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just steps away from Rep. Donna Shalala’s Longworth workplace is the department of health and Human capabilities — the effective company she ran for all eight years of invoice Clinton’s presidency.
The Florida Democrat is the first grownup to be a part of Congress after serving as an HHS secretary (President Ronald Reagan’s first HHS head, Richard Schweiker, and President Trump’s first HHS chief, Tom rate, each held congressional seats before their company appointments). “I could be a freshman, but I’m no longer a rookie,” Shalala likes to inform parts and residence colleagues.
She’s now not on the ways and capacity Committee or on energy and Commerce, the condominium’s two properly health-care panels. however Speaker Nancy Pelosi (D-Calif.) has appointed Shalala to the suggestions Committee, a perch allowing her to showcase her deep policy capabilities. remaining month Shalala managed debate on a invoice that might have required the residence’s chief attorney to defend the cost-effective Care Act against a lawsuit from GOP-led states.
I currently sat down with Shalala to get her techniques on Medicare-for-all, Obamacare, the Trump administration’s drug pricing efforts and greater. Shalala noted she wants to reach established coverage no longer with an entire overhaul of the gadget but through incremental steps, argued that Medicaid might possibly be a more robust automobile than Medicare for doing that and expressed optimism there might be bipartisan work to bring down drug expenses.
right here’s our conversation, with some edits for readability and brevity.
fitness 202: you've got such a captivating point of view as former secretary. What do you hope to accomplish usual now that you’re in Congress?
Shalala: I want to increase people's lives. i do know loads of americans that can't find the money for health insurance. we now have got to determine a method to get every person coated and we have now obtained to use, in my judgment, present vehicles to try this. we now have these structures: Medicare, Medicaid, the cost-efficient Care Act, the little ones's medical health insurance Plan — it is number one.
number two, we should get integrated care. it's a great deal too fragmented. I ran educational health facilities. Oh, my God. you have got a doctor for every a part of your body, but they do not always work seamlessly together. Most of our fees are in persistent care. So we have to determine ways to manipulate that in the fitness-care system and we should do it effectively and readily. We must tackle prescription medication and we bought to do it with out gimmicks like importation.
fitness 202: You’ve mentioned your district has more particular person insurance market enrollees than every other district within the nation. Are you hoping to make any improvements to the ACA?
Shalala: we would very plenty like to make some advancements in the ACA. i was always worried the subsidies weren't deep ample. because you're in fact taking pictures a bunch of people who had lousy medical insurance or didn't have any medical health insurance, who do not get large increases of their pay. I've all the time felt that we should go deeper into the center classification with subsidies.
I also am no fan of high deductibles, even if the basic care is free. We simply noticed all over this shutdown that almost all americans cannot even come up with 4 hundred greenbacks.
fitness 202: So what will also be done in regards to the high deductibles we’ve considered in the market plans?
Shalala: Congress would should give subsidies and shut some doughnut holes. A deductible is basically a doughnut gap. i might be specifically drawn to [deductible] subsidies for americans which have a little bit bigger revenue as a result of I feel that they are the individuals that are truly having a challenge.
I additionally would do some other things. Let americans purchase into the Medicare application at 55. We proposed that at the conclusion of the Clinton administration. We failed to get wherever with it, however we would discovered a means that you just could do it without it costing the believe fund any cash — through simply charging individuals a bit more … to get into it early. i would argue that an early purchase-in might support us cut back the want for high-risk swimming pools. So i'm always attempting to find less demanding ways on current platforms as opposed to inventing anything new to support us get to popular coverage and affordability.
health 202: How are you feeling in regards to the Obamacare marketplaces as they stand now? as a result of as you understand we did see ordinary premiums go down this yr.
Shalala: well, or not it's interesting. We had excessive enrollments in Florida. The locations where we struggled with marketplace is the extra rural areas, the smaller towns, the areas the place it be tough to get the kind of volume that you want. Some insurers pulled out however it turned into as a result of they did not get massive enough market share. So in densely city areas it worked top of the line, certainly if you get the kind of patient mix you recognize you desired to get.
but in Florida or not it's a captivating phenomenon. We bought large enrollments as a result of we haven't any big industries that can easily accommodate a large percentage of the inhabitants [with employer-sponsored coverage]. americans noted to me, ‘you have all these enrollments in south Florida Cuban clinics.’ you have got a set of clinics really with Latin American docs in South Florida. a lot of them Cuban. and you have got hospitals that had gigantic, big numbers of low-paying patients and all and sundry had an economic incentive to sign people up.
fitness 202: The absence of the particular person mandate penalty appears to have had less influence than anticipated. What do you believe?
Shalala: i'd love to have the mandate lower back. but i wouldn't put the mandate returned devoid of doing a little of these other issues to make [insurance] greater low-cost and extra appealing and easier. but I do feel anything we do, our goal must be universal coverage — least expensive, great widespread insurance.
fitness 202: Do you feel that we'll get to some extent at last where Republicans embrace or at the least settle for the proven fact that the ACA is right here?
Shalala: I think we will get to a place where we are going to get some Republican votes — counting on the place they may be from — for bipartisan fixes. for example, my predecessor Ileana Ros-Lehtinen supported the ACA as a result of the number of individuals in our district.
The different issue i would do this I don't think any individual be attracted to: i'd carry [those who can stay on their parents' insurance plans from] 26-year-olds to 30 [year-olds]. And the intent I do that is because they don't need to purchase insurance. a lot of them are caught in graduate college or in the gig economy, and their fogeys would be completely inclined to cowl them and it would not show up on their folks’ enterprise's medical insurance as a result of they're suit.
i know what younger americans's lives are like as a result of I've run universities. i understand how lengthy they're outside of the common market. So I suppose if you did that and let americans buy into Medicare or Medicaid — as a result of Medicaid is much more comprehensive than Medicare is. I've talked to lots of people that assist Medicare-for-all. I talked about i needed to do Medicaid for all. this is a higher program. it be bought long- time period care. and that they observed, ‘neatly, we can repair Medicare’ . . . very expensive to fix.
health 202: Why have Democrats focused so plenty on Medicare-for-all versus Medicaid?
Shalala: Medicare has by no means been associated with welfare, with terrible people. Medicaid has, that's #1. quantity two: We’re at the Capitol. We're at the federal executive. it truly is a Medicare application, not a Medicaid software. only a handful of specialists on Medicaid are in Congress and most of them have retired.
fitness 202: inform me the way you feel about Medicare-for-all.
Shalala: they're going to have hearings. I don't know the place to move as a result of many americans accept as true with the americans who've very decent medical insurance need to be capable of maintain it because they have got more desirable medical insurance than Medicare presently has.
The different factor is that I've talked about to americans in case you appear on the Kaiser polls, Medicare-for-all falls apart once you delivery telling americans what it is going to charge [and] that they will need to give up their latest health insurance. I debated my opponents on Medicare-for-all. I had four or five opponents to my left. They have been fascinated with Medicare-for-all. I said, ‘appear, i'd want to expand access to Medicare,’ but we have been at a labor union. I stated, ‘every grownup in this union has more advantageous health insurance then Medicare, so tell them that they must hand over their health insurance.’
health 202: We know the way neatly it worked for Obama when he promised ‘in case you adore it, you can keep it’ after which some americans misplaced their plans. it is truly powerful.
Shalala: fully. The precept is commonplace fitness care. Medicare-for-all is a method to get there. My option is to be very pragmatic and fill in the gaps.
but I additionally want to circulate against integrated care. and that's the fragmentation of the fitness-care system that drives every person loopy. You go for an operation and right here's what you ask: Does my insurance cover this? And the reply is sure. and then afterwards you discover the anesthesiologist became out of community and you say what does that mean. Who asks no matter if every person is in community this is on your working room? You don't even be aware of who your anesthesiologist is. You don't have any very own relationship along with your anesthesiologist.
fitness 202: Let’s return to Medicare for a minute. What do you think must be fastened in that software?
Shalala: We haven't absolutely closed the doughnut hole in terms of medicine. there may be bipartisan assist to do that. My mother and aunts used to yell at me about that doughnut gap — why did we do a doughnut gap? and that i'd say, ‘smartly, it was a finances determination … they failed to have satisfactory funds in order that they left a gap within the center.’ and they concept that become the stupidest clarification. I imply how do you clarify it to a person it is ninety two? My aunt observed to me, 'but I pay my taxes.’ (laughter)
health 202: They’re in blissful lack of information of how Congress works, I bet.
Shalala: I bear in mind going domestic that Christmas after [Congress passed the] Medicare part D [prescription drug benefit]. And my mother referred to, ‘You know, you are going to have two mornings where you're in reality tied up.’ She said all of our loved ones are coming over that you should signal them up for half D cause they're completely puzzled about it. I literally sat on a computer and signed 14 people up for part D. and he or she mentioned, ‘You have been the secretary of fitness and Human features. You recognize a way to do this.’ I had no theory.
fitness 202: where do you stand on allowing the executive to barter decrease half D expenses at once with drugmakers?
Shalala: My view is the secretary need to have the energy to barter within the same method that the secretary of Veterans Affairs or a state Medicaid director can.
health 202: That seems like fairly a lot a nonstarter with Republicans in the Senate.
Shalala: well, we will see. until you have got extent you can't carry down the can charge. There are not any hints to this. Now, we may do whatever fundamental. We could undertake the formulary the VA makes use of. I imply, in case you failed to want to let them negotiate, take current negotiations.
fitness 202: What do you think of HHS Secretary Alex Azar’s moves on prescription drug expenditures?
Shalala: I cannot inform yet. he is very an expert. someone just requested me whether i believed the administration become going to [push for a bill allowing] negotiation on prescription drugs. I stated appear, if they use Azar to negotiate a bill he is as a minimum a professional. The query is how an awful lot course does he get from [Office of Management and Budget] and the White apartment on it?
he is very subtle. He understands the pricing considerations. He is aware of in addition to any person that you're simplest going to get coupon codes in case you get volume. examine what we did on AIDS medicine. I labored on the Clinton groundwork for a 12 months. President Clinton negotiated with the pharmaceuticals and promised them thousands and thousands of people for a highly discounted series of AIDS medicine. so you've obtained to barter out on the basis of big numbers of individuals to get your charges down.
fitness 202: And Azar’s Medicare half B demonstration would involve a beautiful small share of Medicare drug spending.
Shalala: Yeah. We wouldn't have to reveal it. We be aware of something about markets.
fitness 202: so you'd like to go greater and bolder, essentially.
Shalala: absolutely. whether that you can sell that politically …[but] we also have to be respectful of the analysis dimension of the prescription drugs. I don't need to destroy the industry in the system as a result of they’ve obtained a pipeline it is essential to each person during this country, on the earth. but i'm now not anxious to pay for their ‘D.’ i'm chuffed to pay for their ‘R.’ The rest of the area, or not it's been charge transferring onto us, because the president has stated and as the relaxation of us have mentioned over the years. The rest of the realm … they're negotiating on the basis of extent and they're getting lessen prices and not deciding to buy the ‘R’ part. American taxpayers are deciding to buy the analysis half.
health 202: Do you believe there may be going to be bipartisan work on health policy in the subsequent two years?
Shalala: i'm hoping so. we will see. we will see what they bite on to. I have no idea. I do be aware of that we've got acquired some ideas and i've talked a bit bit to the committee individuals, but I've really obtained to have longer conversations. I want to be very cautious as a result of all this stuff has to have hearings, it has to head through the committees.
I even have had loads of adventure. I've sat on the corporate boards of fitness-care agencies. I've run hospitals and massive fitness-care methods and that i've absolutely been secretary, but my most excellent experience has been talking to americans and seeing what's bothering them. Out-of-pocket expenses, I feel, are a large concern with americans. we now have received to determine a way to get our palms round that situation. These are bread- and-butter considerations, but they're also concerns for corporations because the agencies are going crazy because they have no idea what their fitness-care charges are going to be subsequent yr. So there are a lot of pursuits in containing prices.
fitness 202: It’s certainly some thing both parties are speaking about.
Shalala: if you see the look on the face of home health-care laborers who bought Obamacare for the first time of their lives and got free simple care the first time they ever went to the medical professional, boy, you need to prolong this to all and sundry. i hope we will locate some incentives to get extra governors, including mine, into expanding Medicaid as a result of a lot of Republican governors have finished it — they've performed it below waivers.
I provide a remaining examination by which I ask the college students to make one suggestion to the president of the us to enhance the health-care gadget for everybody. The child that got the A-plus spoke of crusade finance reform. now not unhealthy. He became scared to dying that i'd flunk him however it's a wise answer. as a result of round each and every of those changes there's an array of activity agencies.you're reading The fitness 202, our have to-examine newsletter on health policy. no longer an everyday subscriber?
AHH, OOF and OUCH
AHH: After an almost four-hour physical examination with 11 specialists, President Trump’s docs talked about he is in “very decent health” and is anticipated to dwell in shape for “the length of his Presidency, and beyond,” our submit colleague Anne Gearan writes.
No particulars of the Friday exam at Walter Reed countrywide militia clinical core had been launched, nor became it clear if extra particulars would later be publicized.
“The memo did not include the disciplines of any of the consultants,” Anne writes. “typically, a actual exam comprises assessments of height, weight, blood pressure and other ordinary measures. Trump mentioned ultimate yr that he takes a statin drug to manage his ldl cholesterol.”
The president has “visibly gained weight in recent years,” Anne provides. It’s no secret Trump prefers pork, quickly meals and sweets, and apart from golf, Trump isn't regular to undertaking, she notes. Trump does not smoke or drink.
OOF: Sen. Michael Bennet, the Colorado Democrat for the reason that a 2020 presidential run, criticized calls by some Democrats to get rid of inner most insurance in pursuing Medicare-for-all.
“be aware when President Obama stated, 'if you like your assurance, you could preserve your insurance,'" Bennet pointed out throughout an interview on NBC's “Meet to Press. “after which a couple of people in the us actually lost their insurance because of the style that the plan labored. Now what Democrats are asserting is, 'if you like your assurance, we will take it away from you,' from 180 million americans that get their assurance from their agency and adore it, where 20 million americans who are on Medicare knowledge, and love it. That looks like a nasty opening present for me.”
Sen. Kamala Harris (D-Calif.) raised eyebrows final month when she spoke of all over a CNN city corridor she’d like to dispose of private health insurance. “The idea is that each person gets access to clinical care and also you don't have to go during the system of going via an insurance enterprise, having them give you approval, going via all the bureaucracy, the entire extend that can also require,” Harris referred to.
OUCH: while Washington state’s worst measles outbreak in two many years continues, tons of of people packed into a public hearing about a invoice to make it more difficult for households to opt out of vaccination necessities for measles, mumps and rubella.
many of the seven-hundred or so individuals at the Friday assembly had been opposed to stricter requirements, our publish colleagues Lena H. solar and Kristen Millares younger document.
at the listening to, Washington state health Secretary John Wiesman entreated state lawmakers to move the invoice and debunked claims from some in attendance that vaccines are bad.
“I are looking to remind you that the MMR vaccine is extremely secure and tremendously advantageous,” Wiesman told lawmakers. He added “all reputable scientific reports have found no relation between measles and autism.”
The invoice would dispose of own or philosophical exemptions to acquiring the vaccine -- but would still allow for medical and religious exemptions, Lena and Kristen report. The bill's sponsor, state Rep. Paul Harris (R), represents Clark County, the epicenter of the measles outbreak, and is planning to amend the invoice to "tighten religious exemptions, too," they write.
“Washington is considered one of 17 states that allow own or philosophic exemptions to vaccination necessities, meaning virtually anybody can decide out,” they add.
but the fresh nationwide outbreaks have brought about lawmakers in Washington and a number of states to agree with tightening immunization specifications.
— in the meantime, some teenagers are reality-checking their families’ antivaccination stances and looking for their personal remedy, our submit colleague Alex Horton writes.
“In three states, at the least three self-described teens informed Reddit they have got a standard issue: Their parents are staunchly adverse to vaccination, and that they worry for his or her health if they do not take action,” he writes. “distinctive state legal guidelines affect how ancient minors need to be to make their personal medical decisions.”
An 18-year-historic Ethan Lindenberger from Ogio explained he examine scientific studies, together with from the centers for ailment handle and Prevention, and tried to influence his mother to let him and his 4 more youthful siblings get vaccinated. “I appeared into it, it was clear there became approach extra proof in defense of vaccines,” he instructed The post. but his mother resisted.
“On Dec. 17, he walked into an Ohio department of Heath office in Norwalk and received a cocktail of vaccines for hepatitis A, hepatitis B, influenza and HPV, in accordance with a shot record viewed through The post,” Alex writes.
health ON THE HILL
— Republican lawmakers are itching for hearings on Democrats’ Medicare-for-all proposals, hoping such public airings will provide them an opportunity to home in on an opposing message leading as much as 2020 elections, Politico’s Alice Miranda Ollstein experiences.
“We may still have the opportunity to have a hearing on a bill Democrats say they are for,” the apartment power and Commerce Committee’s precise Republican Rep. Greg Walden (R-Ore.) said. “They’ve campaigned on it. Now, let’s find out what it is and what they’re promoting.”
Rep. Kevin Brady (R-Tex.), the exact Republican on the apartment ways and capacity Committee, pointed out lawmakers wish to “pull the curtain lower back on Medicare for All so the American americans can actually determine it.”
meanwhile, Democrats are embracing these calls. “They feel it’s going to be a ‘gotcha’ moment,” pointed out Rep. Pramila Jayapal (D-Wash.), lead author of a Medicare-for-all invoice. “but they have been wrong on this and proceed to be wrong on it.”
“The Republicans’ counterintuitive flow seeks to exacerbate actual divisions inside the Democratic celebration on how far and how quickly to move past Obamacare and chart a route toward Medicare for All,” Alice writes. “Senior Democrats main the apartment's health committees blasted the GOP request as ‘cynical’ and ‘disingenuous’ and said it could no longer have an effect on their timeline for weighing the policy.”
— Democrats and liberal businesses are focused on Sen. Susan Collins (R-Maine) for her support of Brett M. Kavanaugh after the most recent addition to the Supreme court dissented in a 5-to-four vote to block a restrictive Louisiana abortion legislations.
They’re pointing to the dissent as an indication the latest justice would vote to overturn Roe v. Wade and aspect with conservatives in future abortion-rights linked situations, our put up colleagues Felicia Sonmez and Michael Scherer report.
Demand Justice, a liberal neighborhood that adverse Kavanaugh’s nomination, is planning a greater than $10,000 digital ad crusade in Maine to “inform voters of how Collins’ vote for Kavanaugh helped lead to the close call in Thursday’s ruling,” Felicia and Michael record.
“Democrats are peculiarly incensed at Collins, who delivered a 44-minute-long ground speech in October declaring her support for Kavanaugh,” they write. “on the time, Collins, who helps abortion rights, said she didn't suppose Kavanaugh would vote to overturn the landmark 1973 Roe v. Wade ruling that legalized abortion.”
Annie Clark, communications director for Collins, countered through relating to Kavanaugh’s December vote in deliberate Parenthood’s desire. “all over his confirmation method, deliberate Parenthood turned into Justice Kavanaugh’s no 1 opponent,” Clark referred to in a press release. “They went after him with everything that they'd. And yet, when it came to a case involving them, he became in a position to put that apart and rule impartially and independently.”
— HHS is searching for the authority to reverse an Obama-era coverage that barred foster care and adoption corporations from rejecting potential folks in accordance with their sexual orientation or gender identity. HHS’s office of Civil Rights argues in a 2020 draft budget request that some of the nation’s oldest spiritual companies in areas comparable to Boston, Philadelphia and Washington have long gone out of business because of nondiscrimination necessities that are themselves discriminatory.
President Trump pointed to such a flow on the national Prayer Breakfast final week, our publish colleague Ariana Eunjung Cha reports, telling religious leaders that such faith-primarily based groups would still be capable of get federal funding to “aid inclined toddlers discover their perpetually families while following their deeply held beliefs.”
"faith-based mostly agencies play a vital position in foster care and adoption in the u.s., and in some parts of the nation are the dominant suppliers," Ariana writes. "religious leaders say that HHS’s requested changes would not evade certified individuals from becoming adoptive and foster parents because there are many different companies which will settle for them."
It’s the newest circulation from an administration that has sought to offer protection to spiritual groups that are key supporters of the president. “HHS specifically takes challenge with the concept that an Obama-period rule barring discrimination on the foundation of religion, sexual orientation or gender identification may drive religious-based mostly organizations to need to area infants in household arrangements inconsistent with their perception that marriage is the union of 1 man and one girl," Ariana writes.
Currey cook dinner, an lawyer with Lambda legal, which advocates for LGBTQ communities, noted “no person in here's saying faith-based mostly suppliers don’t have a place within the newborn welfare equipment. It’s notable they're a part of it. What we are announcing is that when you are accepting executive funds and performing a govt service, make sure you no longer be capable of discriminate in opposition t individuals with these dollars."
— And listed below are a number of greater good reads:
The 13-term North Carolina Republican wrote letters to spouse and children of U.S. provider participants killed in action as a method of “asking God to forgive me for my mistake” in vote casting for the war.
Democrats held hearings this week on the precise concerns they campaigned on all the way through the midterms.
“It made me uncomfortable,” the daughter of the late senator John McCain (R-Ariz.) mentioned on late-night tv.
Courts & legislation
Chief Justice John G. Roberts Jr. sided for now with liberals on an abortion case, and the positions of Neil M. Gorsuch and Brett M. Kavanaugh grew to become clearer.
by means of specializing in late-time period abortions, that are quite infrequent, the president paints an inaccurate and misleading image.
The ambitious State of the Union pronouncement has been undermined by using President Donald Trump’s personal actions.
As Friday’s time limit approaches, a federal worker wonders: ‘How am I speculated to dig out?’
New files have shown the powerful have an impact on of three Mar-a-Lago participants in a digital health checklist contract and other VA business.
The Florida congressman is the simplest Republican co-sponsor on a invoice to enable Medicare for negotiate fees, historically nonstarter for the GOP.
Engineers have developed a tiny robotic tablet that injects insulin as soon as it lands in the abdominal.
long island instances
In an unvaccinated inhabitants, one grownup with measles can infect 12 to 18 others.
a bit greater than three months after eleven people were shot to dying whereas worshiping on the Tree of lifestyles synagogue, metropolis leaders and residents are clashing over proposed gun restrictions.
Wall road Journal
condominium Democrats are warming to gun-manage legislations as soon as regarded harmful for all but the most secure incumbents, but continue to be doubtful even if they are going to vote this 12 months on one of the vital more a ways-accomplishing expenses.
Wall road Journal
Sen. Amy Klobuchar (D-Minn.) has officially entered the 2020 race:right through an interview aired on CBS This Morning on Feb. 10, Virginia Gov. Ralph Northam (D) said he is " not going anywhere":
windfall — although the dangers of sea stage rise to coastal houses have become extra largely understood, they may additionally not being wholly accounted for within the real property market.
“The price of any asset, be it commodities, gold, stocks, relies upon fundamentally on people’s beliefs,” referred to Lint Barrage, assistant professor of economics and environmental reports at Brown tuition. “If americans are excessively optimistic in regards to the future cost of an asset, there's abilities for mispricing, and bubbles and overinvestment.”
speakme Friday at a one-day conference at Brown on the political and economic penalties of climate exchange, Barrage described her research on the coastal property market, which included going door-to-door in Rhode Island and interviewing householders about flood risk. people with homes in federally distinct flood zones tended to underestimate the possibility of flooding when in comparison with americans who lived further inland, she discovered.
“The cause all this matters is that markets can not fee risks successfully if individuals don’t accept as true with in them,” she mentioned.
And if the dangers of local weather exchange aren’t being precisely factored into costs now, then it may mean a steep drop in values someplace down the road.
a part of the reason behind the disconnect, at least in Rhode Island and neighboring states, is that the area hasn’t been hit hard or in a widespread method by a typhoon or different severe weather adventure in recent years, mentioned Curt Spalding, former New England regional administrator of the U.S. Environmental protection company who is now a professor at Brown.
“We have not had a shockingly catastrophic climate-connected experience,” he mentioned. “It hasn’t hit domestic yet.”
but when it does, the have an effect on could be profound. home possession represents the economic groundwork for a lot of individuals, talked about Spalding, so if domestic values erode, it is going to damage their average monetary neatly-being. Cities and cities that depend on property taxes will additionally endure if home price is lost.
As a whole lot of forty percent of the U.S. population lives in counties adjoining to a shoreline, and the value of actual estate inside one-eighth of a mile of the coast is estimated to be $1.4 trillion.
recent studies have discovered that residences at risk of flooding are beginning to see their values affected. just last week, researchers from Columbia institution and the nonprofit First highway groundwork launched a look at that concluded that Rhode Island misplaced $44.7 million in home appreciation between 2005 and 2017 on account of accelerated tidal flooding because of sea degree rise.
some of the complications in speaking flood hazards that Barrage and different speakers raised at the conference changed into the federal flood mapping application. Flood-risk maps created via the Federal Emergency management agency are backward-searching and fail to account for future sea stage upward push.
In Rhode Island, the Coastal materials administration Council and the institution of Rhode Island have developed maps that do factor in sea stage upward push. those maps, through an internet application called STORMTOOLS, and flood-harm visualizations for components of Warwick and South County and, extra these days, for the East Bay created as a part of a separate initiative called the Coastal Environmental risk Index intention to train the public about the increasing risks.
“My guess is that these kinds of visualizations might be very advantageous to people to are attempting and internalize these hazards,” Barrage stated.
The 2018 Teddy Award winners built their courses round people, now not claims, and present proof that a worker-centric strategy is a better technique to function.
across the staff’ compensation business, the thought of a worker advocacy model has been around for a while, but has most effective viewed awesome adoption in fresh years.
Even among these no longer adopting a formal advocacy strategy, mindsets are shifting. previously claims-centric classes are becoming worker-centric and it’s a win all around: improved outcomes; more advantageous productivity; safer, healthier employees and an improved final analysis.
That’s what you’ll see in this month’s problem of chance & assurance® for those who examine the profiles of the four recipients of the 2018 Theodore Roosevelt people’ Compensation and disability administration Award, sponsored by means of PMA groups. These 4 courses put worker's entrance and core in every little thing they do.
“We have been concentrated on building up a software with a watch on our companion adventure. charge become on the backside of the list. Doing a far better job by means of our companions changed into on the excellent,” said Steve Legg, director of possibility management for Starbucks.
Starbucks put claims reporting in the fingers of its companions, an exemplary act of have confidence. The coffee business also put itself in people’ shoes to identify and remove points of friction.
That ended in a name middle run by means of Starbucks’ TPA and a dedicated telephonic case management group in order that companions can communicate to a reside person devoid of the frustration of ‘mobilephone tag’ and unanswered questions.
“We were focused on increase a program with an eye on our accomplice event. charge became at the bottom of the listing. Doing a far better job via our partners changed into at the desirable.” — Steve Legg, director of chance management, Starbucks
Starbucks additionally carried out direct deposit for lost-time pay, eliminating traumatic wait times for injured companions, and permitting them to focus on curative.
For Starbucks, as for all of the 2018 Teddy Award winners, the approach is netting measurable effects. With greater partner satisfaction, it has seen a 50 p.c reduce in litigation.
Teddy winner main Line fitness (MLH) adopted worker advocacy in a method that goes a long way past claims.
employees who identify and file security risks can take credit for his or her movements via sending out a formal “employee safeguard Message” to basically 11,000 mailboxes across the firm.
“The focus is relatively cool,” talked about Steve Besack, system director, claims management and worker's’ compensation for the health equipment.
MLH also takes a non-adversarial method to people with repeat accidents, seeing them as a useful resource for opting for areas of development.
“for those who study ‘repeat offenders’ in an unconventional method, they’re a good asset to the application, now not a liability,” pointed out Mike Miller, supervisor, people’ compensation and worker defense for MLH.
Teddy winner Monmouth County, N.J. utilizes excessive-tech movement capture technology to reduce the chance of putting new hires in jobs which are likely to hurt them.
Monmouth County additionally adopted a lot of health initiatives that support worker's manipulate their weight and enrich their health general.
“you'll want to see the appears on their faces when their cholesterol is down, they’ve misplaced weight and their blood sugar is stronger. We’ve had americans lose 30 and forty kilos,” pointed out William McGuane, the county’s supervisor of merits and workers’ compensation.
Do these sound like minor application points? the maths says otherwise: Claims severity has plunged from $5.5 million in 2009 to $1.3 million in 2017.
at the institution of Pennsylvania, putting laborers first ability getting out from at the back of the desk and finding out what each certainly one of them is tasked with, day in, day trip — and looking out for ways to make each of these tasks safer.
usual observations across the sprawling campus have resulted in a ravishing variety of procedure and device alterations that look primary on their personal, however in combination have created a notably safer, healthier campus and greater employee morale.
UPenn’s employees’ comp prices, in the seven-digit figures in 2009, have been essentially reduce in half.
chance & coverage® is proud to honor the work of these 4 corporations. We hope their stories inspire different companies to be true partners with the personnel they depend upon. &Michelle Kerr is affiliate editor of risk & assurance. She will also be reached at [email protected]
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The 2018 Teddy Award winners built their programs around people, not claims, and offer proof that a worker-centric approach is a smarter way to operate.
Across the workers’ compensation industry, the concept of a worker advocacy model has been around for a while, but has only seen notable adoption in recent years.
Even among those not adopting a formal advocacy approach, mindsets are shifting. Formerly claims-centric programs are becoming worker-centric and it’s a win all around: better outcomes; greater productivity; safer, healthier employees and a stronger bottom line.
That’s what you’ll see in this month’s issue of Risk & Insurance® when you read the profiles of the four recipients of the 2018 Theodore Roosevelt Workers’ Compensation and Disability Management Award, sponsored by PMA Companies. These four programs put workers front and center in everything they do.
“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top,” said Steve Legg, director of risk management for Starbucks.
Starbucks put claims reporting in the hands of its partners, an exemplary act of trust. The coffee company also put itself in workers’ shoes to identify and remove points of friction.
That led to a call center run by Starbucks’ TPA and a dedicated telephonic case management team so that partners can speak to a live person without the frustration of ‘phone tag’ and unanswered questions.
“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top.” — Steve Legg, director of risk management, Starbucks
Starbucks also implemented direct deposit for lost-time pay, eliminating stressful wait times for injured partners, and allowing them to focus on healing.
For Starbucks, as for all of the 2018 Teddy Award winners, the approach is netting measurable results. With higher partner satisfaction, it has seen a 50 percent decrease in litigation.
Teddy winner Main Line Health (MLH) adopted worker advocacy in a way that goes far beyond claims.
Employees who identify and report safety hazards can take credit for their actions by sending out a formal “Employee Safety Message” to nearly 11,000 mailboxes across the organization.
“The recognition is pretty cool,” said Steve Besack, system director, claims management and workers’ compensation for the health system.
MLH also takes a non-adversarial approach to workers with repeat injuries, seeing them as a resource for identifying areas of improvement.
“When you look at ‘repeat offenders’ in an unconventional way, they’re a great asset to the program, not a liability,” said Mike Miller, manager, workers’ compensation and employee safety for MLH.
Teddy winner Monmouth County, N.J. utilizes high-tech motion capture technology to reduce the chance of placing new hires in jobs that are likely to hurt them.
Monmouth County also adopted numerous wellness initiatives that help workers manage their weight and improve their wellbeing overall.
“You should see the looks on their faces when their cholesterol is down, they’ve lost weight and their blood sugar is better. We’ve had people lose 30 and 40 pounds,” said William McGuane, the county’s manager of benefits and workers’ compensation.
Do these sound like minor program elements? The math says otherwise: Claims severity has plunged from $5.5 million in 2009 to $1.3 million in 2017.
At the University of Pennsylvania, putting workers first means getting out from behind the desk and finding out what each one of them is tasked with, day in, day out — and looking for ways to make each of those tasks safer.
Regular observations across the sprawling campus have resulted in a phenomenal number of process and equipment changes that seem simple on their own, but in combination have created a substantially safer, healthier campus and improved employee morale.
UPenn’s workers’ comp costs, in the seven-digit figures in 2009, have been virtually cut in half.
Risk & Insurance® is proud to honor the work of these four organizations. We hope their stories inspire other organizations to be true partners with the employees they depend on. &Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]
Managing risk is about managing choices.
Start with a classic dilemma. Every growing season, the farmer confronts a number of decisions—what crops to plant, how much to grow, whether to expand production. Absent information about the price she will get at harvest, the farmer’s options are constricted and she risks catastrophic losses to her farm if the price is below her baseline costs.
On the other side, a firm that processes and distributes food needs to buy from a number of farmers, but is concerned that the price at harvest will be too high to run the business. The uncertainty stunts growth and innovation, resulting in inaction. Status quo prevails.
Over centuries, farmers and buyers have worked out agreements using contracts and insurance products to manage risk and fix an acceptable level of variance on price and volume. Risk management tools distribute risk among multiple parties and promote win-win outcomes. Status quo is overcome. Deals get done. Innovation is possible.
In the nonprofit world, too often risk is precious in our rhetoric but neglected in professional practice. As a result, our grants mostly produce that with which we say we are most dissatisfied: the status quo.
At foundations where board members are determined to contribute to change, leadership can turn to new risk-management tools for guidance. The Commons—a task force organized by Open Road Alliance, Rockefeller Foundation and Arabella Advisors—has produced a set of tools with the overarching goal of encouraging funders to create a deliberate risk profile and integrate risk management best practices into their philanthropic practice. This first-of-its-kind toolkit includes practical steps that can be incorporated into use by both big or small foundations.Outmaneuvering the Status Quo
Thomas Paine warned us of status quo’s power: “a long habit of not thinking a thing wrong, gives it a superficial appearance of being right, and raises at first a formidable outcry in defense of custom.”
In considering how risk management can help foundations overcome the status quo, we must disabuse ourselves of the idea that risk only matters when used as an adjective—risky—to signal unadvisable choices. As when public health experts explain that “risky sexual behavior” leads to unwanted pregnancies and sexually transmitted disease; to defy this caution is to dismiss science.
Risk management, on the other hand, is about harnessing all we know from science in order to improve our chance of realizing a desired future that is different from what we experience today. As financial historian Peter Bernstein explains in his history of risk, Against the Gods, we want our future to hinge on the choices we make, not on fate alone.
This calibration, where we determine what we’re willing to invest today against the chance of a future return, is where many foundations stumble. Financial controls and cultural norms within foundations already require careful attention to the allocation of time, money and reputation. But too often the criteria used to decide allocations fail to account for either the cost of the status quo or the price of change.
Consider a persistent, costly problem such as prisoner recidivism. Foundations will routinely haggle with applicants over budget details and devote outsized attention to the absolute value of the immediate outlay of grant dollars. Yet foundations pay little attention to the costs that will be incurred if the status quo prevails—in this case, unchanged recidivism rates—producing grants that stand little chance of reversing complex trends. Status quo wins. Risk management tools will help foundations understand that the cost of status quo is far more than the amount of the grant funding itself.A Case Study in Risk Management and Change: Quality Rated
To consider how funders may build the price of change into the strategy, consider Quality Rated, a public-private effort in Georgia designed to increase the supply of (and demand for) high quality child care. Quality Rated is built to encourage child-care centers to participate in a voluntary rating system—a Yelp for parents researching child-care—and millions of parents to seek out centers that receive higher ratings.
For years, Georgia child-care advocates couldn’t get anyone to take action. Child-care centers would not invest in improved quality. Parents selected child-care based on convenience and price, not quality. Traditional grantmaking failed to move the system off the status quo.
The genius behind philanthropy’s role in Quality Rated is that instead of funding the underlying service delivery, foundations are directing private investment to specific points in the system where status quo would otherwise thwart innovation. For example, foundations are helping to fund the bonuses that go to teachers at centers that improve upon their initial rating. For parents, foundations are helping to boost the reimbursement levels linked to the selection of higher-quality centers.
While it’s too early to tell if the new system will transform outcomes for children, we do know that the approach has accelerated risk taking and innovation, a necessary step toward the desired outcomes. As of October 2016, more than 2,800 of Georgia’s 4,960 licensed child-care centers had opted into the voluntary Quality Rated program—beating status quo.Invest in Risk, Not Programs
The approach works because foundations do not have to fund the entire cost of the child-care programs in question. We are, in effect, underwriting risk, which can be viewed as the no-man’s-land in between status quo and action.
This approach is old news to community developers, who won’t move forward on a $1 million development if all they can raise from investors is $980,000. When this happens, society doesn’t get 98 percent of the benefit. We get zero. Which is why foundations often will fund the gap, using an investment equal to two percent of the overall deal to maximize the social impact and ensure the community realizes 100 percent of the benefit.
Over several centuries, as Bernstein describes, philosophers, tinkerers and mathematicians have “transformed probability theory from a gamblers’ toy into a powerful instrument for organizing, interpreting and applying information.”
To risk, he says, is to dare. Philanthropy must dare to outmaneuver status quo.
Good morning—Sabah Al-Khair! I am delighted to be back in Dubai, this city of tomorrow, where you—its economic leaders—are dedicated to realizing the vision of a better tomorrow.
This vision is predicated on prosperity that is shared by all, benefiting the poor and the middle class, citizens and immigrants alike; and opportunities that are open to all, including women. It is a vision of fairness over cronyism and partiality, and of trust that government policy is oriented toward the common good.
This is a big vision. But as Sheikh Mohammed bin Rashid Al Maktoum once said “The bigger your vision, the bigger your achievement will be…we cannot let fear keep us small. We have to be brave to be big.”
As you know so well, fiscal policy plays a vital role in creating and nurturing this vision of sustainable and inclusive growth—especially as encapsulated in the Sustainable Development Goals. This is because we need fiscal space for spending on health, education, social protection, and public investment—all key priorities in this region.
This is why I wanted to come back to the Arab Fiscal Forum—my fourth time now. In past years, I talked in detail about fiscal policy—the spending and revenue measures needed to achieve sustainable and inclusive growth. This year, I want to go one level deeper—into the foundations of fiscal policy and good fiscal management.
Because without a stable foundation, even the best policies can flounder. Without a stable foundation, fiscal policy will lack credibility.
In this vein, I will address two key pillars of good fiscal management: (i) strong fiscal frameworks; and (ii) good governance and transparency.Prelude: Global and regional context
Before I do this, let me say a few words about the broader economic context bearing on fiscal policy in the region.
Unfortunately, the region has yet to fully recover from the global financial crisis and other big economic dislocations over the past decade.
Among oil importers, growth has picked up, but it is still below pre-crisis levels. Fiscal deficits remain high, and public debt has risen rapidly—from 64 percent of GDP in 2008 to 85 percent of GDP a decade later. Public debt now exceeds 90 percent of GDP in nearly half of these countries.
The oil exporters have not fully recovered from the dramatic oil price shock of 2014. Modest growth continues, but the outlook is highly uncertain—reflecting in part the need for countries to shift rapidly toward renewable energy over the new few decades, in line with the Paris Agreement. With revenues down, fiscal deficits are only slowly declining—despite significant reforms on both the spending and revenue sides, including the introduction of VAT and excise taxes. This has led to a sharp increase in public debt—from 13 percent of GDP in 2013 to 33 percent in 2018.
At this juncture, the global expansion is weakening, and risks are rising. Just a few weeks ago, we released our revised forecasts. We now think that the global economy will grow by 3.5 percent this year, 0.2 percentage points below what we expected in October. And risks are up, given escalating trade tensions and tightening financial conditions. Unsurprisingly, a weaker global environment has knock-on effects on the region through a variety of channels—trade, remittances, capital flows, commodity prices, and financing conditions.
The bottom line: the economic path ahead for the region is challenging. This makes the task of fiscal policy that much harder, which in turn makes it even more important to build strong foundations to anchor fiscal policy.1. Fiscal Frameworks
The first building block of this foundation is a good fiscal framework. By this I mean the set of laws, institutional arrangements, and procedures needed to achieve a country’s fiscal policy objectives. Such a framework allows governments to map out budgets over the medium term in a way that reflects clear, consistent, and credible goals.
There is scope to improve fiscal frameworks in this region. Some of the weaknesses are short-termism and insufficient credibility.
On short-termism: given that inclusive and sustainable growth is an inherently medium-term goal, fiscal policy needs a medium-term orientation. Focusing on the immediate horizon makes it harder to implement critical but longer-term reforms in such areas as tackling high public wage bills, designing effective social protection systems, and getting rid of harmful fuel subsidies. Short-termism implies that fiscal policy amplifies rather than tames the waves of booms and busts—making it more difficult to achieve sustainable and inclusive growth.
Turning to fiscal credibility: I am referring to such factors as large amounts of spending kept off-budget and poor risk management. Across the region, it is common for sovereign wealth funds to directly finance projects, bypassing the normal budget process. And state-owned enterprises in some countries have high levels of borrowing—again, outside of the budget. Addressing these fiscal risks would not only enhance budget credibility and transparency but would help keep a lid on corruption. Budgetary credibility also calls for better risk management, with a more comprehensive budget based on realistic forecasts.
The good news is that numerous countries are already strengthening their fiscal frameworks—many with IMF assistance. Just to give some examples:
There is scope for further improvement. Perhaps the oil exporters could follow the example of other resource-rich countries such as Chile and Norway in using fiscal rules to protect key priorities such as social spending from commodity price volatility.
Strong fiscal frameworks have other important benefits. They form the basis for sound debt management. They also allow for better coordination between fiscal and monetary policies, so that the two arms of macroeconomic management work together, not at cross purposes.2. Good Governance and Transparency
Let me now turn to the second pillar of good fiscal management—good governance and transparency. In this context, governance refers to the institutional frameworks and practices of the public sector. Strong institutions are crucial for legitimacy, for fostering a clearer understanding of policy objectives among citizens, enhancing their voice, and generating buy-in for fiscal policy.
On the other hand, as many of you have said, weak institutions imply a weak policy foundation that could crack and crumble—because there is inadequate legitimacy and public accountability. Even worse, these cracks could also let corruption creep in. And you know so well, this is social poison—it feeds discord, disengagement, and disillusionment, especially among the young. The word corruption, after all, comes from Latin root for rotting, breaking apart—disintegration. And the word in Arabic, fasad, also connotes this idea of rotting or coming undone.
Corruption is the great disruptor of fiscal policy. Without trust in the fairness of the tax system, it becomes harder to raise the revenue needed for critical spending on health, education, and social protection. And governments might be tempted to favor white elephant projects instead of investments in people and productive potential. Add this up, and we have a recipe for unsustainable fiscal policy combined with social discord.
This a global issue—relevant for large and small countries, advanced and low-income economies, and the public and private sectors. Given this, it is no surprise that IMF research found that weak governance and corruption are associated with significantly lower growth, investment, FDI, and tax revenues—and higher inequality and exclusion.
Specifically, we found that improving on an index of corruption and governance by moving from the bottom quarter to the mean is associated with an increase in the investment-to-GDP ratio of 1.5–2 percentage points and a bump up in annual GDP per capita growth by half a percentage point or more.  We will have more analysis in the upcoming Fiscal Monitor, which will be devoted to the topic of the fiscal costs of corruption and the role of fiscal institutions.
What is the solution to weak governance and corruption? In the fiscal domain, it calls for heightened fiscal transparency—shining a light on all aspects of the budget and the public accounts. This would provide a more accurate picture of the fiscal position and prospects, the long-term costs and benefits of any policy changes, and the potential fiscal risks that might throw them off course. This region has some room for improvement here.
We know that these kinds of reforms pay off. Take the case of Georgia, for example. Until 2003, it was seen as one of the most corrupt countries in the world. But after that, it reformed its institutions and cracked down on corruption. This, along with tax reform, led to immediate improvements. Tax revenues increased from 12 percent of GDP in 2003 to 25 percent of GDP in 2008, as taxpayers had greater faith in the fairness of the system.
I should note that the IMF has been stepping up its engagement in the area of governance and corruption. Last year, we put in place a new framework predicated on a more systematic, evenhanded, effective, and candid engagement on these issues with member countries. We will be reaching out to leaders in this region to discuss how we can work together to implement this framework.
With better governance, we can replace the “disintegration” of corruption with the “integration” of all into the productive economy. We can replace fasad with islah—reforms to set things right, to reconcile people with one another.Conclusion
Let me wrap up. I have argued this morning that good fiscal policy requires good institutional foundations. And solid foundations in areas such as fiscal frameworks and governance give citizens confidence that fiscal policy serves the good of all, not just the wealthy or the well-connected.
Let me end with some wise words attributed to the great Ibn Khaldun, “He who finds a new path is a pathfinder, even if the trail has to be found again by others; and he who walks far ahead of his contemporaries is a leader.”
You are the pathfinders, the leaders, the visionaries. We hope that we can give useful guidance, but we look to you to find the right path to make this vision a reality.
 More specifically, those gains are associated with moving from the 25th percentile to the 50th percentile in an index on corruption and governance.
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CompTIA [76 Certification Exam(s) ]
ComputerAssociates [6 Certification Exam(s) ]
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Counselor [4 Certification Exam(s) ]
CPP-Institue [2 Certification Exam(s) ]
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Filemaker [9 Certification Exam(s) ]
Financial [36 Certification Exam(s) ]
Food [4 Certification Exam(s) ]
Fortinet [13 Certification Exam(s) ]
Foundry [6 Certification Exam(s) ]
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Fujitsu [2 Certification Exam(s) ]
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Google [4 Certification Exam(s) ]
GuidanceSoftware [2 Certification Exam(s) ]
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HDI [9 Certification Exam(s) ]
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HIPAA [2 Certification Exam(s) ]
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IBM [1532 Certification Exam(s) ]
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ICDL [6 Certification Exam(s) ]
IEEE [1 Certification Exam(s) ]
IELTS [1 Certification Exam(s) ]
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Juniper [64 Certification Exam(s) ]
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Logical-Operations [1 Certification Exam(s) ]
Lotus [66 Certification Exam(s) ]
LPI [24 Certification Exam(s) ]
LSI [3 Certification Exam(s) ]
Magento [3 Certification Exam(s) ]
Maintenance [2 Certification Exam(s) ]
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McData [3 Certification Exam(s) ]
Medical [69 Certification Exam(s) ]
Microsoft [374 Certification Exam(s) ]
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Military [1 Certification Exam(s) ]
Misc [1 Certification Exam(s) ]
Motorola [7 Certification Exam(s) ]
mySQL [4 Certification Exam(s) ]
NBSTSA [1 Certification Exam(s) ]
NCEES [2 Certification Exam(s) ]
NCIDQ [1 Certification Exam(s) ]
NCLEX [2 Certification Exam(s) ]
Network-General [12 Certification Exam(s) ]
NetworkAppliance [39 Certification Exam(s) ]
NI [1 Certification Exam(s) ]
NIELIT [1 Certification Exam(s) ]
Nokia [6 Certification Exam(s) ]
Nortel [130 Certification Exam(s) ]
Novell [37 Certification Exam(s) ]
OMG [10 Certification Exam(s) ]
Oracle [279 Certification Exam(s) ]
P&C [2 Certification Exam(s) ]
Palo-Alto [4 Certification Exam(s) ]
PARCC [1 Certification Exam(s) ]
PayPal [1 Certification Exam(s) ]
Pegasystems [12 Certification Exam(s) ]
PEOPLECERT [4 Certification Exam(s) ]
PMI [15 Certification Exam(s) ]
Polycom [2 Certification Exam(s) ]
PostgreSQL-CE [1 Certification Exam(s) ]
Prince2 [6 Certification Exam(s) ]
PRMIA [1 Certification Exam(s) ]
PsychCorp [1 Certification Exam(s) ]
PTCB [2 Certification Exam(s) ]
QAI [1 Certification Exam(s) ]
QlikView [1 Certification Exam(s) ]
Quality-Assurance [7 Certification Exam(s) ]
RACC [1 Certification Exam(s) ]
Real-Estate [1 Certification Exam(s) ]
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RES [5 Certification Exam(s) ]
Riverbed [8 Certification Exam(s) ]
RSA [15 Certification Exam(s) ]
Sair [8 Certification Exam(s) ]
Salesforce [5 Certification Exam(s) ]
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SAP [98 Certification Exam(s) ]
SASInstitute [15 Certification Exam(s) ]
SAT [1 Certification Exam(s) ]
SCO [10 Certification Exam(s) ]
SCP [6 Certification Exam(s) ]
SDI [3 Certification Exam(s) ]
See-Beyond [1 Certification Exam(s) ]
Siemens [1 Certification Exam(s) ]
Snia [7 Certification Exam(s) ]
SOA [15 Certification Exam(s) ]
Social-Work-Board [4 Certification Exam(s) ]
SpringSource [1 Certification Exam(s) ]
SUN [63 Certification Exam(s) ]
SUSE [1 Certification Exam(s) ]
Sybase [17 Certification Exam(s) ]
Symantec [134 Certification Exam(s) ]
Teacher-Certification [4 Certification Exam(s) ]
The-Open-Group [8 Certification Exam(s) ]
TIA [3 Certification Exam(s) ]
Tibco [18 Certification Exam(s) ]
Trainers [3 Certification Exam(s) ]
Trend [1 Certification Exam(s) ]
TruSecure [1 Certification Exam(s) ]
USMLE [1 Certification Exam(s) ]
VCE [6 Certification Exam(s) ]
Veeam [2 Certification Exam(s) ]
Veritas [33 Certification Exam(s) ]
Vmware [58 Certification Exam(s) ]
Wonderlic [2 Certification Exam(s) ]
Worldatwork [2 Certification Exam(s) ]
XML-Master [3 Certification Exam(s) ]
Zend [6 Certification Exam(s) ]
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