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Maximizing health coverage for cipro liquid DAP cipro pill cost clients. Before and after winning the case Outline prepared by Geoffrey Hale and Cathy Roberts - updated August 2012 This outline is intended to assist Disability Advocacy Program (DAP) advocates maximize health insurance coverage for clients they are representing on Social Security/SSI disability determinations. We begin with a discussion of coverage options available while your client’s DAP case is pending cipro pill cost and then outline the effect winning the DAP case can have on your client’s access to health care coverage.

How your client is affected will vary depending on the source and amount of disability income he or she receives after the successful appeal. I. BACKGROUND cipro pill cost.

Public health coverage for your clients will primarily be provided by Medicaid and Medicare. The two programs cipro pill cost are structured differently and have different eligibility criteria, but in order to provide the most complete coverage possible for your clients, they must work effectively together. Understanding their interactions is essential to ensuring benefits for your client.

Here is a brief overview of the programs we will cover. A. Medicaid.

Medicaid is the public insurance program jointly funded by the federal, state and local governments for people of limited means. For federal Medicaid law, see 42 U.S.C. § 1396 et seq., 42 C.F.R.

§ 430 et seq. Regular Medicaid is described in New York’s State Plan and codified at N.Y. Soc.

18 N.Y.C.R.R. § 360, 505. New York also offers several additional programs to provide health care benefits to those whose income might be too high for Regular Medicaid.

i. Family Health Plus (FHPlus) is an extension of New York’s Medicaid program that provides health coverage for adults who are over-income for regular Medicaid. FHPlus is described in New York’s 1115 waiver and codified at N.Y.

§369-ee. ii. Child Health Plus (CHPlus) is a sliding scale premium program for children who are over-income for regular Medicaid.

Medicare is the federal health insurance program providing coverage for the elderly, disabled, and people with end-stage renal disease. Medicare is codified under title XVIII of the Social Security Law, see 42 U.S.C. § 1395 et seq., 42 C.F.R.

§ 400 et seq. Medicare is divided into four parts. i.

Part A covers hospital, skilled nursing facility, home health, and hospice care, with some deductibles and coinsurance. Most people are eligible for Part A at no cost. See 42 U.S.C.

ii. Part B provides medical insurance for doctor’s visits and other outpatient medical services. Medicare Part B has significant cost-sharing components.

There are monthly premiums (the standard premium in 2012 is $99.90. In addition, there is a $135 annual deductible (which will increase to $155 in 2010) as well as 20% co-insurance for most covered out-patient services. See 42 U.S.C.

iii. Part C, also called Medicare Advantage, provides traditional Medicare coverage (Parts A and B) through private managed care insurers. See 42 U.S.C.

Premium amounts for Medicare Advantage plans vary. Some Medicare Advantage plans include prescription drug coverage. iv.

Part D is an optional prescription drug benefit available to anyone with Medicare Parts A and B. See 42 U.S.C. § 1395w, 42 C.F.R.

§ 423.30(a)(1)(i) and (ii). Unlike Parts A and B, Part D benefits are provided directly through private plans offered by insurance companies. In order to receive prescription drug coverage, a Medicare beneficiary must join a Part D Plan or participate in a Medicare Advantage plan that provides prescription drug coverage.

C. Medicare Savings Programs (MSPs). Funded by the State Medicaid program, MSPs help eligible individuals meet some or all of their cost-sharing obligations under Medicare.

L. § 367-a(3)(a), (b), and (d). There are three separate MSPs, each with different eligibility requirements and providing different benefits.

i. Qualified Medicare Beneficiary (QMB). The QMB program provides the most comprehensive benefits.

Available to those with incomes at or below 100% of the Federal Poverty Level (FPL), the QMB program covers virtually all Medicare cost-sharing obligations. Part B premiums, Part A premiums, if there are any, and any and all deductibles and co-insurance. ii.

Special Low-Income Medicare Beneficiary (SLMB). For those with incomes between 100% and 120% FPL, the SLMB program will cover Part B premiums only. iii.

Qualified Individual (QI-1). For those with incomes between 120% and 135% FPL, but not otherwise Medicaid eligible, the QI-1 program covers Medicare Part B premiums. D.

Medicare Part D Low Income Subsidy (LIS or “Extra Help”). LIS is a federal subsidy administered by CMS that helps Medicare beneficiaries with limited income and/or resources pay for some or most of the costs of Medicare prescription drug coverage. See 42 C.F.R.

§ 423.773. Some of the costs covered in full or in part by LIS include the monthly premiums, annual deductible, co-payments, and the coverage gap. Individuals eligible for Medicaid, SSI, or MSP are deemed eligible for full LIS benefitsSee 42 C.F.R.

§ 423.773(c). LIS applications are treated as (“deemed”) applications for MSP benefits, See the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008, Pub. Law 110-275.

II. WHILE THE DAP APPEAL IS PENDING Does your client have health insurance?. If not, why isn’t s/he getting Medicaid, Family Health Plus or Child Health Plus?.

There have been many recent changes which expand eligibility and streamline the application process. All/most of your DAP clients should qualify. Significant changes to Medicaid include.

Elimination of the resource test for certain categories of Medicaid applicants/recipients and all applicants to the Family Health Plus program. N.Y. Soc.

As of October 1, 2009, a resource test is no longer required for these categories. Elimination of the fingerprinting requirement. N.Y.

§369-ee, as amended by L. 2009, c. 58, pt.

C, § 62. Elimination of the waiting period for CHPlus. N.Y.

2008, c. 58. Elimination of the face-to-face interview requirement for Medicaid, effective April 1, 2010.

58, pt. C, § 60. Higher income levels for Single Adults and Childless Couples.

L. §366(1)(a)(1),(8) as amended by L. 2008, c.

Higher income levels for Medicaid’s Medically Needy program. N.Y. Soc.

GIS 08 MA/022 More detailed information on recent changes to Medicaid is available at. III. AFTER CLIENT IS AWARDED DAP BENEFITS a.

Medicaid eligibility. Clients receiving even $1.00 of SSI should qualify for Medicaid automatically. The process for qualifying will differ, however, depending on the source of payment.

These clients are eligible for full Medicaid without a spend-down. See N.Y. Soc.

ii. Medicaid coverage is automatic. No separate application/ recertification required.

iii. Most SSI-only recipients are required to participate in Medicaid managed care. See N.Y.

Eligible for full Medicaid since receiving SSI. See N.Y. Soc.

They can still qualify for Medicaid but may have a spend-down. Federal Law allows states to use a “spend-down” to extend Medicaid to “medically needy” persons in the federal mandatory categories (children, caretakers, elderly and disabled people) whose income or resources are above the eligibility level for regular Medicaid. See 42 U.S.C.

§ 1396 (a) (10) (ii) (XIII). ii. Under spend-down, applicants in New York’s Medically Needy program can qualify for Medicaid once their income/resources, minus incurred medical expenses, fall below the specified level.

For an explanation of spend-down, see 96 ADM 15. B. Family Health Plus Until your client qualifies for Medicare, those over-income for Medicaid may qualify for Family Health Plus without needing to satisfy a spend-down.

It covers adults without children with income up to 100% of the FPL and adults with children up to 150% of the FPL.[1] The eligibility tests are the same as for regular Medicaid with two additional requirements. Applicants must be between the ages of 19 and 64 and they generally must be uninsured. See N.Y.

§ 369-ee et. Seq. Once your client begins to receive Medicare, he or she will not be eligible for FHP, because FHP is generally only available to those without insurance.

For more information on FHP see our article on Family Health Plus. IV. LOOMING ISSUES - MEDICARE ELIGIBILITY (WHETHER YOU LIKE IT OR NOT) a.

SSI-only cases Clients receiving only SSI aren’t eligible for Medicare until they turn 65, unless they also have End Stage Renal Disease. B. Concurrent (SSD and SSI) cases 1.

Medicare eligibility kicks in beginning with 25th month of SSD receipt. See 42 U.S.C. § 426(f).

Exception. In 2000, Congress eliminated the 24-month waiting period for people diagnosed with ALS (Lou Gehrig’s Disease.) See 42 U.S.C. § 426 (h) 2.

Enrollment in Medicare is a condition of eligibility for Medicaid coverage. These clients cannot decline Medicare coverage. (05 OMM/ADM 5.

Medicaid Reference Guide p. 344.1) 3. Medicare coverage is not free.

Although most individuals receive Part A without any premium, Part B has monthly premiums and significant cost-sharing components. 4. Medicaid and/or the Medicare Savings Program (MSP) should pick up most of Medicare’s cost sharing.

Most SSI beneficiaries are eligible not only for full Medicaid, but also for the most comprehensive MSP, the Qualified Medicare Beneficiary (QMB) program. I. Parts A &.

B (hospital and outpatient/doctors visits). A. Medicaid will pick up premiums, deductibles, co-pays.

L. § 367-a (3) (a). For those not enrolled in an MSP, SSA normally deducts the Part B premium directly from the monthly check.

However, SSI recipients are supposed to be enrolled automatically in QMB, and Medicaid is responsible for covering the premiums. Part B premiums should never be deducted from these clients’ checks.[1] Medicaid and QMB-only recipients should NEVER be billed directly for Part A or B services. Even non-Medicaid providers are supposed to be able to bill Medicaid directly for services.[2] Clients are only responsible for Medicaid co-pay amount.

See 42 U.S.C. § 1396a (n) ii. Part D (prescription drugs).

a. Clients enrolled in Medicaid and/or MSP are deemed eligible for Low Income Subsidy (LIS aka Extra Help). See 42 C.F.R.

§ 423.773(c). SSA POMS SI § 01715.005A.5. New York State If client doesn’t enroll in Part D plan on his/her own, s/he will be automatically assigned to a benchmark[3] plan.

See 42 C.F.R. § 423.34 (d). LIS will pick up most of cost-sharing.[3] Because your clients are eligible for full LIS, they should have NO deductible and NO premium if they are in a benchmark plan, and will not be subject to the coverage gap (aka “donut hole”).

See 42 C.F.R. §§ 423.780 and 423.782. The full LIS beneficiary will also have co-pays limited to either $1.10 or $3.30 (2010 amounts).

See 42 C.F.R. § 423.104 (d) (5) (A). Other important points to remember.

- Medicaid co-pay rules do not apply to Part D drugs. - Your client’s plan may not cover all his/her drugs. - You can help your clients find the plan that best suits their needs.

To figure out what the best Part D plans are best for your particular client, go to www.medicare.gov. Click on “formulary finder” and plug in your client’s medication list. You can enroll in a Part D plan through www.medicare.gov, or by contacting the plan directly.

€“ Your clients can switch plans at any time during the year. Iii. Part C (“Medicare Advantage”).

a. Medicare Advantage plans provide traditional Medicare coverage (Parts A and B) through private managed care insurers. See 42 U.S.C.

Medicare Advantage participation is voluntary. For those clients enrolled in Medicare Advantage Plans, the QMB cost sharing obligations are the same as they are under traditional Medicare. Medicaid must cover any premiums required by the plan, up to the Part B premium amount.

Medicaid must also cover any co-payments and co-insurance under the plan. As with traditional Medicare, both providers and plans are prohibited from billing the beneficiary directly for these co-payments. C.

SSD only individuals. 1. Same Medicare eligibility criteria (24 month waiting period, except for persons w/ ALS).

I. During the 24 month waiting period, explore eligibility for Medicaid or Family Health Plus. 2.

Once Medicare eligibility begins. ii. Parts A &.

B. SSA will automatically enroll your client. Part B premiums will be deducted from monthly Social Security benefits.

(Part A will be free – no monthly premium) Clients have the right to decline ongoing Part B coverage, BUT this is almost never a good idea, and can cause all sorts of headaches if client ever wants to enroll in Part B in the future. (late enrollment penalty and can’t enroll outside of annual enrollment period, unless person is eligible for Medicare Savings Program – see more below) Clients can decline “retro” Part B coverage with no penalty on the Medicare side – just make sure they don’t actually need the coverage. Risky to decline if they had other coverage during the retro period – their other coverage may require that Medicare be utilized if available.

Part A and Part B also have deductibles and co-pays. Medicaid and/or the MSPs can help cover this cost sharing. iii.

Part D. Client must affirmatively enroll in Part D, unless they receive LIS. See 42 U.S.C.

§ 1395w-101 (b) (2), 42 C.F.R. § 423.38 (a). Enrollment is done through individual private plans.

LIS recipients will be auto-assigned to a Part D benchmark plan if they have not selected a plan on their own. Client can decline Part D coverage with no penalty if s/he has “comparable coverage.” 42 C.F.R. § 423.34 (d) (3) (i).

If no comparable coverage, person faces possible late enrollment penalty &. Limited enrollment periods. 42 C.F.R.

§ 423.46. However, clients receiving LIS do not incur any late enrollment penalty. 42 C.F.R.

§ 423.780 (e). Part D has a substantial cost-sharing component – deductibles, premiums and co-pays which vary from plan to plan. There is also the coverage gap, also known as “donut hole,” which can leave beneficiaries picking up 100% of the cost of their drugs until/unless a catastrophic spending limit is reached.

The LIS program can help with Part D cost-sharing. Use Medicare’s website to figure out what plan is best for your client. (Go to www.medicare.gov , click on “formulary finder” and plug in your client’s medication list.

) You can also enroll in a Part D plan directly through www.medicare.gov. Iii. Help with Medicare cost-sharing a.

Medicaid – After eligibility for Medicare starts, client may still be eligible for Medicaid, with or without a spend-down. There are lots of ways to help clients meet their spend-down – including - Medicare cost sharing amounts (deductibles, premiums, co-pays) - over the counter medications if prescribed by a doctor. - expenses paid by state-funded programs like EPIC and ADAP.

- medical bills of person’s spouse or child. - health insurance premiums. - joining a pooled Supplemental Needs Trust (SNT).

B. Medicare Savings Program (MSP) – If client is not eligible for Medicaid, explore eligibility for Medicare Savings Program (MSP). MSP pays for Part B premiums and gets you into the Part D LIS.

There are no asset limits in the Medicare Savings Program. One of the MSPs (QMB), also covers all cost sharing for Parts A &. B.

If your client is eligible for Medicaid AND MSP, enrolling in MSP may subject him/her to, or increase a spend-down, because Medicaid and the various MSPs have different income eligibility levels. It is the client’s choice as to whether or not to be enrolled into MSP. C.

Part D Low Income Subsidy (LIS) – If your client is not eligible for MSP or Medicaid, s/he may still be eligible for Part D Low Income Subsidy. Applications for LIS are also be treated as applications for MSP, unless the client affirmatively indicates that s/he does not want to apply for MSP. d.

Medicare supplemental insurance (Medigap) -- Medigap is supplemental private insurance coverage that covers all or some of the deductibles and coinsurance for Medicare Parts A and B. Medigap is not available to people enrolled in Part C. E.

Medicare Advantage – Medicare Advantage plans “package” Medicare (Part A and B) benefits, with or without Part D coverage, through a private health insurance plan. The cost-sharing structure (deductible, premium, co-pays) varies from plan to plan. For a list of Medicare Advantage plans in your area, go to www.medicare.gov – click on “find health plans.” f.

NY Prescription Saver Card -- NYP$ is a state-sponsored pharmacy discount card that can lower the cost of prescriptions by as much as 60 percent on generics and 30 percent on brand name drugs. Can be used during the Part D “donut hole” (coverage gap) g. For clients living with HIV.

ADAP [AIDS Drug Assistance Program] ADAP provides free medications for the treatment of HIV/AIDS and opportunistic s. ADAP can be used to help meet a Medicaid spenddown and get into the Part D Low Income subsidy. For more information about ADAP, go to V.

GETTING MEDICAID IN THE DISABLED CATEGORY AFTER AN SSI/SSDI DENIAL What if your client's application for SSI or SSDI is denied based on SSA's finding that they were not "disabled?. " Obviously, you have your appeals work cut out for you, but in the meantime, what can they do about health insurance?. It is still possible to have Medicaid make a separate disability determination that is not controlled by the unfavorable SSA determination in certain situations.

Specifically, an applicant is entitled to a new disability determination where he/she. alleges a different or additional disabling condition than that considered by SSA in making its determination. Or alleges less than 12 months after the most recent unfavorable SSA disability determination that his/her condition has changed or deteriorated, alleges a new period of disability which meets the duration requirement, and SSA has refused to reopen or reconsider the allegations, or the individual is now ineligible for SSA benefits for a non-medical reason.

Or alleges more than 12 months after the most recent unfavorable SSA disability determination that his/her condition has changed or deteriorated since the SSA determination and alleges a new period of disability which meets the duration requirement, and has not applied to SSA regarding these allegations. See GIS 10-MA-014 and 08 OHIP/INF-03.[4] [1] Potential wrinkle – for some clients Medicaid is not automatically pick up cost-sharing. In Monroe County we have had several cases where SSA began deducting Medicare Part B premiums from the checks of clients who were receiving SSI and Medicaid and then qualified for Medicare.

The process should be automatic. Please contact Geoffrey Hale in our Rochester office if you encounter any cases like this. [2]Under terms established to provide benefits for QMBs, a provider agreement necessary for reimbursement “may be executed through the submission of a claim to the Medicaid agency requesting Medicaid payment for Medicare deductibles and coinsurance for QMBs.” CMS State Medicaid Manual, Chapter 3, Eligibility, 3490.14 (b), available at.

http://www.cms.hhs.gov/Manuals/PBM/itemdetail.asp?. ItemID=CMS021927. [3]Benchmark plans are free if you are an LIS recipient.

The amount of the benchmark changes from year to year. In 2013, a Part D plan in New York State is considered benchmark if it provides basic Part D coverage and its monthly premium is $43.22 or less. [4] These citations courtesy of Jim Murphy at Legal Services of Central New York.

This site provides general information only. This is not legal advice. You can only obtain legal advice from a lawyer.

In addition, your use of this site does not create an attorney-client relationship. To contact a lawyer, visit http://lawhelp.org/ny. We make every effort to keep these materials and links up-to-date and in accordance with New York City, New York state and federal law.

However, we do not guarantee the accuracy of this information.Some "dual eligible" beneficiaries (people who have Medicare and Medicaid) are entitled to receive reimbursement of their Medicare Part B premiums from New York State through the Medicare Insurance Premium Payment Program (MIPP). The Part B premium is $148.50 in 2021. MIPP is for some groups who are either not eligible for -- or who are not yet enrolled in-- the Medicare Savings Program (MSP), which is the main program that pays the Medicare Part B premium for low-income people.

Some people are not eligible for an MSP even though they have full Medicaid with no spend down. This is because they are in a special Medicaid eligibility category -- discussed below -- with Medicaid income limits that are actually HIGHER than the MSP income limits. MIPP reimburses them for their Part B premium because they have “full Medicaid” (no spend down) but are ineligible for MSP because their income is above the MSP SLIMB level (120% of the Federal Poverty Level (FPL).

Even if their income is under the QI-1 MSP level (135% FPL), someone cannot have both QI-1 and Medicaid). Instead, these consumers can have their Part B premium reimbursed through the MIPP program. In this article.

The MIPP program was established because the State determined that those who have full Medicaid and Medicare Part B should be reimbursed for their Part B premium, even if they do not qualify for MSP, because Medicare is considered cost effective third party health insurance, and because consumers must enroll in Medicare as a condition of eligibility for Medicaid (See 89 ADM 7). There are generally four groups of dual-eligible consumers that are eligible for MIPP. Therefore, many MBI WPD consumers have incomes higher than what MSP normally allows, but still have full Medicaid with no spend down.

Those consumers can qualify for MIPP and have their Part B premiums reimbursed. Here is an example. Sam is age 50 and has Medicare and MBI-WPD.

She gets $1500/mo gross from Social Security Disability and also makes $400/month through work activity. $ 167.50 -- EARNED INCOME - Because she is disabled, the DAB earned income disregard applies. $400 - $65 = $335.

Her countable earned income is 1/2 of $335 = $167.50 + $1500.00 -- UNEARNED INCOME from Social Security Disability = $1,667.50 --TOTAL income. This is above the SLIMB limit of $1,288 (2021) but she can still qualify for MIPP. 2.

Parent/Caretaker Relatives with MAGI-like Budgeting - Including Medicare Beneficiaries. Consumers who fall into the DAB category (Age 65+/Disabled/Blind) and would otherwise be budgeted with non-MAGI rules can opt to use Affordable Care Act MAGI rules if they are the parent/caretaker of a child under age 18 or under age 19 and in school full time. This is referred to as “MAGI-like budgeting.” Under MAGI rules income can be up to 138% of the FPL—again, higher than the limit for DAB budgeting, which is equivalent to only 83% FPL.

MAGI-like consumers can be enrolled in either MSP or MIPP, depending on if their income is higher or lower than 120% of the FPL. If their income is under 120% FPL, they are eligible for MSP as a SLIMB. If income is above 120% FPL, then they can enroll in MIPP.

(See GIS 18 MA/001 - 2018 Medicaid Managed Care Transition for Enrollees Gaining Medicare, #4) When a consumer has Medicaid through the New York State of Health (NYSoH) Marketplace and then enrolls in Medicare when she turns age 65 or because she received Social Security Disability for 24 months, her Medicaid case is normally** transferred to the local department of social services (LDSS)(HRA in NYC) to be rebudgeted under non-MAGI budgeting. During the transition process, she should be reimbursed for the Part B premiums via MIPP. However, the transition time can vary based on age.

AGE 65+ Those who enroll in Medicare at age 65+ will receive a letter from their local district asking them to "renew" Medicaid through their local district. See 2014 LCM-02. The Medicaid case takes about four months to be rebudgeted and approved by the LDSS.

The consumer is entitled to MIPP payments for at least three months during the transition. Once the case is with the LDSS she should automatically be re-evaluated for MSP, even if the LDSS determines the consumer is not eligible for Medicaid because of excess income or assets. 08 OHIP/ADM-4.

Consumers UNDER 65 who receive Medicare due to disability status are entitled to keep MAGI Medicaid through NYSoH for up to 12 months (also known as continuous coverage, See NY Social Services Law 366, subd. 4(c). These consumers should receive MIPP payments for as long as their cases remain with NYSoH and throughout the transition to the LDSS.

NOTE during buy antibiotics emergency their case may remain with NYSoH for more than 12 months. See here. EXAMPLE.

Sam, age 60, was last authorized for Medicaid on the Marketplace in June 2020. He became enrolled in Medicare based on disability in August 2020, and started receiving Social Security in the same month (he won a hearing approving Social Security disability benefits retroactively, after first being denied disability). Even though his Social Security is too high, he can keep Medicaid for 12 months beginning June 2020.

Sam has to pay for his Part B premium - it is deducted from his Social Security check. He may call the Marketplace and request a refund. This will continue until the end of his 12 months of continuous MAGI Medicaid eligibility.

He will be reimbursed regardless of whether he is in a Medicaid managed care plan. See GIS 18 MA/001 Medicaid Managed Care Transition for Enrollees Gaining Medicare (PDF) When that ends, he will renew Medicaid and apply for MSP with his local district. See GIS 18 MA/001 - 2018 Medicaid Managed Care Transition for Enrollees Gaining Medicare, #4 for an explanation of this process.

That directive also clarified that reimbursement of the Part B premium will be made regardless of whether the individual is still in a Medicaid managed care (MMC) plan. Note. During the buy antibiotics emergency, those who have Medicaid through the NYSOH marketplace and enroll in Medicare should NOT have their cases transitioned to the LDSS.

They should keep the same MAGI budgeting and automatically receive MIPP payments. See GIS 20 MA/04 or this article on buy antibiotics eligibility changes 4. Those with Special Budgeting after Losing SSI (DAC, Pickle, 1619b) Disabled Adult Child (DAC).

Special budgeting is available to those who are 18+ and lose SSI because they begin receiving Disabled Adult Child (DAC) benefits (or receive an increase in the amount of their benefit). Consumer must have become disabled or blind before age 22 to receive the benefit. If the new DAC benefit amount was disregarded and the consumer would otherwise be eligible for SSI, they can keep Medicaid eligibility with NO SPEND DOWN.

See this article. Consumers may have income higher than MSP limits, but keep full Medicaid with no spend down. Therefore, they are eligible for payment of their Part B premiums.

See page 96 of the Medicaid Reference Guide (Categorical Factors). If their income is lower than the MSP SLIMB threshold, they can be added to MSP. If higher than the threshold, they can be reimbursed via MIPP.

See also 95-ADM-11. Medical Assistance Eligibility for Disabled Adult Children, Section C (pg 8). Pickle &.

1619B. 5. When the Part B Premium Reduces Countable Income to Below the Medicaid Limit Since the Part B premium can be used as a deduction from gross income, it may reduce someone's countable income to below the Medicaid limit.

The consumer should be paid the difference to bring her up to the Medicaid level ($904/month in 2021). They will only be reimbursed for the difference between their countable income and $904, not necessarily the full amount of the premium. See GIS 02-MA-019.

Reimbursement of Health Insurance Premiums MIPP and MSP are similar in that they both pay for the Medicare Part B premium, but there are some key differences. MIPP structures the payments as reimbursement -- beneficiaries must continue to pay their premium (via a monthly deduction from their Social Security check or quarterly billing, if they do not receive Social Security) and then are reimbursed via check. In contrast, MSP enrollees are not charged for their premium.

Their Social Security check usually increases because the Part B premium is no longer withheld from their check. MIPP only provides reimbursement for Part B. It does not have any of the other benefits MSPs can provide, such as.

A consumer cannot have MIPP without also having Medicaid, whereas MSP enrollees can have MSP only. Of the above benefits, Medicaid also provides Part D Extra Help automatic eligibility. There is no application process for MIPP because consumers should be screened and enrolled automatically (00 OMM/ADM-7).

Either the state or the LDSS is responsible for screening &. Distributing MIPP payments, depending on where the Medicaid case is held and administered (14 /2014 LCM-02 Section V). If a consumer is eligible for MIPP and is not receiving it, they should contact whichever agency holds their case and request enrollment.

Unfortunately, since there is no formal process for applying, it may require some advocacy. If Medicaid case is at New York State of Health they should call 1-855-355-5777. Consumers will likely have to ask for a supervisor in order to find someone familiar with MIPP.

If Medicaid case is with HRA in New York City, they should email [email protected]. If Medicaid case is with other local districts in NYS, call your local county DSS. See more here about consumers who have Medicaid on NYSofHealth who then enroll in Medicare - how they access MIPP.

Once enrolled, it make take a few months for payments to begin. Payments will be made in the form of checks from the Computer Sciences Corporation (CSC), the fiscal agent for the New York State Medicaid program. The check itself comes attached to a remittance notice from Medicaid Management Information Systems (MMIS).

Unfortunately, the notice is not consumer-friendly and may be confusing. See attached sample for what to look for. Health Insurance Premium Payment Program (HIPP) HIPP is a sister program to MIPP and will reimburse consumers for private third party health insurance when deemed “cost effective.” Directives:.

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Electrocardiography revealed ST elevation, abnormal Q wave, and coronary T wave in II, III and augmented Vector Foot (aVF). Echocardiography was performed (figure 1 and online supplemental video 1).Supplementary video[emermed-2020-211060supp001.mp4]Figure 1 Echocardiography does cipro contain penicillin. Apical two-chamber view.QuestionWhich of the following statements about the disease is false?.

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AbstractThere has been a rise in the number of studies relating to the role of artificial cipro pill cost intelligence (AI) in healthcare. Its potential in Emergency Medicine (EM) has been explored in recent years with operational, predictive, diagnostic and prognostic emergency department (ED) implementations being developed. For EM researchers building models de novo, collaborative working with data scientists is cipro pill cost invaluable throughout the process. Synergism and understanding between domain (EM) and data experts increases the likelihood of realising a successful real-world model. Our linked manuscript provided a conceptual framework (including a glossary of AI terms) to support clinicians in interpreting AI research.

The aim of this paper is to supplement that framework by exploring the key issues for clinicians and researchers to consider in the process of developing an AI cipro pill cost model.methodsresearch designstatisticsClinical introductionA 68-year-old man presented to the ED with dizziness, nausea and cold sweats. Three days before presentation, he developed pink foamy sputum and exertional dyspnoea. On physical examination, the patient had a Levine III/VI holosystolic murmur, with the strongest point at the left cipro pill cost sternal border of the third intercostal space. His N-terminal pro-brain natriuretic peptide (NT-proBNP) (5970 pg/mL) and troponin T (0.733 ng/mL) were elevated. Electrocardiography revealed ST elevation, abnormal Q wave, and coronary T wave in II, III and augmented Vector Foot (aVF).

Echocardiography was performed (figure 1 and online cipro pill cost supplemental video 1).Supplementary video[emermed-2020-211060supp001.mp4]Figure 1 Echocardiography. Apical two-chamber view.QuestionWhich of the following statements about the disease is false?. The disease is a serious mechanical complication that occurs after ….

What may interact with Cipro?

Do not take Cipro with any of the following:

  • cisapride
  • droperidol
  • terfenadine
  • tizanidine

Cipro may also interact with the following:

  • antacids
  • caffeine
  • cyclosporin
  • didanosine (ddI) buffered tablets or powder
  • medicines for diabetes
  • medicines for inflammation like ibuprofen, naproxen
  • methotrexate
  • multivitamins
  • omeprazole
  • phenytoin
  • probenecid
  • sucralfate
  • theophylline
  • warfarin

This list may not describe all possible interactions. Give your health care providers a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

Cipro name check

Latest antibiotics News By Steven Reinberg HealthDay ReporterFRIDAY, June 24, 2022 Even babies aren't immune from the cipro name check effects of long buy antibiotics, Danish researchers report http://sawyerlawllc.com/slide/homepage-slide-3/. Their study found that about one in three kids aged 14 and younger who tested positive for the cipro were suffering from mood swings, trouble remembering or concentrating, and rashes as much as two months later. "Prolonged symptoms in children must be taken seriously, regardless of whether the parents turn to their own general practitioner or another health service," said lead author Selina Kikkenborg Berg, a clinical professor at Copenhagen University Hospital. "Among children of all ages, long-term symptoms are cipro name check more often seen in those who have had buy antibiotics than in those who have not," she said. Other studies have also investigated long buy antibiotics, but researchers said this was the largest to study the illness in children to date.

While the causes of long buy antibiotics aren't clear, Kikkenborg Berg offered several possibilities. "Micro-blood clots after cipro can settle in the cipro name check brain and cause fatigue and difficulty concentrating," she said. "Also, the cipro stays longer in parts of the body and can affect nerves and tissues, or an overreaction occurs in the immune system, which causes some of the symptoms." She noted that some kids who don't get buy antibiotics may suffer from some of the same symptoms reported in patients with long buy antibiotics. This might result from other s or even from social pressure, Kikkenborg Berg said. But the number of kids with persistent symptoms was significantly higher among those with cipro name check confirmed buy antibiotics s.

The study included just over 44,000 children in Denmark aged 14 and younger, including nearly 11,000 who tested positive for antibiotics. Based on parent surveys, 40% of children aged 3 and younger with buy antibiotics had symptoms for more than two months, compared with 27% of other kids. Among 4- to 11-year-olds, 38% of those with positive tests had persistent symptoms, cipro name check compared with 34% of others. Among 12- to 14-year-olds, 46% of those with confirmed cases had long buy antibiotics symptoms, compared with 41% of those who hadn't been sick. "Some of the children in the control group may have had buy antibiotics without knowing it because they had not tested positive," Kikkenborg Berg said.

She noted cipro name check that some children also may have been affected by shutdowns of schools, leisure activities and other things. Such closings make social interactions difficult and can lead to poor well-being, which can trigger physical symptoms, Kikkenborg Berg added. "Also, children can get long-term symptoms because they have been affected by ordinary childhood diseases or other s, which children get from time to time," she said. The full effect of long buy antibiotics isn't known, and more research is needed to fully understand what causes it and how to treat it cipro name check. "There is still a lot we do not know about buy antibiotics, and one should not rush to recover from an infectious disease," Kikkenborg Berg said.

"If you suffer from fatigue, shortness of breath, fever and other symptoms, take it a little calmly and do not stress the body. Sometimes a viral disease takes longer to recover from." Infectious diseases cipro name check expert Dr. Marc Siegel, a clinical professor of medicine at NYU Langone Medical Center in New York City, noted that a real definition of long buy antibiotics is still up in the air. "We're in the process of learning what long buy antibiotics is so we can better define how many people have it, but for sure kids are not immune to it," Siegel said. Siegel is especially concerned cipro name check about fatigue, trouble concentrating, mood swings and difficulty with breathing, which he sees as hallmarks of long buy antibiotics.

Talk with your pediatrician if your child has any of these symptoms after having buy antibiotics, he suggested. Siegel emphasized that kids should be vaccinated to reduce their risk for severe illness and long buy antibiotics. "There's actually no treatment right now, but I would make sure cipro name check you're fully vaccinated, even if you had buy antibiotics, because that gives you some immunity, which is even greater protection against a re," he said. The findings were published online June 22 in The Lancet Child &. Adolescent Health.

More information cipro name check The U.S. Centers for Disease Control and Prevention has more about kids and buy antibiotics. SOURCES. Selina Kikkenborg Berg, cipro name check PhD, clinical professor, Copenhagen University Hospital, Denmark. Marc Siegel, MD, clinical professor, medicine, NYU Langone Medical Center, New York City.

The Lancet Child &. Adolescent Health, June 22, 2022, online Copyright © 2021 HealthDay.

Latest antibiotics News By Steven Reinberg HealthDay ReporterFRIDAY, cipro pill cost June 24, http://heidimyworld.com/?page_id=2 2022 Even babies aren't immune from the effects of long buy antibiotics, Danish researchers report. Their study found that about one in three kids aged 14 and younger who tested positive for the cipro were suffering from mood swings, trouble remembering or concentrating, and rashes as much as two months later. "Prolonged symptoms in children must be taken seriously, regardless of whether the parents turn to their own general practitioner or another health service," said lead author Selina Kikkenborg Berg, a clinical professor at Copenhagen University Hospital. "Among children of all ages, long-term symptoms are more often seen in those who cipro pill cost have had buy antibiotics than in those who have not," she said.

Other studies have also investigated long buy antibiotics, but researchers said this was the largest to study the illness in children to date. While the causes of long buy antibiotics aren't clear, Kikkenborg Berg offered several possibilities. "Micro-blood clots after cipro can settle in the brain and cause cipro pill cost fatigue and difficulty concentrating," she said. "Also, the cipro stays longer in parts of the body and can affect nerves and tissues, or an overreaction occurs in the immune system, which causes some of the symptoms." She noted that some kids who don't get buy antibiotics may suffer from some of the same symptoms reported in patients with long buy antibiotics.

This might result from other s or even from social pressure, Kikkenborg Berg said. But the cipro pill cost number of kids with persistent symptoms was significantly higher among those with confirmed buy antibiotics s. The study included just over 44,000 children in Denmark aged 14 and younger, including nearly 11,000 who tested positive for antibiotics. Based on parent surveys, 40% of children aged 3 and younger with buy antibiotics had symptoms for more than two months, compared with 27% of other kids.

Among 4- to 11-year-olds, 38% of those with positive tests had persistent cipro pill cost symptoms, compared with 34% of others. Among 12- to 14-year-olds, 46% of those with confirmed cases had long buy antibiotics symptoms, compared with 41% of those who hadn't been sick. "Some of the children in the control group may have had buy antibiotics without knowing it because they had not tested positive," Kikkenborg Berg said. She noted that some children also may have been affected by shutdowns of schools, cipro pill cost leisure activities and other things.

Such closings make social interactions difficult and can lead to poor well-being, which can trigger physical symptoms, Kikkenborg Berg added. "Also, children can get long-term symptoms because they have been affected by ordinary childhood diseases or other s, which children get from time to time," she said. The full effect of long buy antibiotics isn't known, and more research is needed to cipro pill cost fully understand what causes it and generic cipro online how to treat it. "There is still a lot we do not know about buy antibiotics, and one should not rush to recover from an infectious disease," Kikkenborg Berg said.

"If you suffer from fatigue, shortness of breath, fever and other symptoms, take it a little calmly and do not stress the body. Sometimes a viral disease takes longer cipro pill cost to recover from." Infectious diseases expert Dr. Marc Siegel, a clinical professor of medicine at NYU Langone Medical Center in New York City, noted that a real definition of long buy antibiotics is still up in the air. "We're in the process of learning what long buy antibiotics is so we can better define how many people have it, but for sure kids are not immune to it," Siegel said.

Siegel is especially concerned about fatigue, trouble concentrating, mood swings and difficulty with breathing, which he sees as hallmarks of long cipro pill cost buy antibiotics. Talk with your pediatrician if your child has any of these symptoms after having buy antibiotics, he suggested. Siegel emphasized that kids should be vaccinated to reduce their risk for severe illness and long buy antibiotics. "There's actually no treatment right now, but I would make sure you're fully vaccinated, even if you had buy antibiotics, because that gives you some immunity, cipro pill cost which is even greater protection against a re," he said.

The findings were published online June 22 in The Lancet Child &. Adolescent Health. More information The U.S cipro pill cost. Centers for Disease Control and Prevention has more about kids and buy antibiotics.

SOURCES. Selina Kikkenborg Berg, PhD, clinical professor, Copenhagen University Hospital, Denmark cipro pill cost. Marc Siegel, MD, clinical professor, medicine, NYU Langone Medical Center, New York City. The Lancet Child &.

Adolescent Health, June 22, 2022, online Copyright © 2021 HealthDay.

Cipro side effects

The world has never had better medicine, more knowledgeable doctors or cipro side effects he said stronger data on disease. But these benefits are not equally shared. To take one conspicuous example cipro side effects. Two years of data from the Centers for Disease Control and Prevention show that Black, Hispanic and Native American people are significantly more likely to be hospitalized and die from buy antibiotics than white people in the U.S.

Health inequity includes the lack of access to appropriate care, the failure to address social factors that influence health, and the dangerous conditions that people in some neighborhoods endure. Achieving equity requires campaigns cipro side effects on all these fronts. These four health-care champions—a data-digging epidemiologist, an activist midwife, a doctor who traded clinic work for community activism and a pollution-tracking entrepreneur—embody that effort. €”J.H.

The Social Rules of Health Michael Marmot Credit cipro side effects. Joel Kimmel Michael Marmot has spent his entire life working with data—finding, analyzing and applying them. When he was 12, his focus was cricket statistics. When he cipro side effects was a student, it was branches of medicine.

He mastered biochemistry, physiology and epidemiology. And when he was a physician in the 1960s in Sydney, it was his patients. Marmot was cipro side effects fascinated by what united or differentiated them, as if they, too, were a data set. Marmot's mindset would eventually influence millions of other physicians by inspiring tools to identify the social determinants of health.

Back then there was no such framework. €œThere was this idea that the social conditions that so clearly affected patients' health were out of the reach cipro side effects of doctors,” he says. When he thought about an immigrant mother who was abused by her husband and struggled with chronic pain or about a young woman who had had a difficult childhood and now experienced depression, he wondered. Why treat people and then send them back into the situation that made them sick?.

In 1971 Marmot pivoted to research, pursuing a cipro side effects Ph.D. At the University of California, Berkeley, to study coronary heart disease (CHD). Textbooks at the time blamed it on behavioral factors such as diet and smoking, but Marmot suspected stress and social factors contributed, too. His 1976 analysis of medical records from Japanese American men confirmed it—the cipro side effects men with the most Westernized lifestyles had rates of CHD three to five times higher than those of men with more traditional Japanese lifestyles, a difference not explained by food or tobacco.

His Whitehall studies in the late 1970s and 1980s similarly revealed that the health of British civil servants was related to factors such as income and job satisfaction. Marmot found that the lower employees were in their workplace hierarchy, the higher their risk of dying from heart disease. Over the next 30 years Marmot amassed more insights and data cipro side effects. In 2012, for instance, he found that the strongest predictors of health for adolescents are national wealth, income inequality and access to education.

His work established and legitimized the phrase “social determinants of health” in health policy and medical circles. Marmot's approach cipro side effects changed how physicians, public health experts and governments think about health inequity. In 2008 the U.K. Secretary of state for health asked him to investigate health gaps.

The resulting “Marmot Review” revealed that injustice degrades the health of cipro side effects nearly all U.K. Citizens and is preventable. Because of Marmot's influence, physicians today have ways both to talk about social conditions and to address them through community partnerships—a practice called social prescribing. €œUnderstanding the social determinants of health ensures you focus on what matters to patients rather than just what the matter is with them,” says Sam Everington, a general practitioner at the Bromley cipro side effects by Bow Center in London, who pioneered social prescribing and cites Marmot's work as crucial for training doctors.

Today Marmot directs the University College London Institute of Health Equity. His work has been cited more than 250,000 times. His Review has spread, cipro side effects from the eastern Mediterranean in 2019 to Manchester in 2021. His focus is still on data.

€œHealth equity comes from greater equity in society,” he says. Delivering Equity cipro side effects at Birth Shafia Monroe Credit. Joel Kimmel As a teenager in Boston in the 1970s, Shafia Monroe learned a startling fact. Black infants were more likely to die than babies of any other race.

And there seemed to cipro side effects be no urgency in the scientific community to address the disparity. €œWe've got Harvard [and] Tufts, and nobody's doing anything,” she remembers thinking. This early knowledge sparked a lifetime's work in expanding Black mothers' access to doulas and midwives—caregivers who help mothers with practical and emotional support during labor and delivery. For this work, Monroe has come cipro side effects to be recognized as the mother of the Black midwives' movement.

Because Black women are frequently misdiagnosed, mistreated and racially stigmatized in health care, they and their babies are more likely to die in childbirth. Inspired by cipro side effects Black women known as “granny” midwives who helped mothers like them in the postemancipation South, Monroe trained as a midwife herself and realized something important. If more Black mothers could get one-on-one birth support from other Black women, they and their babies might be healthier. She did not yet have empirical proof, but she knew Black women wanted support from other women of color—either midwives, for at-home births, or doulas, for hospital births.

In 1978 cipro side effects Monroe formed the nonprofit Traditional Childbearing Group, and she soon began working with similar professionals from Ghana, Uganda, Pakistan and Alabama. Together they trained midwives, taught $5 birthing classes, provided breastfeeding information and supported at-home births. In 1988 the Massachusetts Department of Public Health started funding their work. €œDoctors were calling us up because people were having better birth cipro side effects outcomes,” Monroe recounts.

Since then, research has affirmed her observations. In 2007 a comparative analysis of birth outcomes among more than 11,000 women found that second-time mothers with doula support had lower rates of cesarean deliveries. A smaller study in 2017 found that women with doulas had lower rates of preterm birth and of cipro side effects low-birthweight infants. In 1991 Monroe launched the International Center for Traditional Childbearing (ICTC), which has trained more than 2,000 doulas.

In 2011 she helped Oregon pass legislation that reimbursed doulas through Medicaid. Other states cipro side effects are following suit. €œCommunity-competent and culturally and structurally competent doulas can help make the labor room safer for a birthing woman,” says Arline Geronimus, a research professor at the University of Michigan Population Studies Center, whose work has demonstrated the health burden of racial discrimination on Black mothers. She praises the ICTC for training doulas who are more likely to be trustworthy to women of color, as well as its policy work to allow those with low incomes to access doula services.

Inequity persists, however cipro side effects. Compared with their white counterparts, Black infants are 2.3 times more likely to die, and Black women are 3.5 times more likely to die of pregnancy-related causes. So Monroe's work continues through actions such as advocating for an Alabama bill to expand access to traditional midwife care, as well as mentoring others fighting for birth justice. €œI was alone for many years, but the movement has cipro side effects birthed itself into the next generation,” she says.

Treating Inequity as Disease Vera Cordeiro Credit. Joel Kimmel Vera Cordeiro founded one of the world's most influential health programs, but as a child she never wanted to go near medicine. She loved art and literature, spending her cipro side effects days writing poetry in her treehouse and reflecting on the ways she, born into a wealthy family outside Rio de Janeiro, experienced life differently from her neighbors—many of them sick and poor. Following family pressure, Cordeiro went to medical school, where she met a professor equally interested in people.

If someone died of a heart attack, that professor would encourage his students to consider how circumstances such as the patient's marriage or job affected their illness. In 1988, while working in the pediatric ward of Rio's Hospital da Lagoa, Cordeiro saw for herself how life and medicine intertwine cipro side effects. €œWe'd treat a child for pneumonia, but then we'd send her back to a house where she could not eat well or where her father was jobless, and then she'd come back again with a different ,” Cordeiro says. Other doctors faced the same frustrations, so she started asking her patients nonmedical questions such as whether they had food or clean water or jobs, and she called on other medical professionals and friends to help them.

In 1991 she turned that informal practice into a formal organization cipro side effects by founding Associação Saúde Criança Renascer at the hospital. Through the association, doctors can screen for poverty, unemployment, housing issues and other root causes of disease, and volunteers help to fulfill those needs with money, food and other resources. The teams also help the parents develop Family Action Plans, setting long-term goals around things such as access to nutritious food and training for a stable job. €œSaúde Criança is a pioneer in the design and delivery of comprehensive antipoverty programs,” says James Habyarimana of Georgetown University, cipro side effects a public policy professor specializing in health outcomes.

He praises the organization for recognizing how one dimension of poverty, such as income, affects other dimensions, such as housing, which together determine a child's health. He says it could be replicated in all but the poorest parts of the world. Children who were enrolled in the program were significantly less likely to need surgery or clinical cipro side effects treatment, according to Habyarimana's 2013 study. If they were hospitalized, their stays were 86 percent shorter than other children's.

At the start of the program 56 percent of families identified their well-being as bad or very bad, but by the end 51 percent reported it was good or very good. That success might cipro side effects explain why the organization, now called the Dara Institute, has grown rapidly. It has served 75,000 people across Brazil and inspired some 20 programs in Africa, Asia and Latin America. It has even reached Baltimore, where, since 2017, the University of Maryland has been adapting Dara's methods to its local context.

Now 71, Cordeiro is president of the Dara Institute and is still cipro side effects fighting for the person behind the disease. She shows before-and-after photographs of patients' houses—bathrooms once dilapidated and doors once cracked now renovated, allowing families to live with more dignity in their homes—and says their stories keep her going. €œPeople move my heart.” The Air We Breathe Davida Herzl Credit. Joel Kimmel Growing up in southern California, Davida Herzl used to cipro side effects look out to the Port of Long Beach with her parents, who ran a supply-chain business, to watch the container ships come in.

She wondered how those ships' emissions affected people living nearby. €œYou see the underbelly of what it takes to live our lives with convenience,” she says now. As an adult, cipro side effects Herzl created a powerful sensor-based pollution-measurement system to prove what many people suspected. Poor neighborhoods have poor air.

The social justice component of her work took root long ago, she says, when she was growing up as a multiracial Jewish girl with a belief that everyone is entitled to clean air. But it cipro side effects was not until 2008 that she found a way to act. A landmark study published that year linked air pollution with premature mortality and a range of illnesses, including asthma, respiratory s, lung cancer and heart disease. Those consequences disproportionately affect communities of cipro side effects color, subsequent research found.

The entrepreneur in Herzl emerged shortly after can u buy cipro over the counter. Despite pressure to reduce emissions, most stakeholders did not know how to address the problem. €œWe were completely missing the data and measurement infrastructure to understand two very critical things cipro side effects. Where are emissions coming from, and who are they impacting?.

€ she says. In 2010 Herzl launched Aclima, a technology company that uses sensors to measure air pollution and greenhouse gases at the hyperlocal cipro side effects level. Aclima creates high-resolution air-quality maps by aggregating data points over time, showing where, for instance, carbon dioxide or carbon monoxide is concentrated. Aclima has teamed up with governments and local organizers that use the resulting data maps to catalyze action.

In 2015 a project with NASA, cipro side effects the U.S. Environmental Protection Agency and Google used Aclima sensors on Google Street View vehicles to carry out a comprehensive air-quality analysis in Denver. In 2019 a similar effort in San Diego revealed high concentrations of fine particulate matter and black carbon in Otay Mesa and San Ysidro, communities with busy border ports. Those two pollutants are cipro side effects associated with lung and heart dysfunction and poor cognitive function.

That same year a block-by-block analysis of West Oakland measured especially high levels of nitrogen dioxide in Marcus Garvey Commons and near the Mandela Parkway, where some of the highest poverty rates in the Bay Area are found. €œThe work being done by Herzl with local organizations is so important because it helps to identify which communities should be prioritized when creating policies to reduce pollution exposure,” says David Reichmuth, senior engineer at the Union of Concerned Scientists. His 2019 report demonstrated that in California, Latinos, African Americans and Asian Americans are exposed to more cipro side effects vehicular pollution than are white people. Reichmuth points to West Oakland, where Aclima's air-quality analysis was used by community groups such as the West Oakland Environmental Indicators Project to generate a plan designed to reduce emissions.

With these and other initiatives, data lead the conversation, Herzl says. €œIt's less about finger-pointing and more about saying, ‘Here's the science cipro side effects. What are we collectively going to do about it?. €™â€ This article is part of “Innovations In.

Health Equity,” an editorially independent special report that was produced with financial support from Takeda Pharmaceuticals.CLIMATEWIRE | Europe’s plan to slash Russian fossil fuel imports and accelerate cipro side effects renewable energy production will test its ability to find the minerals, metals and other components that are needed for a dramatic shift to clean power. The plan, outlined by the European Commission Wednesday, would speed the continent toward a historic transition to wind and solar energy, while diversifying its sources of natural gas and expanding energy efficiency. But it could come at a high cost. The rapid switch to renewables will depend on Europe’s ability to mine or import the materials cipro side effects that are needed for clean energy technology, like copper, lithium and cobalt.

And it comes as supply chains strain against rising demand for renewable energy globally. €œWhat we’re talking about doing is going from variable cost volatility on hydrocarbons to fixed-cost volatility on transition metals and minerals, going from the limitations on European domestic capacity to produce hydrocarbons to limitations on European domestic capacity to manufacture and deploy full value-chain renewables,” said Kevin Book, managing director of ClearView Energy Partners LLC. €œThese are risk-shifting cipro side effects choices, and a lot of the details will matter,” he added. The plan builds on a package of legislation that would reduce Europe’s greenhouse gas emissions 55 percent by 2030 and reach net zero by midcentury.

It aims to accelerate renewable energy to 45 percent of the E.U. Energy mix by 2030, up from cipro side effects 40 percent now. That would bring total renewable energy generation to more than 1,200 gigawatts within eight years. If the E.U.

Achieves its near-term targets, the European Commission estimates that it would cut two-thirds of its current gas cipro side effects imports by the end of this year, with a goal to end them completely well before the end of the decade. €œToday, we are taking our ambition yet to another level to make sure that we become independent from Russian fossil fuels as quickly as possible,” said European Commission President Ursula von der Leyen. Some experts say more details will be needed to determine whether those plans are achievable. Europe could face shortages of the materials needed for its clean cipro side effects energy transition, or risk forming new dependencies on unsustainable suppliers, according to a recent report commissioned by the metals industry group Eurometaux and written by the Belgium-based research university KU Leuven.

It found that the E.U. Target of zeroing out emissions by 2050 would require around 35 percent more copper and aluminum than it consumes today, and around 45 percent more silicon — a key component in solar panels. At the same time, lithium demand could grow by 35 times, to more than 800,000 tons, and as much cipro side effects as 26 times more rare earth elements will be needed. Cobalt and nickel demand could rise by 330 percent and 100 percent, respectively.

Those materials are needed to produce electric vehicles, batteries, wind turbines and solar panels — all of which are key to meeting Europe’s ambitious emissions-cutting targets. An international energy strategy, also released yesterday, acknowledged those supply chain cipro side effects risks. €œWhile the EU is determined to end its dependence on Russian energy, it is equally determined to avoid new dependencies in the future,” the strategy states. €œAs demand for fossil fuels decreases, increased demand for raw materials, including rare earths and metals could lead to new supply challenges in the course of the energy transition.” The E.U.’s plan comes as the world pushes closer to the temperature limits that scientists say could lead to irreversible climate impacts.

Rising seas, greenhouse gas concentrations, and ocean cipro side effects heat and acidification all reached record highs last year, according to an annual report released yesterday by the World Meteorological Organization. United Nations Secretary-General António Guterres responded to the report by calling for a massive infusion of renewable energy. €œWe must secure, scale up and diversify the supply of critical components and raw materials for renewable energy technologies,” he said, pointing to how raw materials and supply chains for renewable energy technology are concentrated in a handful of countries. €œThe renewable age cannot flourish until cipro side effects we bridge this vast chasm,” he added.

A race to source up The E.U. Energy strategy lists ways to avoid future trade dependencies by encouraging new mining and refining within Europe and cipro side effects by recycling scrap metals and waste. It also mentions the potential for strategic raw material partnerships and trade agreements with countries in Africa and Latin America. One challenge, particularly for solar power, will be boosting production of solar panels and other components in Europe.

While the cipro side effects E.U. Plan offers funding to increase domestic production, it will be hard to overcome the competitive advantages that have pulled production from Europe and sent it to China and Southeast Asia, said Bram Claeys, a senior adviser at the Regulatory Assistance Project, a nonprofit focused on the clean energy transition. When it comes to raw materials, Europe also has the ability to source some commodities domestically, including the aluminum and copper used in its electricity networks. But mining projects in Europe — as well cipro side effects as renewable build-outs like offshore wind — have faced opposition from local communities and green groups.

Timing, too, remains a challenge. New mines take years to be permitted and developed — if they ever are. Record-high energy prices could also cipro side effects limit the ability to refine metals used in clean energy technologies. And on an accelerated scale, those delays matter.

€œ2030 is practically tomorrow in infrastructure terms,” said Book of ClearView Energy. Even then, some of the minerals Europe will need most, such as cobalt, nickel and cipro side effects rare earths, will still need to be imported. And proposed due diligence rules that would require E.U. Companies to avoid human rights abuses and environmental degradation through their supply chains could put some suppliers off limits.

Then there’s cipro side effects this barrier. Europe imports much of its copper, aluminum and nickel from Russia. €œEurope wants to diversify suppliers and accelerate the circular economy, to reuse and recycle materials in Europe,” said Claeys of the Regulatory Assistance Project. Supply chain bottlenecks and geopolitical uncertainties could create cipro side effects additional challenges.

A recent report by the International Energy Agency shows that renewable power generation is on track to break global records this year. But its growth is expected to plateau in 2023, due to a lack of supplies and slow permitting. Investing in tomorrow The plan the European Commission presented yesterday expands cipro side effects on an ambitious proposal released in March that many observers said would be difficult to achieve so quickly (Climatewire, March 9). A number of other strategies were also published alongside yesterday’s announcement.

One piece of the plan aims to double current solar power capacity to more than 320 gigawatts by 2025 and install 600 GW by decade’s end. It would also make rooftop solar installations mandatory on commercial and public buildings starting in 2025 and all new residential buildings in cipro side effects 2029. In addition, Denmark, Germany, Belgium and the Netherlands pledged to increase their offshore wind capacity from 15 GW today to 150 GW by 2050, despite long permitting times that have slowed the pace of wind development. The European Commission also recommended measures that would accelerate complex permitting processes and dedicate “go-to” areas for renewables with lower environmental risks.

€œAbundant supply of raw and processed materials is essential for the energy transition,” Dries Acke, policy director at SolarPower Europe, said in an cipro side effects email. The group represents 260 organizations in the solar sector and has pushed for more investment in domestic manufacturing and the elimination of trade barriers to ease access to raw materials and components for photovoltaic solar production. While some work has been done to identify which raw materials will be needed to meet Europe’s clean energy ambitions, “a further critical outlook on raw materials for E.U. Solar, and their availability, is needed,” Acke added cipro side effects.

Recycling could help. According to the KU Leuven study, local recycling of metals used in cars and wind turbines could provide Europe with up to 75 percent of its clean energy metal needs, but that won’t happen until after 2040. After that point, future growth would depend cipro side effects on Europe’s ability to invest in recycling operations now and prevent scrap metals from being shipped to other countries. Workforce shortages are another problem — and one the E.U.

Plan would address through a skills training program. €œInstallers across cipro side effects Europe, and in many markets internationally, report difficulty finding the skilled labor needed to build and install projects,” said Acke. At the same time that the E.U. Is boosting its ambition, some member states have increased their renewable targets.

Germany now cipro side effects plans to meet 100 percent of its electricity needs with renewable sources by 2035, five years earlier than originally planned. And the Netherlands plans to double its offshore wind generation to nearly 22 GW by 2030. Those moves will require more materials as other parts of the world are also clamoring for expanded renewable capacity. Solutions are available, some experts cipro side effects say.

€œEveryone is aware of the commodity cycle that we’re in right now and the price spikes that are there. And some of those price spikes can be alleviated by simple investment,” said Jon Creyts, chief program officer at RMI. Regarding lithium, cipro side effects not enough capital has been invested to harvest it at the scale required, he said. That’s different than cobalt, of which there are concentrated reserves in a few places in the world, but all sorts of ethical and extraction concerns.

€œSo to the extent that governments are focused on those issues, it is about understanding and tracking the attributes and making sure that there is a fair trade around these minerals,” Creyts said. €œBut more importantly it is about investing in the alternatives and making sure we can innovate our way out of a dependence on cobalt or nickel or some of the other metals that are right now significant constraints to the energy transition.” Reprinted from E&E News with permission from POLITICO, cipro side effects LLC. Copyright 2022. E&E News provides essential news for energy and environment professionals..

The world has never had better cipro pill cost medicine, more knowledgeable doctors or stronger data on disease. But these benefits are not equally shared. To take cipro pill cost one conspicuous example.

Two years of data from the Centers for Disease Control and Prevention show that Black, Hispanic and Native American people are significantly more likely to be hospitalized and die from buy antibiotics than white people in the U.S. Health inequity includes the lack of access to appropriate care, the failure to address social factors that influence health, and the dangerous conditions that people in some neighborhoods endure. Achieving equity requires campaigns cipro pill cost on all these fronts.

These four health-care champions—a data-digging epidemiologist, an activist midwife, a doctor who traded clinic work for community activism and a pollution-tracking entrepreneur—embody that effort. €”J.H. The Social cipro pill cost Rules of Health Michael Marmot Credit.

Joel Kimmel Michael Marmot has spent his entire life working with data—finding, analyzing and applying them. When he was 12, his focus was cricket statistics. When he was a student, it was branches of cipro pill cost medicine.

He mastered biochemistry, physiology and epidemiology. And when he was a physician in the 1960s in Sydney, it was his patients. Marmot was fascinated by what united or differentiated cipro pill cost them, as if they, too, were a data set.

Marmot's mindset would eventually influence millions of other physicians by inspiring tools to identify the social determinants of health. Back then there was no such framework. €œThere was this idea that the social conditions that so clearly affected patients' health were out of cipro pill cost the reach of doctors,” he says.

When he thought about an immigrant mother who was abused by her husband and struggled with chronic pain or about a young woman who had had a difficult childhood and now experienced depression, he wondered. Why treat people and then send them back into the situation that made them sick?. In 1971 Marmot pivoted to research, pursuing cipro pill cost a Ph.D.

At the University of California, Berkeley, to study coronary heart disease (CHD). Textbooks at the time blamed it on behavioral factors such as diet and smoking, but Marmot suspected stress and social factors contributed, too. His 1976 analysis of cipro pill cost medical records from Japanese American men confirmed it—the men with the most Westernized lifestyles had rates of CHD three to five times higher than those of men with more traditional Japanese lifestyles, a difference not explained by food or tobacco.

His Whitehall studies in the late 1970s and 1980s similarly revealed that the health of British civil servants was related to factors such as income and job satisfaction. Marmot found that the lower employees were in their workplace hierarchy, the higher their risk of dying from heart disease. Over the next 30 years Marmot amassed more insights cipro pill cost and data.

In 2012, for instance, he found that the strongest predictors of health for adolescents are national wealth, income inequality and access to education. His work established and legitimized the phrase “social determinants of health” in health policy and medical circles. Marmot's approach changed how physicians, cipro pill cost public health experts and governments think about health inequity.

In 2008 the U.K. Secretary of state for health asked him to investigate health gaps. The resulting “Marmot Review” revealed that injustice degrades the health cipro pill cost of nearly all U.K.

Citizens and is preventable. Because of Marmot's influence, physicians today have ways both to talk about social conditions and to address them through community partnerships—a practice called social prescribing. €œUnderstanding the social determinants of health ensures you focus on what matters to patients rather than just what the matter is with them,” says Sam Everington, cipro pill cost a general practitioner at the Bromley by Bow Center in London, who pioneered social prescribing and cites Marmot's work as crucial for training doctors.

Today Marmot directs the University College London Institute of Health Equity. His work has been cited more than 250,000 times. His Review has spread, from the eastern Mediterranean in 2019 to Manchester in cipro pill cost 2021.

His focus is still on data. €œHealth equity comes from greater equity in society,” he says. Delivering Equity at Birth Shafia cipro pill cost Monroe Credit.

Joel Kimmel As a teenager in Boston in the 1970s, Shafia Monroe learned a startling fact. Black infants were more likely to die than babies of any other race. And there seemed to be no urgency in cipro pill cost the scientific community to address the disparity.

€œWe've got Harvard [and] Tufts, and nobody's doing anything,” she remembers thinking. This early knowledge sparked a lifetime's work in expanding Black mothers' access to doulas and midwives—caregivers who help mothers with practical and emotional support during labor and delivery. For this work, Monroe has come to be recognized as the mother of cipro pill cost the Black midwives' movement.

Because Black women are frequently misdiagnosed, mistreated and racially stigmatized in health care, they and their babies are more likely to die in childbirth. Inspired by Black women known as “granny” midwives who helped cipro pill cost mothers like them in the postemancipation South, Monroe trained as a midwife herself and realized something important. If more Black mothers could get one-on-one birth support from other Black women, they and their babies might be healthier.

She did not yet have empirical proof, but she knew Black women wanted support from other women of color—either midwives, for at-home births, or doulas, for hospital births. In 1978 Monroe formed the nonprofit Traditional Childbearing Group, and she soon began working with similar professionals from cipro pill cost Ghana, Uganda, Pakistan and Alabama. Together they trained midwives, taught $5 birthing classes, provided breastfeeding information and supported at-home births.

In 1988 the Massachusetts Department of Public Health started funding their work. €œDoctors were calling us up because people cipro pill cost were having better birth outcomes,” Monroe recounts. Since then, research has affirmed her observations.

In 2007 a comparative analysis of birth outcomes among more than 11,000 women found that second-time mothers with doula support had lower rates of cesarean deliveries. A smaller study in 2017 found that women with doulas had lower rates of preterm birth and of low-birthweight infants cipro pill cost. In 1991 Monroe launched the International Center for Traditional Childbearing (ICTC), which has trained more than 2,000 doulas.

In 2011 she helped Oregon pass legislation that reimbursed doulas through Medicaid. Other states are cipro pill cost following suit. €œCommunity-competent and culturally and structurally competent doulas can help make the labor room safer for a birthing woman,” says Arline Geronimus, a research professor at the University of Michigan Population Studies Center, whose work has demonstrated the health burden of racial discrimination on Black mothers.

She praises the ICTC for training doulas who are more likely to be trustworthy to women of color, as well as its policy work to allow those with low incomes to access doula services. Inequity persists, however cipro pill cost. Compared with their white counterparts, Black infants are 2.3 times more likely to die, and Black women are 3.5 times more likely to die of pregnancy-related causes.

So Monroe's work continues through actions such as advocating for an Alabama bill to expand access to traditional midwife care, as well as mentoring others fighting for birth justice. €œI was alone for many cipro pill cost years, but the movement has birthed itself into the next generation,” she says. Treating Inequity as Disease Vera Cordeiro Credit.

Joel Kimmel Vera Cordeiro founded one of the world's most influential health programs, but as a child she never wanted to go near medicine. She loved art and literature, spending her days cipro pill cost writing poetry in her treehouse and reflecting on the ways she, born into a wealthy family outside Rio de Janeiro, experienced life differently from her neighbors—many of them sick and poor. Following family pressure, Cordeiro went to medical school, where she met a professor equally interested in people.

If someone died of a heart attack, that professor would encourage his students to consider how circumstances such as the patient's marriage or job affected their illness. In 1988, while working in the pediatric ward of Rio's Hospital da Lagoa, Cordeiro saw for herself how life and cipro pill cost medicine intertwine. €œWe'd treat a child for pneumonia, but then we'd send her back to a house where she could not eat well or where her father was jobless, and then she'd come back again with a different ,” Cordeiro says.

Other doctors faced the same frustrations, so she started asking her patients nonmedical questions such as whether they had food or clean water or jobs, and she called on other medical professionals and friends to help them. In 1991 she turned that informal practice into a formal organization by founding Associação Saúde Criança Renascer at the hospital cipro pill cost. Through the association, doctors can screen for poverty, unemployment, housing issues and other root causes of disease, and volunteers help to fulfill those needs with money, food and other resources.

The teams also help the parents develop Family Action Plans, setting long-term goals around things such as access to nutritious food and training for a stable job. €œSaúde Criança is a pioneer in the design and delivery of comprehensive antipoverty programs,” cipro pill cost says James Habyarimana of Georgetown University, a public policy professor specializing in health outcomes. He praises the organization for recognizing how one dimension of poverty, such as income, affects other dimensions, such as housing, which together determine a child's health.

He says it could be replicated in all but the poorest parts of the world. Children who were enrolled in the program were significantly less likely to need surgery or clinical treatment, according to Habyarimana's 2013 cipro pill cost study. If they were hospitalized, their stays were 86 percent shorter than other children's.

At the start of the program 56 percent of families identified their well-being as bad or very bad, but by the end 51 percent reported it was good or very good. That success might explain why the organization, now called the cipro pill cost Dara Institute, has grown rapidly. It has served 75,000 people across Brazil and inspired some 20 programs in Africa, Asia and Latin America.

It has even reached Baltimore, where, since 2017, the University of Maryland has been adapting Dara's methods to its local context. Now 71, Cordeiro cipro pill cost is president of the Dara Institute and is still fighting for the person behind the disease. She shows before-and-after photographs of patients' houses—bathrooms once dilapidated and doors once cracked now renovated, allowing families to live with more dignity in their homes—and says their stories keep her going.

€œPeople move my heart.” The Air We Breathe Davida Herzl Credit. Joel Kimmel Growing up in southern California, Davida Herzl used to look out to the Port cipro pill cost of Long Beach with her parents, who ran a supply-chain business, to watch the container ships come in. She wondered how those ships' emissions affected people living nearby.

€œYou see the underbelly of what it takes to live our lives with convenience,” she says now. As an cipro pill cost adult, Herzl created a powerful sensor-based pollution-measurement system to prove what many people suspected. Poor neighborhoods have poor air.

The social justice component of her work took root long ago, she says, when she was growing up as a multiracial Jewish girl with a belief that everyone is entitled to clean air. But it cipro pill cost was not until 2008 that she found a way to act. A landmark study published that year linked air pollution with premature mortality and a range of illnesses, including asthma, respiratory s, lung cancer and heart disease.

Those consequences disproportionately affect cipro pill cost communities of color, subsequent research found. The entrepreneur in Herzl emerged shortly after. Despite pressure to reduce emissions, most stakeholders did not know how to address the problem.

€œWe were completely missing the data and measurement infrastructure to understand cipro pill cost two very critical things. Where are emissions coming from, and who are they impacting?. € she says.

In 2010 Herzl launched Aclima, a technology company that cipro pill cost uses sensors to measure air pollution and greenhouse gases at the hyperlocal level. Aclima creates high-resolution air-quality maps by aggregating data points over time, showing where, for instance, carbon dioxide or carbon monoxide is concentrated. Aclima has teamed up with governments and local organizers that use the resulting data maps to catalyze action.

In 2015 a project with NASA, cipro pill cost the U.S. Environmental Protection Agency and Google used Aclima sensors on Google Street View vehicles to carry out a comprehensive air-quality analysis in Denver. In 2019 a similar effort in San Diego revealed high concentrations of fine particulate matter and black carbon in Otay Mesa and San Ysidro, communities with busy border ports.

Those two pollutants are cipro pill cost associated with lung and heart dysfunction and poor cognitive function. That same year a block-by-block analysis of West Oakland measured especially high levels of nitrogen dioxide in Marcus Garvey Commons and near the Mandela Parkway, where some of the highest poverty rates in the Bay Area are found. €œThe work being done by Herzl with local organizations is so important because it helps to identify which communities should be prioritized when creating policies to reduce pollution exposure,” says David Reichmuth, senior engineer at the Union of Concerned Scientists.

His 2019 report cipro pill cost demonstrated that in California, Latinos, African Americans and Asian Americans are exposed to more vehicular pollution than are white people. Reichmuth points to West Oakland, where Aclima's air-quality analysis was used by community groups such as the West Oakland Environmental Indicators Project to generate a plan designed to reduce emissions. With these and other initiatives, data lead the conversation, Herzl says.

€œIt's less about finger-pointing cipro pill cost and more about saying, ‘Here's the science. What are we collectively going to do about it?. €™â€ This article is part of “Innovations In.

Health Equity,” an editorially independent special report that was produced with cipro pill cost financial support from Takeda Pharmaceuticals.CLIMATEWIRE | Europe’s plan to slash Russian fossil fuel imports and accelerate renewable energy production will test its ability to find the minerals, metals and other components that are needed for a dramatic shift to clean power. The plan, outlined by the European Commission Wednesday, would speed the continent toward a historic transition to wind and solar energy, while diversifying its sources of natural gas and expanding energy efficiency. But it could come at a high cost.

The rapid switch to renewables will depend on Europe’s ability to mine or import cipro pill cost the materials that are needed for clean energy technology, like copper, lithium and cobalt. And it comes as supply chains strain against rising demand for renewable energy globally. €œWhat we’re talking about doing is going from variable cost volatility on hydrocarbons to fixed-cost volatility on transition metals and minerals, going from the limitations on European domestic capacity to produce hydrocarbons to limitations on European domestic capacity to manufacture and deploy full value-chain renewables,” said Kevin Book, managing director of ClearView Energy Partners LLC.

€œThese are cipro pill cost risk-shifting choices, and a lot of the details will matter,” he added. The plan builds on a package of legislation that would reduce Europe’s greenhouse gas emissions 55 percent by 2030 and reach net zero by midcentury. It aims to accelerate renewable energy to 45 percent of the E.U.

Energy mix cipro pill cost by 2030, up from 40 percent now. That would bring total renewable energy generation to more than 1,200 gigawatts within eight years. If the E.U.

Achieves its near-term targets, the European Commission estimates that cipro pill cost it would cut two-thirds of its current gas imports by the end of this year, with a goal to end them completely well before the end of the decade. €œToday, we are taking our ambition yet to another level to make sure that we become independent from Russian fossil fuels as quickly as possible,” said European Commission President Ursula von der Leyen. Some experts say more details will be needed to determine whether those plans are achievable.

Europe could face shortages of the materials needed for cipro pill cost its clean energy transition, or risk forming new dependencies on unsustainable suppliers, according to a recent report commissioned by the metals industry group Eurometaux and written by the Belgium-based research university KU Leuven. It found that the E.U. Target of zeroing out emissions by 2050 would require around 35 percent more copper and aluminum than it consumes today, and around 45 percent more silicon — a key component in solar panels.

At the same time, lithium demand could grow by 35 cipro pill cost times, to more than 800,000 tons, and as much as 26 times more rare earth elements will be needed. Cobalt and nickel demand could rise by 330 percent and 100 percent, respectively. Those materials are needed to produce electric vehicles, batteries, wind turbines and solar panels — all of which are key to meeting Europe’s ambitious emissions-cutting targets.

An international energy strategy, also released yesterday, acknowledged those cipro pill cost supply chain risks. €œWhile the EU is determined to end its dependence on Russian energy, it is equally determined to avoid new dependencies in the future,” the strategy states. €œAs demand for fossil fuels decreases, increased demand for raw materials, including rare earths and metals could lead to new supply challenges in the course of the energy transition.” The E.U.’s plan comes as the world pushes closer to the temperature limits that scientists say could lead to irreversible climate impacts.

Rising seas, greenhouse gas concentrations, and cipro pill cost ocean heat and acidification all reached record highs last year, according to an annual report released yesterday by the World Meteorological Organization. United Nations Secretary-General António Guterres responded to the report by calling for a massive infusion of renewable energy. €œWe must secure, scale up and diversify the supply of critical components and raw materials for renewable energy technologies,” he said, pointing to how raw materials and supply chains for renewable energy technology are concentrated in a handful of countries.

€œThe renewable age cannot flourish until we bridge this vast chasm,” he added cipro pill cost. A race to source up The E.U. Energy strategy lists ways to avoid future trade dependencies by encouraging new mining and refining within Europe and by recycling scrap cipro pill cost metals and waste.

It also mentions the potential for strategic raw material partnerships and trade agreements with countries in Africa and Latin America. One challenge, particularly for solar power, will be boosting production of solar panels and other components in Europe. While the cipro pill cost E.U.

Plan offers funding to increase domestic production, it will be hard to overcome the competitive advantages that have pulled production from Europe and sent it to China and Southeast Asia, said Bram Claeys, a senior adviser at the Regulatory Assistance Project, a nonprofit focused on the clean energy transition. When it comes to raw materials, Europe also has the ability to source some commodities domestically, including the aluminum and copper used in its electricity networks. But mining projects in Europe — as well as renewable build-outs like offshore wind — have faced opposition from local communities and cipro pill cost green groups.

Timing, too, remains a challenge. New mines take years to be permitted and developed — if they ever are. Record-high energy cipro pill cost prices could also limit the ability to refine metals used in clean energy technologies.

And on an accelerated scale, those delays matter. €œ2030 is practically tomorrow in infrastructure terms,” said Book of ClearView Energy. Even then, some of the minerals Europe will need most, such as cobalt, nickel and rare earths, will still cipro pill cost need to be imported.

And proposed due diligence rules that would require E.U. Companies to avoid human rights abuses and environmental degradation through their supply chains could put some suppliers off limits. Then there’s this barrier cipro pill cost.

Europe imports much of its copper, aluminum and nickel from Russia. €œEurope wants to diversify suppliers and accelerate the circular economy, to reuse and recycle materials in Europe,” said Claeys of the Regulatory Assistance Project. Supply chain cipro pill cost bottlenecks and geopolitical uncertainties could create additional challenges.

A recent report by the International Energy Agency shows that renewable power generation is on track to break global records this year. But its growth is expected to plateau in 2023, due to a lack of supplies and slow permitting. Investing in tomorrow The plan the European Commission presented yesterday cipro pill cost expands on an ambitious proposal released in March that many observers said would be difficult to achieve so quickly (Climatewire, March 9).

A number of other strategies were also published alongside yesterday’s announcement. One piece of the plan aims to double current solar power capacity to more than 320 gigawatts by 2025 and install 600 GW by decade’s end. It would also make rooftop solar installations mandatory on commercial and public buildings starting in 2025 and cipro pill cost all new residential buildings in 2029.

In addition, Denmark, Germany, Belgium and the Netherlands pledged to increase their offshore wind capacity from 15 GW today to 150 GW by 2050, despite long permitting times that have slowed the pace of wind development. The European Commission also recommended measures that would accelerate complex permitting processes and dedicate “go-to” areas for renewables with lower environmental risks. €œAbundant supply of raw and processed materials is essential for the energy transition,” Dries Acke, policy director at cipro pill cost SolarPower Europe, said in an email.

The group represents 260 organizations in the solar sector and has pushed for more investment in domestic manufacturing and the elimination of trade barriers to ease access to raw materials and components for photovoltaic solar production. While some work has been done to identify which raw materials will be needed to meet Europe’s clean energy ambitions, “a further critical outlook on raw materials for E.U. Solar, and their availability, cipro pill cost is needed,” Acke added.

Recycling could help. According to the KU Leuven study, local recycling of metals used in cars and wind turbines could provide Europe with up to 75 percent of its clean energy metal needs, but that won’t happen until after 2040. After that point, future growth cipro pill cost would depend on Europe’s ability to invest in recycling operations now and prevent scrap metals from being shipped to other countries.

Workforce shortages are another problem — and one the E.U. Plan would address through a skills training program. €œInstallers across Europe, and in many markets internationally, report difficulty finding the skilled labor needed to build and install cipro pill cost projects,” said Acke.

At the same time that the E.U. Is boosting its ambition, some member states have increased their renewable targets. Germany now plans to meet 100 percent of its electricity needs cipro pill cost with renewable sources by 2035, five years earlier than originally planned.

And the Netherlands plans to double its offshore wind generation to nearly 22 GW by 2030. Those moves will require more materials as other parts of the world are also clamoring for expanded renewable capacity. Solutions are available, some cipro pill cost experts say.

€œEveryone is aware of the commodity cycle that we’re in right now and the price spikes that are there. And some of those price spikes can be alleviated by simple investment,” said Jon Creyts, chief program officer at RMI. Regarding lithium, not enough capital has been invested to harvest cipro pill cost it at the scale required, he said.

That’s different than cobalt, of which there are concentrated reserves in a few places in the world, but all sorts of ethical and extraction concerns. €œSo to the extent that governments are focused on those issues, it is about understanding and tracking the attributes and making sure that there is a fair trade around these minerals,” Creyts said. €œBut more importantly it is about investing in the alternatives and making sure we can innovate our way out of a dependence on cobalt or nickel or some of the other metals that are right now significant constraints to the energy transition.” Reprinted from E&E News with cipro pill cost permission from POLITICO, LLC.

Copyright 2022. E&E News provides essential news for energy and environment professionals..