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New England editorial roundup

Associated Press Updated: September 6, 2014 at 9:00 am

The Times Record of Brunswick (Maine), Sept. 4, 3014

Cold Cape Cod clams, delectable Maine lobster, Georges Bank halibut, sweet northern shrimp, tiny populations of wild salmon, sea-running alewives, and every species one can imagine in the Gulf of Maine thrive there because of cold, nutrient- filled waters.

But that may all be a fond memory in the not too distant future. The Gulf of Maine is warming up, according to the National Oceanic and Atmospheric Administration (NOAA), faster than 99 percent of the world's oceans.

Until 2004, the temperature in the Gulf of Maine was rising, but was rising at a level like other bodies of water, about 0.05 degrees per year. That's still too much to be sustainable, but it would have given populations a chance to adapt over time.

Now, the temperature in the Gulf is increasing by a half-degree every year — 10 times the previous rate.

It's related to global warming, but the exact mechanism is still being debated. Is it atmospheric events, like hurricanes, bringing warm water into the Gulf on a more regular basis? Has the Gulf Stream shifted further west? Has the ocean absorbed all the carbon it can hold from the atmosphere and is responding by warming up? Did Arctic sea ice have a much stronger cooling effect on the Gulf of Maine than previously thought?

Whatever the mechanism, the results will be devastating.

Almost all of New England's commercial fisheries are being adversely affected even now. Infant lobsters are on the decline near the shore, and they are moving off into deeper, colder waters where it will be much more expensive to trap them as adults. Scallops and shrimp have had their seasons severely curtailed or canceled because of low numbers. Clams are being predated by a relatively new arrival — the green crab. Herring stocks are so low that baby puffins are starving to death. And as the waters warm, the plankton that feed rare right whales and other cetaceans will die off, sending the large mammals ever northward.

The species that are replacing the ones leaving for colder climes aren't nearly as valuable — several species of squid, the dreaded green crab and slightly more valuable blue crab and sea bass, are suddenly turning up in Maine fishermen's nets.

The Gulf of Maine is fast becoming a living laboratory for global climate change in a manageable setting, which is a good thing for climate scientists, but a bad thing for the Gulf of Maine and all the creatures that live beneath its waves and on its rocky shores and islands.

The Gulf represents a canary in a coal mine in terms of climate change. This is a change we must take seriously. For a time, our fishermen and women can fish for bass instead of cod, squid instead of shrimp, blue crab instead of lobster. But in the end, those species will move off, too. Bringing the Gulf's fever down will take the concerted efforts, not only of the people of Maine, but the entire world. Their canaries might still be singing right now, but unless everyone pulls together, it's a matter of time before the canary song — and the whale song — is silent around the globe.

The Bennington (Vt.) Banner, Sept. 5, 2014

You may not have heard of the Primary Care Cliff, but it looms at the end of fiscal year 2015.

As it is, the lack of sufficient primary care is an ongoing crisis in the U.S. Nearly one in five Americans — about 60 million people — live in areas with too few primary care physicians and other health professionals.

The Robert Graham Center, which conducts family medicine policy research, says in a study that the U.S. is expected to need 52,000 more primary care physicians by 2025. The three factors necessitating this increase will be population growth, an aging population and impacts from implementation of the Affordable Care Act.

Vermont Sen. Bernie Sanders states in a Sept. 3 press release that the current "situation may become significantly worse unless Congress renews support for community health centers that care for 22 million Americans."

There are three key programs involved. First are Federally Qualified Health Centers, such as the Battenkill Valley Health Center Inc. in Arlington. The health centers provide affordable primary care, dental care, mental health counseling and low-cost prescription drugs for low- and middle-income Americans.

Sanders four years ago helped lead the effort to secure $12.5 billion in the Affordable Care Act to expand community health centers and to recruit more doctors, dentists, nurses and other primary health providers.

According to the National Association of Community Health Centers, in fiscal 2016 mandatory funding for health centers will cease unless it is reauthorized. "With only discretionary funding at current levels, Health Centers would see up to 70 percent reductions in grant funding, leading to significant cuts to operations and reduction or elimination of health care access in some of the nation's most vulnerable communities," the NACHC notes.

This reduction would occur at a time when the demand for these centers is growing. For one thing, according to the NACHC, "beyond the impact of health care reform, the number of uninsured health center patients is projected to rise as the uninsured are squeezed out of other provider settings."

Said Sanders, "Millions of Americans could lose access to community health centers. Members of Congress will need to work in a bipartisan way to extend funding if we are to continue to provide Americans with the greatest health care needs a reliable source of primary care.

"Without access to affordable primary care, people put off going to a doctor until they get so sick they end up in expensive hospital emergency rooms," he added. "In some cases they simply wait too long and their illness becomes terminal."

Two other key programs facing the funding cliff are the National Health Service Corps and Teaching Health Center programs.

According to the NACHC, "The National Health Service Corps is a vital program that provides scholarships and loan repayment to providers that commit to serving in underserved areas. The Teaching Health Center program is an innovative effort focused on growing the supply of primary care providers trained in community-based settings."

According to the U.S. Health Services Administration, in 2013 some 8,900 ACA-supported National Health Service Corps medical personnel provided care to more than 9.3 million people across the country.

"More than 85 percent of NHSC providers continue to serve in high-need areas two years after their service commitment is met, " said Health Resource and Services Administration Administrator Mary K. Wakefield. "The Affordable Care Act's investment in the NHSC helps ensure underserved communities have access to quality health care."

The Teaching Health Center Graduate Medical Education Program is a five-year $230 million initiative created by the ACA to increase the number of primary care residents and dentists trained in a variety of community based sites, including urban, rural, tribal communities. During the 2014-2015 academic year, 60 Teaching Health Center Graduate Medical Education programs in 24 states supported more than 550 residents.

"Physicians trained in health centers are more than three times as likely to work in a health center and more than twice as likely to work in an underserved area as those not trained in health centers," according to the U.S. Health Resources and Services Administration.

The chairman of a Senate subcommittee on primary care, Sen. Sanders has introduced legislation to avert the funding cliff. His bill would authorize $25 billion over five years in new funding for health centers. Another $4.9 billion would be set aside from 2016 to 2020 for the National Health Service Corps to provide scholarships and loan repayments for health care professionals committed to practice in underserved areas. The measure also would increase the number of community health centers providing residency training through the Teaching Health Center Graduate Medical Education program.

"At a time when we already are in the midst of a primary care crisis, we cannot wait until the last moment to act," Sanders said of the three critical programs that lose funding at the end of the next fiscal year.

We agree with Sen. Sanders. The time to act is now. After the November election, Republicans may take over majority status in the Senate, along with retaining a majority in the House. Absolute GOP opposition to Obamacare is well known. Successful navigation of this Primary Care Fiscal Cliff will only get more difficult as the end of fiscal 2015 nears.

The time to sound the trumpet is now.

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