Work requirements are the centerpiece of HHS's Trump Administration strategy to undo the ACA expansion for low income working age adults. This article examines the June 29, 2018 trial court opinion in Stewart v. Azar which held that HHS's approval of Kentucky's Section 1115 work demonstration was “arbitrary and capricious.” The purpose of Medicaid is to provide health coverage and HHS may not ignore the loss of coverage that will result from a work requirement.

The Affordable Care Act1 promises to improve access to coverage and care for two vulnerable groups: low-income persons who are excluded by a lack of resources and chronically ill and disabled people who are excluded by the dysfunction of our existing insurance and care delivery systems. ACA’s sprawling provisions raise a wealth of implementation challenges that are exacerbated by the compromises required to move reform through Congress. In particular, the compromise between regulatory/public program advocates and advocates for private, market-driven programs (...) requires thoughtful regulatory coordination between public and private health systems. (shrink)

The Affordable Care Act1 promises to improve access to coverage and care for two vulnerable groups: low-income persons who are excluded by a lack of resources and chronically ill and disabled people who are excluded by the dysfunction of our existing insurance and care delivery systems. ACA’s sprawling provisions raise a wealth of implementation challenges that are exacerbated by the compromises required to move reform through Congress. In particular, the compromise between regulatory/public program advocates and advocates for private, market-driven programs (...) requires thoughtful regulatory coordination between public and private health systems. (shrink)

Successful behavior requires actively acquiring and representing information about the environment and people, and manipulating and using those acquired representations flexibly to optimally act in and on the world. The frontal lobes have figured prominently in most accounts of flexible or goal-directed behavior, as evidenced by often-reported behavioral inflexibility in individuals with frontal lobe dysfunction. Here, we propose that the hippocampus also plays a critical role by forming and reconstructing relational memory representations that underlie flexible cognition and social behavior. There (...) is mounting evidence that damage to the hippocampus can produce inflexible and maladaptive behavior when such behavior places high demands on the generation, recombination, and flexible use of information. This is seen in abilities as diverse as memory, navigation, exploration, imagination, creativity, decision-making, character judgments, establishing and maintaining social bonds, empathy, social discourse, and language use. Thus, the hippocampus, together with its extensive interconnections with other neural systems, supports the flexible use of information in general. Further, we suggest that this understanding has important clinical implications. Hippocampal abnormalities can produce profound deficits in real-world situations, which typically place high demands on the flexible use of information, but are not always obvious on diagnostic tools tuned to frontal lobe function. This review documents the role of the hippocampus in supporting flexible representations and aims to expand our understanding of the dynamic networks that operate as we move through and create meaning of our world. (shrink)

Health care reform that includes universal coverage could lower a major barrier to care for people of color and ethnic minorities—the inability to pay for care. But universal coverage alone, even with comparable fee-for-service payment or appropriately risk-adjusted capitated reimbursement, will not eradicate the racial and ethnic inequities in health care delivery. Restrictive admissions practices, geographic inaccessibility, culture, racial stereotypes, and the failure to employ minority health care professionals will still create barriers to minority health care. In addition to universal (...) financing, health care reform should include new civil rights legislation to address and reduce these noneconomic barriers to minority health care. (shrink)

Health care reform that includes universal coverage could lower a major barrier to care for people of color and ethnic minorities—the inability to pay for care. But universal coverage alone, even with comparable fee-for-service payment or appropriately risk-adjusted capitated reimbursement, will not eradicate the racial and ethnic inequities in health care delivery. Restrictive admissions practices, geographic inaccessibility, culture, racial stereotypes, and the failure to employ minority health care professionals will still create barriers to minority health care. In addition to universal (...) financing, health care reform should include new civil rights legislation to address and reduce these noneconomic barriers to minority health care. (shrink)

Affective computing adopts a computational approach to study affect. We highlight the AC approach towards automated affect measures that jointly model machine-readable physiological/behavioral signals with affect estimates as reported by humans or experimentally elicited. We describe the conceptual and computational foundations of the approach followed by two case studies: one on discrimination between genuine and faked expressions of pain in the lab, and the second on measuring nonbasic affect in the wild. We discuss applications of the measures, analyze measurement accuracy (...) and generalizability, and highlight advances afforded by computational tipping points, such as big data, wearable sensing, crowdsourcing, and deep learning. We conclude by advocating for increasing synergies between AC and affective science and offer suggestions toward that direction. (shrink)

Medicaid is uniquely equipped to serve low-income populations. We identify four features that form the “soul” of Medicaid, explain how the administration is testing them, and explore challenges in accountability contributing to this struggle. We highlight the work of watchdogs acting to protect Medicaid and conclude with considerations for future health reform.

Although an age-old problem, the debate over immortality has become reanimated in light of recent advances in life extension technologies, accompanied by an ever-growing body of enthusiasts, both within academic circles as well as the public in general. For these people, death is no longer a natural process, but a disease, and one that might be prevented. It seems that the desire for immortality is a result, in part, of a profound sense of incompleteness and frustration that death will rob (...) us of our future goals and achievements. Consequently, this paper takes as its main focus an individual who affirms life and does not wish it to end, at least prematurely. ‘Prematurely’ is understood as occurring before the individual desires life to end, no matter what age or condition they are in. If premature death is a harm, however, does this imply that ‘more life’ is always better? Ultimately this paper questions whether the desire for immortality would rectify the problems it was originally intended to solve. (shrink)

Stem cell policy in the United States is an amalgam of federal and state policies. The scientific development of human pluripotent embryonic stem cells triggered a contentious national stem cell policy debate during the administration of President George W. Bush. The Bush “compromise” that allowed federal funding to study only a very limited number of ESC derived cell lines did not satisfy either the researchers or the patient advocates who saw great medical potential being stifled. Neither more restrictive legislation nor (...) expansion of federal funding proved politically possible and the federal impasse opened the door for a variety of state-based experiments. In 2004, California became the largest and most influential state venture into stem cell research by passing “Prop 71,” a voter initiative that created a new stem cell agency and funded it with $3 billion. Several states followed suit with similar programs to protect the right of investigators to do stem cell research and in some cases to invest state funding in such projects. Other states devised legislation to restrict stem cell research and in five states, criminal penalties were included. Thus, the US stem cell policy is a patchwork of multiple, often conflicting, state and federal policies. (shrink)

Literature addressing organizational ethical behavior has focused intensely on cognitive moral development, and more recently the automatic and natural moral inclinations. Research addressing the incapacity for moral reasoning, such as psychopathy, is rarely addressed in organizational behavior. Our first aim is to develop a construct definition for functional psychopathy that is appropriate for organizational science and theoretically consistent with the extensive previous clinical and criminal research in this field. Second, we apply two versions of a scale not previously used in (...) business research relative to moral judgments. This scale is a self-reported measure of functional psychopathy and is useful for its relationships with ethically relevant business decisions. Further, we examine which factors emerge as having the highest relationship with ethical decision making. Third, we seek to advance the usefulness of this construct by more precisely placing psychopathy within its nomological network. With these goals in mind, a combined sample of business school seniors participated in three studies. Findings indicate a significant influence of psychopathy over a range of ethically relevant business decisions, as well as negative correlations with factors of the Moral Approbation and the Moral Awareness scales. We conclude with directions for future research and considerations for practice. (shrink)

The objective of this paper is to augment the business values literature by building upon research that claims individual value frames are subject to hierarchical re-scaling, value redefinition, and value removal or induction. In contrast to the person-organization cultural fit approach of value congruence, we postulate that the cognitive discomforts resulting from just-world needs, self-identity completion and self-concept maintenance, as moderated by contextual and dispositional variables, are resolved through the selection and accentuation of legitimating and justifying values that ultimately cast (...) the nature of the world as fair, complete central self-identities, and affirm the self. Research and practical implications are discussed. (shrink)

This Handbook covers the most urgent, controversial, and important topics in the philosophy of sex. It is both philosophically rigorous and yet accessible to specialists and non-specialists, covering ethics, political philosophy, metaphysics, the philosophy of science, and the philosophy of language, and featuring interactions with neighboring disciplines such as psychology, bioethics, sociology, and anthropology. The volume's 40 chapters, written by an international team of both respected senior researchers and essential emerging scholars, are divided into eight parts: I. What is Sex? (...) Is Sex Good? II. Sexual Orientations III. Sexual Autonomy and Consent IV. Regulating Sexual Relationships V. Pathologizing Sex and Sexuality VI. Contested Desires VII. Commercialized Sex VIII. Technology and the Future of Sex The broad scope of coverage, depth in insight and research, and accessibility in language make The Routledge Handbook of Philosophy of Sex and Sexuality a comprehensive introduction for newcomers to the subject as well as an invaluable reference work for those advanced students and researchers in the field. (shrink)

The neural representation of a repeated stimulus is the standard against which a deviant stimulus is measured in the brain, giving rise to the well-known mismatch response. It has been suggested that individuals with dyslexia have poor implicit memory for recently repeated stimuli, such as the train of standards in an oddball paradigm. Here, we examined how the neural representation of a standard emerges over repetitions, asking whether there is less sensitivity to repetition and/or less accrual of “standardness” over successive (...) repetitions in dyslexia. We recorded magnetoencephalography as adults with and without dyslexia were passively exposed to speech syllables in a roving-oddball design. We performed time-resolved multivariate decoding of the MEG sensor data to identify the neural signature of standard vs. deviant trials, independent of stimulus differences. This “multivariate mismatch” was equally robust and had a similar time course in the two groups. In both groups, standards generated by as few as two repetitions were distinct from deviants, indicating normal sensitivity to repetition in dyslexia. However, only in the control group did standards become increasingly different from deviants with repetition. These results suggest that many of the mechanisms that give rise to neural adaptation as well as mismatch responses are intact in dyslexia, with the possible exception of a putatively predictive mechanism that successively integrates recent sensory information into feedforward processing. (shrink)

Cocreating meaning in collaboration is challenging. Success is often determined by people's abilities to coordinate their language to converge upon shared mental representations. Here we explore one set of low‐level linguistic behaviors, linguistic alignment, that both emerges from, and facilitates, outcomes of high‐level convergence. Linguistic alignment captures the ways people reuse, that is, “align to,” the lexical, syntactic, and semantic forms of others' utterances. Our focus is on the temporal change of multi‐level linguistic alignment, as well as how alignment is (...) related to communicative outcomes within a unique collaborative problem‐solving paradigm. The primary task, situated within a virtual educational video game, requires creative thinking between three people where the paths for possible solutions are highly variable. We find that over time interactions are marked by decreasing lexical and syntactic alignment, with a trade‐off of increasing semantic alignment. However, greater semantic alignment does not translate into better team performance. Overall, these findings provide greater clarity on the role of linguistic coordination within complex and dynamic collaborative problem‐solving tasks. (shrink)

Following other contributions about the MAX accidents to this journal, this paper explores the role of betrayal and moral injury in safety engineering related to the U.S. federal regulator’s role in approving the Boeing 737MAX—a plane involved in two crashes that together killed 346 people. It discusses the tension between humility and hubris when engineers are faced with complex systems that create ambiguity, uncertain judgements, and equivocal test results from unstructured situations. It considers the relationship between moral injury, principled outrage (...) and rebuke when the technology ends up involved in disasters. It examines the corporate backdrop against which calls for enhanced employee voice are typically made, and argues that when engineers need to rely on various protections and moral inducements to ‘speak up,’ then the ethical essence of engineering—skepticism, testing, checking, and questioning—has already failed. (shrink)

Scientific claims are selected in part for their ability to survive. Scientists can pursue an r-strategy of broad, easy-to-spread ideas, or a K-strategy of stress-tested, bulletproof statements. The “generalizability crisis” is an exquisite mutation that allows dull, K-strategic methodology articles to spread nearly as quickly as the fast-breeding, r-strategic memes of pop-psychology.

The currently leading cognitive theory of consciousness, Global Workspace Theory,1,2 postulates that the primary functions of consciousness include a global broadcast serving to recruit internal resources with which to deal with the current situation and to modulate several types of learning. In addition, conscious experiences present current conditions and problems to a "self" system, an executive interpreter that is identifiable with brain structures like the frontal lobes and precuneus.1Be it human, animal or artificial, an autonomous agent3 is said to be (...) functionally conscious if its control structure (mind) implements Global Workspace Theory and the LIDA Cognitive Cycle, which includes unconscious memory and control functions needed to integrate the conscious component of the system. We would therefore consider humans, many animals4 and even some virtual or robotic agents5,6 to be functionally conscious. Such entities may approach phenomenal consciousness, as found in human and other biological brains, as additional brain-like features are added.Here we argue that adding mechanisms to produce a stable, coherent perceptual field7 in a LIDA controlled mobile robot might provide a small but significant step toward phenomenal consciousness in machines.>8 We also propose that implementing several of the various notions of self in such a LIDA controlled robot may well prove another step toward phenomenal consciousness in machines. (shrink)

In an attempt to discover the facial action units for affective states that occur during complex learning, this study adopted an emote-aloud procedure in which participants were recorded as they verbalised their affective states while interacting with an intelligent tutoring system (AutoTutor). Participants’ facial expressions were coded by two expert raters using Ekman's Facial Action Coding System and analysed using association rule mining techniques. The two expert raters received an overall kappa that ranged between.76 and.84. The association rule mining analysis (...) uncovered facial actions associated with confusion, frustration, and boredom. We discuss these rules and the prospects of enhancing AutoTutor with non-intrusive affect-sensitive capabilities. (shrink)

Reading is one of the most common everyday activities, yet research elucidating how affective influence reading processes and outcomes is sparse with inconsistent results. To investigate this question, we randomly assigned participants (N = 136) to happiness (positive affect), sadness (negative affect), and neutral video-induction conditions prior to engaging in self-paced reading of a long, complex science text. Participants completed assessments targeting multiple levels of comprehension (e.g. recognising factual information, integrating different textual components, and open-ended responses of concepts from memory) (...) after reading and after a week-long delay. Results indicated that the Sadness (vs. Happiness) condition had higher comprehension scores, with the largest effects emerging for assessments targeting deeper levels comprehension immediately after reading. Eye-tracking analyses revealed that such benefits may be partly driven by sustained attentional focus over the 20-minute reading session. We discuss results with respect to theories on affect, cognition, and text comprehension. (shrink)