Trump Sabotages Obamacare by Cutting Enrollment Period, Outreach

Trump trying to sabotage Obamacare by cutting enrollment period, and funding for outreach to tell people about it. Outreach funding is being cut 90%, from $100 million last year to $10 million this year. So individuals and private organizations will need to let people know about their options. The new enrollment period for 2018 is November 1 to December 15, 2017, for heath insurance starting January 1. (This is half as long as the open enrollment period was last year.) Note: this is the ACA enrollment period. The Medicare open-enrollment period is different. Medicaid is also different.) See "Ex-Medicare chief promotes ObamaCare enrollment on Twitter after Trump cuts outreach funding,"


Don't let the name fool you, ACA 'skinny' repeal has major consequences

Comment by JSJ: We don't like the individual mandate either, but this is the worst possible way to fix it, and would do far more harm than good.

What is crazy is that this county is so allergic to "taxes" that it extorts a healthcare tax from individuals in a very inefficient and damaging way, just so that it isn't called a "tax." Better to let the IRS collect more taxes and have a workable healthcare system that is not a huge burden on people.


Why Single-Payer Health Care Saves Money

One Woman’s Slide From Middle Class to Medicaid


Get cancer now, before Congress cuts your health insurance

If we lose our heathcare ...


24-Hour Healthcare Vigil today-tomorrow in Philadelphia - photos

Moral Mondays organizer Rev.William Barber (in the black and purple vestment) addressed the opening rally of the 24-hour vigil, at about 4:30 PM today at Senator Toomey's office in downtown Philadelphia.

Toomey is one of the Republican senators who secretly drafted the AHCA, the "Trumpcare" Senate version released today. It is designed to slash Medicaid, and also greatly reduce healthcare for middle-class patients who are considered expensive - those who are older, or have  pre-existing conditions. The money "saved" at the cost of hundreds of thousands of lives will be used for tax breaks for rich individuals and corporations.

One of the speakers noted that the retired Senate historian recently said that the Senate has never drafted a major bill like this in secrecy, since before World War I (

Now the Republican leadership will try to pass this bill in a few days, to make it a done deal before the July 4 recess.


OK to re-post these photos.

Secret Senate Healthcare Bill Released

Here is the full text of the 142-page draft, made public today, June 22. It was created in secret by 13 senators, all Republicans and all men, without a single hearing and without significant input from doctors, hospitals, or other healthcare industries:

The Republican-controlled Senate will now try to pass it into law in a few days, before senators go home from the July 4 recess and hear from their voters. If it becomes law, it will greatly affect the 20% of Americans now covered by Medicaid, and a sixth of the total U.S. economy.

For more information:

* New York Times report on the draft released today:

* Letter to Senate leaders from 10 health-industry industry executives, on how to make healthcare more efficient and effective:

* The Upshot's analysis of the Republican's AHCA bill (published yesterday before the Senate draft was available):


Express Scripts Sues Maker of Overdose Drug, Intensifying Feud

This very expensive overdose rescue is naloxone, the same drug as Narcan, with equipment to automatically inject a dose of the drug.


HIV Medicine Association Position on the Amended AHCA

May 2, 2017: We are deeply troubled by the harm that would come to people with HIV and millions of other Americans if the amended American Health Care Act advances in Congress. We urge Congressional members to oppose the bill and protect access to healthcare coverage not only for the 1.1 million people with HIV but also for the more than 52 million others with pre-existing conditions in the U.S.

Our concerns with the AHCA grew with the proposed MacArthur Amendment that would allow states to waive key protections put in place by the Affordable Care Act.  Allowing states to waive the community rating granting insurers the flexibility to charge higher premiums for individuals based on health status would be a major setback for those with pre-existing conditions, like HIV, who are in urgent need of affordable healthcare coverage. Higher premiums and the less generous premium assistance available under the AHCA for lower income individuals would return us to the time when individuals with HIV were virtually locked out of the individual insurance market. To make matters worse, allowing states to waive the Essential Health Benefit requirement that guarantees coverage for a minimum set of services, including prescription drugs and mental health and substance use treatment, would leave patients with more costly healthcare coverage that does not meet their basic medical needs.

This latest amendment to the AHCA combined with phasing out Medicaid expansion and reducing federal support for the Medicaid program through a per capita cap financing formula would reverse recent progress made to reduce the uninsured rate and improve health outcomes among persons with HIV.  We urge Congressional members to ensure that any changes to the ACA improve healthcare access for our patients rather than leaving them worse off.  Their lives and our nation’s public health depend on it.

# # #

The HIV Medicine Association is the professional home for nearly 5,000 physicians, scientists, and other health care professionals dedicated to the field of HIV/AIDS. Nested within the Infectious Diseases Society of America, HIVMA promotes quality in HIV care and advocates policies that ensure a comprehensive and humane response to the AIDS pandemic informed by science and social justice. See more at:


Republicans may try again to repeal Obamacare, as early as this week

See "Republicans finalize new Obamacare repeal proposal,"
The new repeal version is even worse than the first. It pretends to keep coverage for pre-existing conditions - but states could obtain a waiver of this fake provision, by establishing high-risk pools for expensive patients. These pools have failed in the past because not enough money is appropriated, leaving the patients to pay enormous premium surcharges. Last we heard, the new repeal proposal even makes the waivers automatic, unless the U.S. Health and Human Services rejects them within 60 days.

Waivers can also allow states to let insurance companies delete coverage for "essential health benefits," including:
  • Ambulatory patient services (outpatient care you get without being admitted to a hospital) 
  • Emergency services 
  • Hospitalization (like surgery and overnight stays) 
  • Pregnancy, maternity, and newborn care (both before and after birth) 
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy) 
  • Prescription drugs 
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills) 
  • Laboratory services 
  • Preventive and wellness services and chronic disease management 
  • Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits).
[This list from - note that PrEP coverage could be ended since it is "preventive."]

For more information see Washington Post columnists Eugene Robinson,

Our comment: The key problem is the excessive cost of U.S. healthcare. There are huge inefficiencies in its delivery, and real reforms are needed. For example, of course costs will rise without limit when pharmaceutical companies, hospitals, insurance companies, and doctors can charge anything, and government will pay whatever is asked so that millions of Americans are not locked out of care. But the Republicans want to save money only by abandoning the poor and sick - to put that money into tax reduction for the rich, more wars around the world, and the wall.


ACT UP 30th Anniversary, New York, March 30, 2017

I took these yesterday, March 30. They are in chronological order, earliest ones first.

For info see


Survey: U.S. doctors support single-payer; here is why

A LinkedIn survey of 500 doctors found 48% supporting single payer, vs. 32% opposed - even though they expected to earn less money. The question was, "Would you support a move to single-payer healthcare, like universal Medicare coverage." The article quotes the doctors to detail some of the horrible paperwork, healthcare, and ethical costs of U.S. medical care now. See Insurance is Driving Physicians Mad; Nearly Half Now Say They’d Prefer Single-Payer.

Also, on wait times for new-patient appointments, see Healthcare Dive (an industry newsletter),


US healthcare kills: Canadians with cystic fibrosis live 49 years average, US Americans 37; whole cause is lack of healthcare

"Compared with patients in the United States who had private insurance coverage, patients in Canada had a similar risk of early death. Compared with patients who had public insurance like Medicaid, Canadians with cystic fibrosis had a 44 percent lower risk of early death. And compared with Americans who were uninsured, Canadians had a 77 percent lower risk of early death." New York Times,

The original research was published March 14, 2017, in Annals of Internal Medicine, (extended abstract available, but full  text behind paywall).

Comment: Deathcare

This study shows one way to quantify loss of life caused by excluding the poor (and some others) from healthcare. Dozens or hundreds of other studies could be done.

That access to healthcare saves lives seems obvious. But at least one conservative used selected data to argue that Obamacare does not save many lives, - published well after the two articles linked above (which it does not mention).

Another big fight will be the Trump/Republican budget, proposing huge cuts to almost all Federal activities except war - including medical research. (In science, NASA is to be spared - but focused on Mars, apparently to distract attention from Earth, which some consider more important.)


Trumpcare fails as Trump and Republicans cancel vote; Obamacare remains for now

by John S. James

Congressional Republicans cancelled a vote on the bill to repeal Obamacare, after it became clear that the replacement they proposed could not get enough votes to win.

The bill that failed was almost unanimously opposed by doctors' and other medical organizations - and then made worse to get votes of right-wing Republicans, upsetting moderate Republicans who otherwise would have voted for it. To reduce premiums, the final bill would have allowed health-insurance companies to offer policies without maternity care, emergency care, treatment for mental health or substance abuse disorders, prescription drugs, lab tests, rehabilitation, and four other "essential benefits" required by Obamacare. Many moderate Republicans could not vote for that.

For more news see GOP health-care bill: House Republican leaders abruptly pull their rewrite of the nation’s health-care law. You can also search for news on this (or any other recent news) at

Comment: What's Next

What's driving the problem is the excessive cost of U.S. health care - currently one sixth of the entire U.S. gross domestic product. The U.S. spends far more on healthcare per person than any other country in the world, but is currently #42 in life expectancy at birth (according to the CIA's list,

All the cost-reduction proposals we heard in the huge national debate leading up to the failed Trumpcare bill were either to deny healthcare to the poor, or to sell much-worse policies to the middle class. None dealt with the fundamental reason that U.S. healthcare costs so much.

The reason is that U.S. healthcare is dominated by corporations and individuals that are all about making money, whatever their mission statements may say. Almost all incentives in the system are to charge higher prices. Greed and fear work tolerably well for organizing a stock market; they don't work well for medicine.

For example, drug companies have huge biases toward developing only the most expensive therapies. New antibiotics are not a focus even though resistant infections kill many thousands of people each year in the U.S. alone. Why? Because antibiotics cure too quickly; the companies want drugs that need to be taken for years, ideally for life, so that more money can be extracted.

Combining unscrupulous, predatory, what-the-market-will-bear pricing, with the traditional ideology that human life is priceless, causes market prices to rise toward infinity (especially when there is no competition, due either to patent laws, or to regulatory logjams for generics) - not just drug prices but most prices throughout the complex, non-transparent medical system. Quite commonly one person's medical bills can be half a million dollars or more. Since almost nobody can pay that out of pocket (and they would have to pay extra-high prices if they did, since they don't have the negotiating power than insurance companies do), the idea is that almost everyone will be insured. There is little "market discipline" in this system; insurance companies usually pay if high-status doctors say it's needed. So prices go up and up while profiteers pocket the cash.

The real business model of health insurance is to find excuses not to pay for care - and also to get rid of expensive patients, one way or another (for example, automatic premium payments can go away automatically and silently at the end of the year). Despite their complaints about not being able to make money, health-insurance companies have been remarkably successful in recent years; see Gripes About Obamacare Aside, Health Insurers Are in a Profit Spiral.

And since the poor could not possibly pay the insurance premiums, co-pays, and deductibles, government pays for their care through Medicaid. This is what Republican want to get rid of - let the poor suffer and die without access to medical care. Or they can go to an emergency room when necessary to postpone death - which is not comprehensive medical care, and costs a median of $1,233 per visit (as of three years ago), according to a study by the National Institutes of Health,

And more and more of the middle class can't pay for effective insurance either, as costs go up and up. So both political parties propose various subsidies to help them, but ultimately not enough.

The result in an extremely expensive system that burdens the middle class, the poor, and the taxpayers. It has become unsustainable.

But mainstream politicians have avoided the real causes of excessive costs and prices, since talking about this would threaten profiteers who fund their campaigns. So others must take the initiative to get these problems addressed.

If Republicans or Democrats want to help improve Obamacare, they can start by talking with healthcare professionals and finding proposals that working doctors and other health professionals can support. No more schemes that are almost unanimously opposed by the medical community, please.


Good laptops for about $200: Windows 10, or Chromebook

by John S. James, March 2017

We found a surprisingly good value in an 11.6-inch Windows 10 laptop for $200, and after three weeks of use we are still impressed by what we got for the money. This laptop (ASUS E200HA) travels very well, so is good for working in coffeehouses or libraries, or for out-of-town travel (for home use you might want a larger screen, which of course is less portable).

But before buying Windows you might also consider the Chromebook - designed and programmed by Google but manufactured and sold by various other companies. Chromebooks can cost even less than $200, and are much easier than Windows to set up and use.

Trumpcare in Congress: Quick Overview Now

by John S. James, March 20

This week the House of "Representatives" may vote on the major Republican effort to repeal Obamacare, replacing it with what is increasingly called Trumpcare (though President Trump doesn't want his name on his own main project). The Congressional Budget Office (the most thorough and objective analyst of the plans) predicts that 14 million people will lose healthcare in the first year, rising 24 million by 2026, compared to not changing the law.

Despite strong oppositions by doctors, medical organizations, hospitals, and many others including Trump voters, Republicans are determined to push this through. They have a majority in the House (due to heavy gerrymandering and voter suppression) - and a small majority in the Senate (due to voter suppression but not gerrymandering, since the Senate's election districts are fixed at state borders).

Most or all of the Republican replacements for Obamacare will basically end Medicaid, the Federal program of medical care for the poor, who have no other way to get acceptable healthcare in most cases (federally qualified health centers could help in some areas, but without Medicaid their funding is uncertain - as is their ability to scale up fast enough to treat 14 million more patients next year). And for the middle class, the plans will increase healthcare costs for older individuals, and also increase costs in certain geographic areas (including some that voted heavily for Trump), based on hastily devised formulas. For healthy young people who are unlikely to need much medical care, costs will often decrease, especially in certain areas. Total Federal costs will decrease by many billions of dollars - which Trump already plans to give in tax cuts, mainly to very rich individuals and corporations. (The big war budget comes from huge cuts in other programs, including the National Institutes of Health and other scientific and medical research - when the U.S. already spends about as much for its military as all countries on Earth put together.)

Some Republican plans promise to protect those with pre-existing conditions, but whether and how this will work in practice is not clear. Tax credits under some plans will help middle-class persons pay for insurance or other healthcare expenses; but this will not help much in cases of serious illness if out-of-pocket expenses greatly exceed the person's total federal taxes for the year. U.S. medical care for serious conditions often costs hundreds of thousands of dollars.

If a bill passes the House and the Senate, Trump will almost certainly sign it into law.

When these changes will happen depends on the plan that is finally adopted. Some changes, including the end of the Medicaid entitlement, will likely take place immediately. (The entitlement, which exists now and has existed since President Johnson started Medicaid in the 1960s, means that Medicaid patients have a right to certain healthcare, so they will still get treated even if the program runs out of money; Congress is ultimately responsible for finding enough funds. Without the entitlement, patients' treatment can stop when money runs out for the year.)

The  Medicaid expansion (allowing persons under 65 and with incomes up to 133% of the Federal poverty level to get healthcare through the program - at 65 they become eligible for Medicare instead) may be phased out over several years - or much faster, depending on what replacement plan if any becomes law. (Federal Poverty Level is currently $12,060 for an individual, $16,240 for a family of 2, $20,420 for a family of 3, etc.; see  - and multiply by 133% to get eligibility for Medicaid in the 31 states who's governors have accepted the expansion. But be aware that the whole program could go away.)

And what is NOT in the Republican plans? Any serious effort to reduce the greatly inflated costs of U.S. healthcare, except by kicking many millions of people out of medical care entirely. And of course single-payer is nowhere in sight; it could eliminate all sorts of gamesmanship, and endless paperwork and paperlesswork - ending most unnecessary surgeries,  tests, and other procedures, and allowing doctors to focus on providing medical care instead of justifying and processing reimbursements.

Last Week: Trumpcare Got Even Worse

Many "conservative" Republicans don't like Trumpcare, calling it "Obamacare lite." They don't like the concessions that Ryan and Trump made to reduce political opposition - such as saying that they will not allow insurance companies to reject people with pre-existing conditions, and phasing in the end of Medicaid over several years instead of much faster.

So Ryan and Trump sweetened the bill for conservatives by allowing a work requirement for able-bodied adults. The main effect will be dropping many people from Medicaid. It is unlikely to increase employment much, for many reasons - especially lack of jobs for those without special skills and experience, and millions of mostly minority citizens being made unemployable by police records that can hardly be avoided in many U.S. cities. And to the extent that the work requirement does increase employment, it will allow employers to reduce already unlivable wages for probably millions of people.

The other change being talked about is allowing states to get Federal Medicaid support (until it goes away) as a block grant instead of per Medicaid patient - in return for more "flexibility" in how states run their programs, and decide who gets treated and who does not.

Also, almost all complex federal laws have tricky wordings that deliver gifts to insider special interests - without the public, press, or most of Congress that votes for the law knowing what is going on. Keep an eye out for these. They could possibly even include attacks on MediCARE - which is ignored in the original Trumpcare, but some of the other Republican proposals for replacing Obamacare proposed changing Medicare as well. Conservative Republicans have never been happy with the three major entitlement programs, Social Security, Medicare, or Medicaid. They picked Medicaid to attack first for strategic reasons, because it is mostly (though not entirely) for the poor and lower-paid middle class.

For More Information

We are preparing an ongoing list of published articles with reliable information at the time of publication. Be aware that the situation changes very fast, often day to day, so older articles may no longer be correct.


Drug prices: Problems in funding patient advocacy groups

New York Times, March 1: 

More Than 80 Percent of Patient Groups Accept Drug Industry Funds, Study Shows

"Nearly 'nine out of every 10 are taking money,' said Dr. Ezekiel J. Emanuel, an oncologist and vice provost at the University of Pennsylvania. He is one of the authors of the study, which looked at the top 104 nonprofit patient advocacy groups that reported more than $7.5 million in annual revenues for 2014. 'I think that is not well known — I think that is a shock.'"

Comment: If we want to build social capital that can help get abusive healthcare prices under control, it's not enough to say that most patient advocacy groups are bad. I've been involved in patient advocacy for 3 decades, and it's very difficult to get other  funding. People want to do advocacy, but for a serious commitment almost everyone needs at least a stipend to live on, and minimal computer etc. expenses. (Even the original Emanual article in the New England Journal of Medicine is behind a paywall - starting at $20 for 24-hour access, and you have to register just to see that price.)

Foundations are reluctant because they don't know the medical area, many won't consider individuals or new organizations, and most require 501(c)3 status, which doesn't allow much advocacy. Governments cannot help advocacy, of course. Individual donors will need to step up and help create new organizations to handle this.

Note: ACT UP Philadelphia is an all-volunteers organization that does not accept any drug company funding. Funding is difficult, but possible because this organization has been active for 30 years. We cannot build a whole movement that way.


ACT UP testimony on housing needs of people with HIV in Philadelphia

Testimony by Max Ray-Riek
Member, ACT UP Philadelphia

Philadelphia is completing its first HOPWA needs assessment in 20 years. The quantitative portion of the assessment is not complete, but the qualitative portion has been released, and points to some very important themes that will be crucial to get right if we want to fight the many epidemics threatening Philadelphia’s public health, including HIV but also homelessness, drug and alcohol addiction, and mental illness.

In order to move forward, we need to build on the needs assessment to craft a comprehensive, city-wide plan for improving the public health of Philadelphia through ending homelessness, and the HOPWA needs assessment provides some clear next steps.

Solution Step 1: We need to coordinate care and services across multiple city departments and private agencies, through a centralized housing case management service. This needs to include centralizing data and maintaining a single master wait list in which people are automatically applied to any program for which they are eligible.

Federal best practices strongly recommend the housing hub model I am describing, but Philadelphia has challenges to overcome to get there.


Tuesday with Toomey protests continue - office will move March 1

Below are pictures we took February 21 at Toomey's current office, 17th and JFK. The crowd has not diminished from two weeks ago. The group  will meet again at this location on February 28.

The new office, at the U.S. Customs House, 200 Chestnut St, is harder for most working people to get to on their lunch break. For news of the demos and their location, see, or search for TuesdayswithToomey.

Republican Senator Toomey also conducted a fake Town Hall meeting totally controlled by the organizers - a conference call announced 90 minutes before it began, according the news article above.


Resistance Recess events: important

"The week of February 18–26 is the first recess of the 115th Congress—time specifically set aside for members of Congress to meet with constituents and get the pulse of the communities they represent.

"This is the perfect time to raise our voices. We will show up at our elected officials' events, town halls, other public appearances, and even plan our own events, if they refuse to meet with us, to make it clear to those who represent us, as well as to the media, that tolerance of Trump's hurtful agenda is unacceptable and politically toxic. ..."

Meet the Press this week: what's happening in Washington

Experts have different views on whether Trump can recover from the chaos and put together a functioning government, perhaps by next year. Long transcript but worth it,

The video (dated Feb. 19th) will probably be available at, but it's not there as we publish this, since the show is  currently on the air.

NBC's Meet the Press is the longest-running TV show in U.S. history (and probably worldwide).


Trump's EPA head Scott Pruitt confirmed today (Feb. 17)

Smog in Beijing, by 螺钉 (Own work) [CC BY-SA 3.0 ], via Wikimedia Commons
As Oklahoma's attorney general, Scott Pruitt sued the EPA 14 times, trying to roll back its protections against mercury, vehicle exhaust, and other  air pollution.

Thanks largely to the EPA, the U.S. has until now maintained good air quality compared to many other countries:

Environment is a health issue. Air pollution is believed to contribute to the deaths of 1.6 million people each year in China

For more on Pruitt and his Senate confirmation, see


HIV science and medicine conference (CROI 2017) Feb 13 - 16; watch the news

An excellent way to follow newspaper, newsletter, and other media reports of this major HIV scientific/medical conference is to visit and search for: CROI Seattle.


Dental cavities: new brush-on treatment SDF usually cures them with no drilling or injection

SDF is a new brush-on cavity treatment that kills decay-causing bacteria and can cure most cavities with no drilling - and no injection, since no anesthetic is needed. Cost is minimal, much less than the usual drill-and-fill cavity treatment. SDF is FDA-approved for some uses, and was first available to U.S. dentists in 2015 (but has been used in some countries for decades, for all ages).

The biggest public-health advantage is that each dentist (or dental assistant) can now treat many more patients than before, at greatly reduced cost -- reducing the burden of untreated tooth decay in those who could not pay for dentistry until now.


Tuesdays with Toomey - photos today Feb. 7

Every Tuesday hundreds of people gather outside the office of Republican Senator Pat Toomey in Philadelphia, and more at his other offices around the state - Pennsylvania actions with national relevance According to many reports Toomey is dodging his constituents in Philadelphia at least, with phones unanswered, no office meetings, and no public town-halls meetings; no great surprise since Republicans represent big money, and voters are to be tricked and managed, or ignored if that's not possible. We took these pictures in Philadelphia today (Feb. 7), an ordinary Tuesday.

For more info from social media and the press, search for TuesdaysWithToomey. The Philadelphia protest is at 17th and JFK, starting every Tuesday at 12:20 (20 minutes after noon so that downtown workers can get there on their lunch break). Many of these people had never been to a demonstration before the Trump presidency.


Air pollution may contribute greatly to dementia

"Residing in places with fine PM (particulate matter) exceeding EPA standards increased the risks for global cognitive decline and all-cause dementia respectively by 81 and 92%," according to a major study of over 3,600 older American women, all of whom started the study without dementia. And women with a gene that causes a higher risk of Alzheimer's were almost three times as likely to develop dementia if they lived in a higher-pollution area, compared to women with the same gene in areas with low air pollution.

For more information see: 

Comment: we checked global air pollution maps at and found that the U.S. is doing surprisingly well among industrialized countries, even in most urban areas such as New York City. Much of China is very bad, with 10 or more times the average U.S. air pollution. Many places  in Mexico, Eastern Europe, and elsewhere are similarly bad.  We suggest checking air-pollution maps before planning extensive trips abroad.

This U.S. success is not an accident, but is due to the Clean Air Act and the EPA (U.S. Environmental Protection Agency). Today all three branches of government are controlled by a political party that is an enemy of both. China shows what happens when you let industry use the Earth's atmosphere as a free, unlimited hazardous-waste dump.

2017-01-31 - Experts tell how to make Congress listen

More than 30 progressive staffers who worked for members of Congress contributed to a 26-page report on how to work in small, local groups to make your 3 Congressional representatives more responsive to what you need and want. They know what matters to senators and representatives, and how to get them to listen. See

Their strategy is based on that of the Tea Party, which unfortunately was successful in fighting Obama's agenda. The Tea Party succeeded in spite of the fact that it was fighting a much more popular president than we have today, who also had much larger Congressional majorities. The Tea Party defeated not only Democrats, but even important Republicans who were not fanatic enough. It worked because enough people cared. And people care today.

The report is called Indivisible, subtitled A Practical Guide for Resisting the Trump Agenda. You can read it online or download a copy at

You can also use that website to help you find or start a local group. All the information is currently available in English and Spanish.