The key to smoother streets in Lincoln could be a bump in the city sales tax.
After months of study, the mayor’s 25-member transportation coalition Thursday released the results of its examination of Lincoln’s transportation problems — and its recommended solutions.
The biggest challenge? Each year, the city falls about $33 million short in transportation funding, said co-chair Bob Caldwell of NEBCO.
That includes $21 million for road maintenance, $7 million in signal upgrades and other improvements, and $5 million for new streets.
“Nobody raised their hand and wanted to do property taxes, nobody raised their hand and wanted to do more wheel taxes,” Caldwell said. “They think we should spread the burden a little wider.”
So the Citizens' Transportation Coalition is recommending the city increase the sales tax to raise $20 million to $28 million annually — a move that would capture tax dollars from out-of-town visitors and commuters.
Lincoln voters would have to approve an increase. The city is already collecting an additional quarter-cent sales tax to fund four fire stations and install a new emergency radio system, but that tax expires in September.
The coalition didn’t specify whether it believes the city should levy a quarter-cent or half-cent increase, but the math is clear. A quarter-cent would raise just $12 million a year, while a half-cent would generate about $24 million — right in the range of the group’s recommendation.
“So that gives you an indication of where they are,” said Miki Esposito, the group’s other co-chair and director of Public Works and Utilities.
To bridge the rest of the gap, the coalition is recommending a series of other changes, including: more regular maintenance to extend pavement life; an increase in contracting with private companies so the city can focus resources where they’re needed; changes to the impact fee system; and allowing street design flexibility — for instance, reducing the width of a lane from 12 feet to 11 can save $500,000 per mile in construction costs.
The coalition is also urging the city to adopt 24 best practices, including developing a citizen advisory council, streamlining its business processes and making traffic signal timing more efficient.
The group — made up of community leaders, city staff and elected officials — started its work in early August with a bus tour of the city.
They felt immediately what they were up against.
“We went down roads on that bus that were silky smooth, but let me tell you, that was very few of the roads,” Caldwell said. “We went into some neighborhoods that looked like those roads hadn’t been touched in a long time.”
With the help of a $450,000 contract with consultants, the group dove into city policies and plans and researched how so-called peer cities — such as Omaha, Columbia, Missouri, and Fort Collins, Colorado — tackle transportation needs, and what they pay.
It learned those other cities spend an average of $10,000 per lane mile on maintenance, while Lincoln spends about $2,400 per mile on its 2,600 lane miles.
And it learned streets are expensive: $12 million to build a mile of a four-lane arterial; $600,000 to resurface a lane mile; and $300,000 to upgrade a signaled intersection.
The additional $20 million to $28 million is needed to pay for existing and future transportation needs not covered by state and federal funds, the city’s wheel tax and impact fees.
“That’s what’s going to help us bridge that gap and fix our roads,” Caldwell said.
The coalition officially ended its work Thursday, and its report is now in the hands of Mayor Chris Beutler and the City Council.
“They need to dive in and engage with each other to come up with something they’re comfortable with,” Esposito said.
This year's flu season is busy, and it's being made even worse in some areas by a nationwide shortage of IV fluids.
Nearly every state in the country is experiencing widespread flu outbreaks, and Nebraska is no exception.
There have been more than twice as many positive influenza laboratory tests in Nebraska this flu season compared to last year, and Nebraska ranked fifth among states with the highest levels of flu activity in the most-recent weekly Walgreens Flu Index.
As of Dec. 30, there had been more than 2,000 lab-confirmed cases of the flu statewide.
More up-to-date data from Lancaster County showed 237 positive tests here as of Wednesday.
This year's most-active flu strain has been causing serious illnesses in some people, especially the very young and the very old.
Tim Timmons, supervisor for the Lincoln-Lancaster County Health Department's communicable disease program, said more than one-third of the confirmed cases in the county are in people 65 and older and more than half are in people 50 and older.
As of Dec. 30, there had been 306 flu-related hospitalizations statewide and eight flu-related deaths, with two of those occurring in Lancaster County. The average age of those people was 86. Those numbers will be updated Friday.
Bryan Health spokesman Edgar Bumanis said the hospital's two Lincoln campuses had 91 admissions of people with "influenza-like" illnesses last week, which is more than double the average of 35 per week that it typically sees when the flu season is in its early stages.
As of Wednesday, the hospital system had 18 in-patients at its two campuses with lab-confirmed cases of the flu.
"It seems higher than what we've had in recent years," he said.
CHI St. Elizabeth spokesman Evan Sheaff said the health system has seen an increase in flu patients across its several Nebraska hospital locations, and Lincoln is no exception.
At St. Elizabeth, "we have seen a significant increase in viral respiratory illnesses — this includes influenza," Sheaff said in an email.
However, he said, volumes have not been unusual or larger than expected.
Statewide, about 6 percent of all emergency room visits the last week of December were for influenza-like illnesses.
The numbers are higher in Lincoln and are increasing. As of Dec. 30, nearly 11 percent of local hospital admissions were for people with flu symptoms. As of Jan. 6, that jumped to 14 percent.
The increase in flu cases comes at a time when fluids used to deliver medicine and treat dehydrated patients are in short supply.
Supplies of saline and nutrient solutions were already tight before hurricanes pounded Puerto Rico last year and cut power to manufacturing plants that make much of the U.S. supply of fluid-filled bags used to deliver sterile solutions to patients.
Hospital officials, pharmacists and other staff have been devising alternatives and workarounds, training doctors and nurses on new procedures and options, and hitting the phones to try to secure fluids from secondary suppliers.
"If we can't support patients coming in emergency rooms who have the flu, more people are going to die," predicts Deborah Pasko, director of medication safety and quality at the American Society of Health System Pharmacists, a professional group. "I see it as a crisis."
Both Bryan and St. Elizabeth said they have been hit by the shortages but have been able to work around them so that patient care has not been affected.
Scott Persson, Bryan's pharmacy manager, called the shortages "very real and ongoing concerns."
But he said the organization's two hospitals have been able to meet their patients' medication and fluid needs.
"This is being done via adapting numerous methods of delivering therapy in order to conserve available resources, as well as engaging several vendors to maintain the most-stable supply line possible," Persson said in a statement.
Sheaff, the St. Elizabeth spokesman, said CHI hospitals across the country have been able to shift around supplies of IV solutions to hospitals with the most-critical needs.
St. Elizabeth and other CHI hospitals also have made changes to preserve fluids, such as administering some antibiotics through a syringe rather than an IV bag.
Because of those measures, "A patient will not have a different experience at St. Elizabeth, or any of our other facilities, due to this shortage."
Timmons said it's likely to be several weeks before flu cases start to decline.
"At this point the trend is up," he said. "We don't know when it will peak."
In the meantime, he recommended people who have not gotten a flu shot to do so. Also, he said those with flu-like symptoms should stay home from work or school.
WASHINGTON — Rewriting the rules on health care for the poor, the Trump administration said Thursday it will allow states to require "able-bodied" Medicaid recipients to work, a hotly debated first in the program's half-century history.
Seema Verma, head of the Centers for Medicare and Medicaid Services, said requiring work or community involvement can make a positive difference in people's lives and in their health. The goal is to help people move from public assistance into jobs that provide health insurance. "We see people moving off of Medicaid as a good outcome," she said.
But opponents said work requirements will become one more hoop for low-income people to jump through, and many could be denied needed coverage because of technicalities and challenging new paperwork. Lawsuits are expected as individual states roll out work requirements.
"All of this on paper may sound reasonable, but if you think about the people who are affected, you can see people will fall through the cracks," said Judy Solomon of the Center on Budget and Policy Priorities, which advocates for the poor.
Created in 1965 for families on welfare and low-income seniors, Medicaid now covers more than 70 million people, or about 1 in 5 Americans. The federal-state collaboration has become the nation's largest health insurance program.
Beneficiaries range from pregnant women and newborns to elderly nursing home residents. Medicaid was expanded under former President Barack Obama, with an option allowing states to cover millions more low-income adults. Many of them have jobs that don't provide health insurance.
People are not legally required to hold a job to be on Medicaid, but states traditionally can seek federal waivers to test new ideas for the program.
Verma stressed that the administration is providing an option for states to require work, not making it mandatory across the country. Her agency spelled out safeguards that states should put in place to get federal approval for their waivers.
States can also require alternatives to work, including volunteering, caregiving, education, job training and even treatment for a substance-abuse problem.
The administration said 10 states have applied for waivers involving work requirements or community involvement. They are: Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin. Advocates for low-income people say they expect Kentucky's waiver to be approved shortly.
In Kentucky, which expanded Medicaid, Republican state Sen. Damon Thayer said work requirements could lessen the program's impact on the state budget. They also hearken back to the program's original intent, he added, "as temporary assistance to try to help people get back on their feet, not a permanent subsidy for someone's lifestyle, if they're capable of working."
But congressional Democrats said the Trump administration is moving in the wrong direction. "Health care is a right that shouldn't be contingent on the ideological agendas of politicians," said Sen. Ron Wyden of Oregon, the top Democrat on the Senate committee that oversees Medicaid.
The debate about work requirements doesn't break neatly along liberal-conservative lines.
A poll last year from the nonpartisan Kaiser Family Foundation found that 70 percent of the public supported allowing states to require Medicaid recipients to work, even as most Americans opposed deep Medicaid cuts sought by congressional Republicans and the Trump administration.
Another Kaiser study found that most working-age adults on Medicaid are already employed. Nearly 60 percent work either full time or part time, mainly for employers that don't offer health insurance.
Most who are not working report reasons such as illness, caring for a family member or going to school. Some Medicaid recipients say the coverage has enabled them to get healthy enough to return to work.
Thursday's administration guidance spells out safeguards that states should consider in seeking work requirements. These include:
• Exempting pregnant women, disabled people and the elderly.
• Taking into account hardships for people in areas with high unemployment, or for people caring for children or elderly relatives.
• Allowing people under treatment for substance abuse to have their care counted as "community engagement" for purposes of meeting a requirement.
The administration said states must fully comply with federal disability and civil rights laws to accommodate disabled people and prevent those who are medically frail from being denied coverage. States should try to align their Medicaid work requirements with similar conditions in other programs, such as food stamps and cash assistance.
The National Association of Medicaid Directors, a nonpartisan group representing state officials, said in a statement there's no consensus on whether work requirements are the right approach.
"This is a very complex issue that will require thoughtful and nuanced approaches," said the group.
Trump's new direction can be reversed by a future administration. Although waivers can have lasting impact they don't amount to a permanent change in the program. They're considered "demonstration programs" to test ideas. The administration says the impact will be closely evaluated.
A Lincoln senator wants to flip the script on giving consent for sex.
Instead of the common rule of "no means no," which implies that unless a person says no, the other person in a sexual encounter assumes there's permission, an affirmative consent would be required.
Silence would not mean it's OK.
Sen. Patty Pansing Brooks introduced a bill (LB988) Thursday that would adopt affirmative consent as the standard for criminal sexual assault cases.
As it is now, state law says a person must express a lack of consent through words or conduct.
With the bill, consent means words or overt actions that indicate a knowing and voluntary agreement, freely given, to engage in sexual contact or intercourse. A person could also still withdraw consent with words or conduct.
According to the bill, these things would not imply or give consent: current or previous dating, social or sexual relationship by itself; how the person is dressed; the victim's use of drugs or alcohol.
The University of Nebraska already uses the affirmative standard in its sexual misconduct policy.
Pansing Brooks said a college student led the way on the bill.
Brodey Weber, a sophomore at the University of Nebraska-Lincoln, has been interested in the topic since high school, when he went to a national Young Democrats convention. He heard a speaker there, the president of the California state senate, Kevin de Leon, the first in the nation to introduce a "Yes Means Yes" bill.
Writing in The Washington Post, de Leon and Hannah-Beth Jackson said that while “no means no” has become a well-known slogan, it places the burden on victims, making it their responsibility to show resistance.
No means no "has also been mocked and twisted into offensive slogans by some college fraternities. Others, like conservative radio host Rush Limbaugh, have contorted it further, promulgating the notion that no really means yes 'if you know how to spot it,'" they said.
Weber came back to Lincoln, and for a class project researched laws on affirmative standards in other states, such as California, Montana, New York and Illinois, to see how Nebraska could follow their lead. In other states, the bills have had bipartisan support, he said.
"The way I looked at it is, I can't keep waiting for someone else in Nebraska to finally do something about it," he said. "I've always been a very big believer in activism. If I want something changed, I have to do what I can to change it."
When he interned in Pansing Brooks' office, he offered her office his research. The senator then crafted a bill and brought it forward.
If the bill would be passed, Weber acknowledged, it would take time to convert to an affirmative-consent culture.
But it didn't take him long to understand the idea that in sexual encounters a person needs to get a yes.
"I don't think it should be the hardest thing for individuals to understand that to engage in sexual activity they just need a clear, enthusiastic and simple yes to do so," he said.
And when drugs or alcohol are involved, "it is very important to be even more careful just because of how slippery and messy it can get," he said.