s union miner’s insurance, he came to the clinic to get a dental filling and have his eyes checked. His Medicaid doesn’t pay for dental check-ups, and he gets just $735 a month in federal disability payments and $20 in food stamps.

“If it wasn’t for this (clinic), my teeth would rot out of my head and I would be in bad shape,” he said before his checkup, sitting shirtless in the heat. Johnson’s assessment of lawmakers’ work on health care is more succinct than any tweet: “They don’t care about us.”

Kantsos voted for Donald Trump last fall in the hope that he could shake up Washington. She said the president needs to concentrate more on his job and less on Twitter.

Sutherland supported Trump, too, and said he thinks the president deserves more time. But Sutherland, who comes to the clinic for dental work and medicine, wishes lawmakers understood how hard life can be in Appalachia. Last year, he said, he walked 30 miles to the Wise clinic because he had no car; it took more than seven hours. Others have it bad, too.

“I’m not the only one,” he said, sitting in a tent where people were getting teeth pulled a few feet away. “I’m really not the only one.”


►  Harvey and Irma to slow U.S. economy but rebound should follow

With businesses disrupted, fuel and chemical refineries out of commission and consumers struggling to restore their lives, Hurricanes Harvey and Irma will likely pack a tough double-whammy for the U.S. economy.

Nearly one-fifth of the nation’s oil refining capacity has been shut down because of Harvey, and fuel production has dropped sharply as a result, according to Bank of America Merrill Lynch. Consumers will also spend less in the immediate aftermath of the storms. Even those ready to make purchases will face closed storefronts and dark restaurants.

Irma will cause tourists to delay — and in many cases never take — trips to Florida’s beaches or Disney World. Chemical refineries have also been closed, reducing the production of plastics.

Damage estimates from the two storms are still early, particularly for Irma. Hurricane Harvey will likely cost up to $108 billion, according to Bank of America Merrill Lynch, which would make it the second-most-expensive hurricane after Katrina.

Mark Zandi, chief economist for Moody’s Analytics, estimates that Irma will cause $64 billion to $92 billion in damage.

While the economic toll pales beside the human costs, analysts estimate that the nation’s annualized growth rate will be one-half to one full percentage point slower in the July-September quarter than it would otherwise have been.

But repair work, reconstruction and purchases of replacement cars and other goods should provide an offsetting boost later this year and in early 2018.

“Construction activity will rocket in the affected areas,” predicted Ian Shepherdson, chief economist at Pantheon Macroeconomics. “Households’ spending on building materials, furniture, appliances, and vehicles will all be much higher than otherwise would have been the case.”

Catastrophic natural disasters often don’t depress the U.S. economy in the long run. The destruction of property reduces the nation’s total wealth. But all the rebuilding and restoration work tends to stimulate economic growth in the following months.

The rebuilding can take time. After Hurricane Katrina bashed New Orleans in 2005, it took seven months for home building permits in the city to return to their pre-hurricane levels, according to Goldman Sachs.

Economists at Goldman estimate that Harvey and Irma will slice growth in the July-September quarter by 0.8 percentage point to an annual rate of 2 percent. But they forecast a healthy rebound, with annualized economic activity 0.4 percentage point higher in the October-December quarter, 0.2 percentage point higher in the January-March quarter next year, and 0.4 percentage point higher in the April-June period.

Irma has so far wreaked much less damage than initially feared, with Citi analyst James Naklicki estimating total costs could reach $50 billion, down from earlier estimate of as much as $150 billion.

Still, more than 7 million people have lost power because of Irma, with most of them living in Florida. The state makes up about 5 percent of the U.S. economy. Flooding from Irma could affect about $1.2 billion of the state’s crops, Bank of America Merrill Lynch estimates, and elevate food prices.

With oil refineries along the Gulf Coast shut down, gas prices have jumped about 30 cents a gallon nationwide, on average, since Harvey made landfall in late August. That will temporarily reduce Americans’ spending power because they will have less money to spend on other items.

The impact of Harvey has been particularly harsh in Houston, the nation’s fourth-largest city. The entire metro area accounts for about 3.2 percent of the nation’s economy.

Higher gas costs will likely increase measures of inflation in the coming months, economists say, but the rise will likely be small and temporary.

Housing costs could rise, too. The cost of lumber has already been rising because of the wildfires in the western United States, said John Mothersole, an economist at IHS Markit. Hurricane-related repairs and rebuilding could push prices higher.

Nearly 90 percent of U.S. chemical refinery capacity has been closed down, Mothersole said. That could make all sorts of plastics more expensive, including PVC pipes and other building materials.

The Federal Reserve, which adjusts interest rates to keep inflation in check, will likely discount any increase in prices.

“The Fed is going to view this, correctly, as a transitory event,” Mothersole said.

Still, Fed policymakers may have a difficult time analyzing the broader underlying health of the economy because of the hurricane distortions.

For example, the number of jobs added in September could be 20,000 to 100,000 lower because of storm disruptions, Goldman Sachs estimates.


►  Getting up to speed on the Equifax data breach scandal

Equifax has been scrambling to explain itself since disclosing last week that it exposed vital data about 143 million Americans — effectively most of the U.S. adult population. It’s come under fire from members of Congress, state attorneys general, and people who are getting conflicting answers about whether their information was stolen.

The company keeps track of the detailed financial affairs of all Americans in order to gauge how much of a risk they are for borrowing money. That means it and its competitors, TransUnion and Experian, are a detailed storehouse of some of the most personal and sensitive information of Americans’ financial lives. And all of it could be used for identity theft.

Here’s the latest on what you need to know about the breach:

WHAT EQUIFAX IS SAYING

Equifax is trying again to clarify language about people’s right to sue, and said Monday it has made other changes to address customer complaints.

The company is trying to staff up its call centers more in order to handle the increased customer service calls. It also now says people will get randomly generated PINs when they try to put a security freeze in place. People had complained about PINs being based on the time and date requests were made.

Equifax also acknowledged that its language particularly over the right to sue has been confusing at best, and said it was removing that language from their website. “Enrolling in the free credit file monitoring and identity theft protection that we are offering as part of this cybersecurity incident does not waive any rights to take legal action,” it said.

Some lawyers have already announced suits that they hope will be class-action cases.

AM I AFFECTED? IT’S BEEN HARD TO TELL

Equifax has been the focus of anger and distrust, not only for the breach but over how it initially was handled.

It discovered the hack July 29, but didn’t publicly announce it until more than a month later. People trying to find out if they were affected have gotten some confusing or contradictory information. Consumers calling the number Equifax set up complained of jammed phone lines and uninformed representatives, and initial responses from the website gave inconsistent responses. Many got no response, just a notice that they could return later to register for identity protection. Equifax says it’s fixed the issue of inconsistent responses, in which people could get one response on the computer and a different one when checking on the phone.

The site is equifaxsecurity2017.com and the number is 866.447.7559. Equifax also says it’ll send a notice to all who had personally identifiable information stolen. Equifax is offering free credit monitoring for a year, which people can sign up for at the website.

But considering the size and scope of the breach, it’s probably better just to assume you were part of it.

WHAT ABOUT THE CONTROVERSY OVER THE RIGHT TO SUE THEM?

There has been a significant amount of confusion about that. It partly comes from the industry practice of mandatory arbitration, in which the fine print on many financial products says customers have to use a private third-party arbitration service in order to resolve their disputes. Regulators are trying to crack down on the practice, particularly after the Wells Fargo sales practices scandal.

Equifax released a statement Friday evening declaring that the arbitration requirement and class-action waiver will not apply to this particular breach. In its statement Monday, it said it had again adjusted the language in the FAQs on its website.

WHAT SHOULD I DO?

Ultimately, the onus will probably be on consumers to try to protect themselves. People should do all the things they’re probably already heard about:

— Closely monitor their own credit reports, which are available free once a year, and stagger them to see one every four months.

— Stay vigilant, possibly for a long time. Scammers who get ahold of the data could use it at any time — and with 143 million to choose from, they may be patient.

— Consider freezing your credit reports. That stops thieves from opening new credit cards or loans in your name, but it also prevents you from opening new accounts. So if you want to apply for something, you need to lift the freeze a few days beforehand.

WHO’S INVESTIGATING THIS?

A host of state and federal authorities as well as politicians have stepped in to investigate. Credit bureaus like Equifax are lightly regulated compared to other parts of the financial system. Expect more scrutiny from regulators over the credit bureaus.

The chairmen of at least two U.S. House committees say they want to hold hearings. Like the Wells Fargo sales scandal, the Equifax breach is causing bipartisan outrage and concern, but there has been no talk of any new laws to further regulate the industry. Several state attorneys general have also said they would investigate, which could result in fines at the state level.

Lastly the Consumer Financial Protection Bureau, the nation’s watchdog entity for financial issues, says it has the authority to investigate the data breach, and fine and sanction Equifax if warranted.

Company executives are also under scrutiny, after it was found that three Equifax executives sold shares worth a combined $1.8 million just a few days after the company discovered the breach, according to documents filed with securities regulators. Equifax said the three executives “had no knowledge that an intrusion had occurred at the time they sold their shares.”

Given the seriousness of the breach, there are worries about the long-term future of the company. The sole purpose of why Equifax and the other credit bureaus exist is to be a secure storehouse of crucial financial information. Equifax failed at that.

The stock has fallen more than 25 percent since Thursday and the company is meeting with investors this week in New York in hopes to contain the fallout.


►  How to fix identity-theft issues posed by the Equifax hack

The Equifax breach didn’t just expose sensitive personal information of 143 million Americans — it underscored the huge vulnerabilities that make widespread identity theft possible.

More than 15 million Americans were victims of ID fraud last year, a record high; fraudsters stole about $16 billion, according to an annual survey by Javelin Strategy & Research. The theft of personal information can turn peoples’ lives inside out, damage their finances, eat away at their time and cause tremendous anxiety and emotional distress.

The Equifax attack was particularly damaging. Intruders made off with precisely the information needed to pose as ordinary citizens and defraud them — and did so with data for roughly 44 percent of the U.S. population.

Experts have warned for years that the widespread use of Social Security numbers, lax corporate security and even looser individual password practices could lead to an identity-theft apocalypse.

As Congress, state law enforcement and the nation’s chief financial watchdog look into the Equifax debacle, here are some of today’s biggest security problems and what it could take to fix them.

___

SOCIAL SECURITY NUMBERS

A decade ago, computer scientist Annie Anton warned Congress that widespread business use of Social Security numbers as identifiers was making them more attractive to identity thieves. “This is a problem of our own making and it is a problem that we can eliminate,” she testified to a House committee in June 2007.

Yet the problem remains un-eliminated. Anton, now a Georgia Tech researcher whose office isn’t far from Equifax’s Atlanta headquarters, argues that SSNs should be encrypted to shield them from prying eyes, much like passwords are. Equifax apparently didn’t take this precaution , a fact Anton calls “shocking.” The company didn’t immediately respond to requests on Monday for more information about its encryption practices.

Some advocates would like to outlaw the use of Social Security numbers by private companies, and even by government agencies outside of the Social Security Administration. Such efforts have gone nowhere, although several states have passed a patchwork of laws aiming to limit access to SSNs and other sensitive information.

Further changes may simply be too late. Even before the Equifax breach, millions of SSNs were already exposed from various hacks — and no one can change them without enormous hassle.

One alternative might be to replace the venerable SSN with a national ID card protected with encryption, much the way credit cards with embedded chips work today. Knowing the number alone wouldn’t be enough; a thief would need the physical card as well. But while other nations have adopted such cards, many Americans have traditionally resisted a national ID.

As Ryan Kalember, senior vice president of cybersecurity strategy at the security company Proofpoint, says, it’s time to address “why we rely on these trivial and compromised pieces of information for some of the most important financial transactions we make.”

___

LAX CORPORATE SECURITY

Security is ultimately an expense on a company’s financial sheets, an important function that produces neither revenue nor obvious benefits (though any failures are immediately obvious).

As a result, many security departments are underfunded or lack the authority to impose sound security practices across the company — including on employees who write software, said Rich Mogull, who runs the security research firm Securosis. And those other employees sometimes make mistakes that lead to breaches, Mogull said.

“Those most responsible ... don’t have the economic incentives to actually make it a priority,” Mogull said.

It might also help if more top executives lost their jobs after a major breach, Mogull said. A massive data breach at Target in 2014, for instance, contributed to the departure of CEO Gregg Steinhafel.

“Boards are now feeling the pressure and responsibility to make sure this stuff doesn’t happen,” said David Hickton, a former U.S. attorney who now directs a cyberlaw institute at the University of Pittsburgh.

But even at companies that give security top priority, the risk is never zero. “Companies can build the proverbial 10-foot firewall around their network and sensitive information, but criminals are always going to find that 11-foot ladder,” said Craig Newman, a privacy and data-security attorney at the Patterson Belknap Webb & Tyler law firm.

___

BAD, BAD PASSWORDS

Though Equifax blamed an unspecified “website application vulnerability” in its attack, a more common risk is bad passwords, Kalember said. A breach in one easy-to-guess employee password can get hackers in the door. Once inside, other systems on the network are typically unprotected.

But getting people to adopt strong passwords is difficult — who can remember seemingly random strings of characters for dozens or hundreds of services? Password managers can securely store strong, randomized passwords, but most people don’t use them. The fallback for many people is to reuse passwords, which means that when one service gets hacked, other accounts are also vulnerable.

Ultimately, passwords should be just one of many ways to authenticate one’s identity, Kalember said.

Two-factor authentication — which asks users to enter a second form of identification, such as a code texted to their phone — can provide additional protections. But it’s not always available, and it can be cumbersome for those who aren’t tech-savvy.


►  Apple unveils $999 iPhone X, loses ‘home’ button

Apple has broken the $1,000 barrier with its latest, and most expensive, phone, the iPhone X.

With a price starting at $999 and a host of new features, the phone will be a big test for both Apple and consumers. Will people be willing to shell out really big bucks for a relatively fragile device that’s become an essential part of daily life?

On Tuesday, CEO Tim Cook called the iPhone X “the biggest leap forward” since the first iPhone. (“X” is pronounced like the number 10, not the letter X.) It loses the home button, which revolutionized smartphones when it launched; offers an edge-to-edge screen; and will use facial recognition to unlock the phone.

Apple also unveiled a new iPhone 8 and a larger 8 Plus with upgrades to cameras, displays and speakers.

Those phones, Apple said, will shoot pictures with better colors and less distortion, particularly in low-light settings. The display will adapt to ambient lighting, similar to a feature in some iPad Pro models. Speakers will be louder and offer deeper bass.

Both iPhone 8 versions will allow wireless charging, a feature already offered in many Android phones, including Samsung models. Some Android phones have also previously eliminated the home button and added edge-to-edge screens.

Apple shares were mostly flat after the announcement, down 64 cents to $160.86.

STEVE JOBS HOMAGE

This was the first product event for Apple at its new spaceship-like headquarters in Cupertino, California. Before getting to the new iPhone, the company unveiled a new Apple Watch model with cellular service and an updated version of its Apple TV streaming device.

The event opened in a darkened auditorium, with only the audience’s phones gleaming like stars, along with a message that said “Welcome to Steve Jobs Theater.” A voiceover from Jobs, Apple’s co-founder who died in 2011, opened the event before CEO Tim Cook took stage.

“Not a day that goes by that we don’t think about him,” Cook said. “Memories especially come rushing back as we prepared for today and this event. It’s taken some time but we can now reflect on him with joy instead of sadness.”

The iPhone X costs twice what the original iPhone did. It sets a new price threshold for any smartphone intended to appeal to a mass market.

NEW WATCH

Apple’s latest Watch has built-in cellular service. The number on your phone will be the same as your iPhone. The Series 3 model will also have Apple Music available through cellular service. It won’t need a new plan, but will require a data add-on to your existing plan.

“Now, you can go for a run with just your watch,” said Jeff Williams, Apple’s chief operating officer and in charge of Watch development.

Apple is also adding more fitness features to the Watch, and says it is now the most used heartrate monitor in the world. Now, Apple Watch will notify users when it detects an elevated heart rate when they don’t appear to be active. It’ll also detect abnormal heart rhythms.

The Series 3 will start at $399. One without cellular goes for $329, down from $369 for the comparable model now. The original Series 1, without GPS, sells for $249, down from $269. The new watch comes out September 22.

APPLE TV GETS UPGRADE

A new version of the Apple TV streaming device will be able to show video at “4K” resolution — a step up from high definition — and a color-improvement technology called high-dynamic range, or HDR.

Many rival devices already offer these features. But there isn’t a lot of video in 4K and HDR yet, nor are there many TVs that can display it. Apple TV doesn’t have its own display and needs to be connected to a TV.

Apple said it’s been working with movie studios to bring titles with 4K and HDR to its iTunes store. They will be sold at the same prices as high-definition video, which tends to be a few dollars more than standard-definition versions. Apple said it’s working with Netflix and Amazon Prime to bring their 4K originals to Apple TV, too.

The new Apple TV device will cost $179 and ships on September 22. A version without 4K will cost less.


►  FEMA estimates 25 percent of Florida Keys homes are gone

Search-and-rescue teams made their way into the Florida Keys’ farthest reaches Tuesday, while authorities rushed to repair the lone highway connecting the islands and deliver aid to Hurricane Irma’s victims. Federal officials estimated one-quarter of all homes in the Keys were destroyed.

Two days after Irma roared into the island chain with 130 mph winds, residents were allowed to return to the parts of the Keys closest to Florida’s mainland.

But the full extent of the death and destruction there remained a question mark because cellphone service was disrupted and some places were inaccessible.

“It’s going to be pretty hard for those coming home,” said Petrona Hernandez, whose concrete home on Plantation Key with 35-foot walls was unscathed, unlike others a few blocks away. “It’s going to be devastating to them.”

Elsewhere in Florida, life inched closer to normal, with some flights again taking off, many curfews lifted and major theme parks reopening. Cruise ships that extended their voyages and rode out the storm at sea began returning to port with thousands of passengers.

The number of people without electricity in the steamy late-summer heat dropped to around 10 million — half of Florida’s population. Utility officials warned it could take 10 days or more for power to be fully restored. About 110,000 people remained in shelters across Florida.

Seven deaths in Florida have been blamed on Irma, along with four in South Carolina and two in Georgia. At least 35 were killed in the Caribbean.

“We’ve got a lot of work to do, but everybody’s going to come together,” Florida Governor Rick Scott said. “We’re going to get this state rebuilt.”

Irma’s rainy remnants, meanwhile, pushed through Alabama and Mississippi after drenching Georgia. Flash-flood watches and warnings were issued around the Southeast.

While nearly all of Florida was engulfed by the 400-mile-wide storm, the Keys — home to about 70,000 people — appeared to be the hardest hit. Drinking water and power were cut off, all three of the islands’ hospitals were closed, and the supply of gasoline was extremely limited.

Officials said it was not known how many people ignored evacuation orders to stay behind in the Keys.

Federal Emergency Management Agency administrator Brock Long said that preliminary estimates suggested that 25 percent of the homes in the Keys were destroyed and 65 percent sustained major damage.

“Basically every house in the Keys was impacted,” he said.

In Islamorada, a trailer park was devastated, the homes ripped apart as if by a giant claw. A sewage-like stench hung over the place.

Debris was scattered everywhere, including refrigerators, washers and dryers, a 25-foot fishing boat and a Jacuzzi. Homes were torn open to give a glimpse of their contents, including a bedroom with a small Christmas tree decorated with starfish.

One man and his family came to check on a weekend home and found it destroyed. The sight was too much to bear. The man told his family to get back in the car, and they drove off toward Miami.

In Key Largo, Lisa Storey and her husband said they had yet to be contacted by the power company or by city, county or state officials. As she spoke to a reporter, a helicopter passed overhead.

“That’s a beautiful sound, a rescue sound,” she said.

An aircraft carrier was positioned off Key West to help in the search-and-rescue effort. And crews worked to repair two washed-out, 300-foot sections of U.S. 1, the only highway from the mainland, and check the safety of the 42 bridges linking the islands.

Authorities stopped people and checked for documentation such as proof of residency or business ownership before allowing them back into the Upper Keys, including Key Largo, Tavernier and Islamorada.

The Lower Keys — including the chain’s most distant and most populous island, Key West, with 27,000 people — were still off-limits, with a roadblock in place where the highway was washed out.

In Lower Matecumbe Key, just south of Islamorada, 57-year-old Donald Garner checked on his houseboat, which had only minor damage. Nearby, three other houseboats were partially sunk. Garner had tied his to mangroves.

“That’s the only way to make it,” said Garner, who works for a shrimp company.

While the Keys are studded with mansions and beachfront resorts, about 13 percent of the people live in poverty and could face big obstacles as the cleanup begins.

“People who bag your groceries when you’re on vacation, the bus drivers, hotel cleaners, cooks and dishwashers, they’re already living beyond paycheck to paycheck,” said Stephanie Kaple, who runs an organization that helps the homeless in the Keys.

Corey Smith, a UPS driver who rode out the hurricane in Key Largo, said it was a relief that many buildings on the island escaped major damage. But he said conditions were still not good, with branches blocking roads and supermarkets closed.

“They’re shoving people back to a place with no resources,” he said by telephone. “It’s just going to get crazy pretty quick.”

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