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California Dabbles With Reining in Health Spending

California is now among the states trying to keep health-care costs down by setting spending caps — a task that pits public officials against a deeply entrenched and heavily lawyered set of players.

It’s uncertain whether the state can get insurers, hospitals and medical groups to collaborate on containing costs even as they jockey for their slice of California’s $400 billion-plus health-care pie.

The verdict could take years.

In late April, the state’s new Office of Health Care Affordability set a five-year target for spending growth that starts at 3.5 percent for 2025 and drops to 3 percent by 2029. The goal of the embryonic agency is to make care more affordable and accessible while improving health outcomes and reducing inequity.

To do so, California’s affordability office must confront high prices, unnecessary medical treatments, overuse of high-cost care like emergency rooms, and administrative waste. Not to mention state policies that favor greater investment in health care, which means more revenue for the industry.

This year, when the office was considering an annual per capita spending growth target of 3 percent, the California Hospital Association said the figure did not account for the state’s aging population, new investments in its Medicaid program and other cost pressures. Instead, the hospitals proposed a 5.3 percent average annual target over the five-year period.

The California Medical Association, which represents the state’s doctors, has expressed similar concerns.

For health-care organizations that miss the target, a long and messy process begins that could end with fines of as much as 100 percent of the overspending. But that probably wouldn’t happen until 2030 or beyond, if ever.

In 2013, Massachusetts was the first state to set annual spending targets. Connecticut, Delaware, Nevada, New Jersey, Oregon, Rhode Island and Washington are among other states that have set targets.

The results in Massachusetts have been mixed: The state beat its target in three of the first five years, falling below the average national spending increase.

But more recently, its health spending has increased. In 2022, it exceeded the target by nearly double, and the state’s Health Policy Commission, which oversees spending control efforts, warned of “many alarming trends.”

Proponents of California’s affordability agency hope that open dialogue — coupled with plans to make more detailed spending data public, including for specific health-care organizations — will foster greater industry accountability.

Rhode Island, despite a preexisting policy of limiting hospital price increases, exceeded its overall health-care spending growth target in 2019, the year it took effect. In 2020 and 2021, spending was largely skewed by the coronavirus pandemic. But in 2022, the spending increase came in at half the state’s target rate.

This article is not available for syndication due to republishing restrictions. If you have questions about the availability of this or other content for republication, please contact NewsWeb@kff.org.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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HHS Celebrates One-Year Anniversary of the U.S. National Plan to End Gender-Based Violence with Fact Sheet of Recent Accomplishments

HHS Gov News - June 11, 2024
HHS Celebrates One-Year Anniversary of the U.S. National Plan to End Gender-Based Violence with Fact Sheet of Recent Accomplishments

End of Internet Subsidy Leaves Millions Facing Telehealth Disconnect

When the clock struck midnight on May 31, more than 23 million low-income households were dropped from a federal internet subsidy program that for years had helped them get connected.

The Affordable Connectivity Program was created in 2021, in the midst of the covid-19 pandemic, to help people plug into jobs, schools and health care by reducing their internet costs by up to $75 a month.

Helping connect households was particularly important in rural America, where telehealth services are often leaned on to fill health care gaps and address provider shortages.

But that aid evaporated last month when Congress didn’t move to keep it funded.

“Internet bills for millions of Americans are increasing because Congressional Republicans failed to act,” White House spokesperson Robyn Patterson emailed me.

Some lawmakers have argued that too much of the subsidy money went to people who don’t need it. Last month, Republicans and Democrats introduced proposals to address those concerns. The ACP debate continues, with a funding measure expected to be part of the Spectrum and National Security Act of 2024, under consideration Wednesday by the Senate’s Commerce, Science and Transportation Committee.

The day before the subsidies expired, White House officials offered a consolation prize, announcing they had worked out a deal with 15 internet providers that agreed to keep offering low-cost plans. The announcement isn’t really new, though, nor as robust as a previous deal.

In 2022, the Biden administration announced that 20 companies would offer plans for $30 a month or less. AT&TVerizon and Comcast are among the players continuing to sell low-cost plans the administration says will benefit an estimated 10 million households.

Of course, low-cost plans still come with bills consumers must pay. And without the connectivity program’s monthly assistance, 77 percent of households that benefited from it will have to change plans or drop their internet connections, Jessica Rosenworcel, chair of the Federal Communications Commission, wrote in a letter to lawmakers.

“A consistent theme is that many ACP recipients are seniors on fixed incomes struggling to pay competing bills and make ends meet,” she wrote.

Those affected are people like Myrna Broncho, 69, a Shoshone-Bannock tribal member who talked with me at the Fort Hall Reservation in southeastern Idaho. She had qualified for a $75 subsidy, enough to eliminate her internet bill after she signed on last year.

Without the subsidy, she’ll have to “go back on my tight budget.” Retired and ranching, Broncho said she uses the internet for shopping, paying bills and keeping track of her health care.

Rosenworcel’s letter arguing for renewed funding for the ACP was sent to a handful of lawmakers, including Sens. Maria Cantwell (D-Wash.), who chairs the commerce committee, and Ted Cruz (R-Tex.), who has proposed greatly narrowing eligibility for the program.

This article is not available for syndication due to republishing restrictions. If you have questions about the availability of this or other content for republication, please contact NewsWeb@kff.org.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Bird Flu Tests Are Hard To Get. So How Will We Know When To Sound the Pandemic Alarm?

Stanford University infectious disease doctor Abraar Karan has seen a lot of patients with runny noses, fevers, and irritated eyes lately. Such symptoms could signal allergies, covid, or a cold. This year, there’s another suspect, bird flu — but there’s no way for most doctors to know.

If the government doesn’t prepare to ramp up H5N1 bird flu testing, he and other researchers warn, the United States could be caught off guard again by a pandemic.

“We’re making the same mistakes today that we made with covid,” Deborah Birx, who served as former President Donald Trump’s coronavirus response coordinator, said June 4 on CNN.

To become a pandemic, the H5N1 bird flu virus would need to spread from person to person. The best way to keep tabs on that possibility is by testing people.

Scientifically speaking, many diagnostic laboratories could detect the virus. However, red tape, billing issues, and minimal investment are barriers to quickly ramping up widespread availability of testing. At the moment, the Food and Drug Administration has authorized only the Centers for Disease Control and Prevention’s bird flu test, which is used only for people who work closely with livestock.

State and federal authorities have detected bird flu in dairy cattle in 12 states. Three people who work on separate dairy farms tested positive, and it is presumed they caught the virus from cows. Yet researchers agree that number is an undercount given the CDC has tested only about 40 people for the disease.

“It’s important to know if this is contained on farms, but we have no information because we aren’t looking,” said Helen Chu, an infectious disease specialist at the University of Washington in Seattle who alerted the country to covid’s spread in 2020 by testing people more broadly.

Reports of untested sick farmworkers — as well as a maternity worker who had flu symptoms — in the areas with H5N1 outbreaks among cattle in Texas suggest the numbers are higher. And the mild symptoms of those who tested positive — a cough and eye inflammation, without a fever — are such that infected people might not bother seeking medical care and, therefore, wouldn’t be tested.

The CDC has asked farmworkers with flu symptoms to get tested, but researchers are concerned about a lack of outreach and incentives to encourage testing among people with limited job security and access to health care. Further, by testing only on dairy farms, the agency likely would miss evidence of wider spread.

“It’s hard to not compare this to covid, where early on we only tested people who had traveled,” said Benjamin Pinsky, medical director of the clinical virology laboratory at Stanford University. “That left us open to not immediately recognizing that it was transmitting among the community.”

In the early months of covid, the rollout of testing in the United States was catastrophically slow. Although the World Health Organization had validated a test and other groups had developed their own using basic molecular biology techniques, the CDC at first insisted on creating and relying on its own test. Adding to delays, the first version it shipped to state health labs didn’t work.

The FDA lagged, too. It didn’t authorize tests from diagnostic laboratories outside of the CDC until late February 2020.

On Feb. 27, 2020, Chu’s research lab detected covid in a teenager who didn’t meet the CDC’s narrow testing criteria. This case sounded an alarm that covid had spread below the radar. Scaling up to meet demand took time: Months passed before anyone who needed a covid test could get one.

Chu notes this isn’t 2020 — not by a long shot. Hospitals aren’t overflowing with bird flu patients. Also, the country has the tools to do much better this time around, she said, if there’s political will.

For starters, tests that detect the broad category of influenzas that H5N1 belongs to, called influenza A, are FDA-approved and ubiquitous. These are routinely run in the “flu season,” from November to February. An unusual number of positives from these garden-variety flu tests this spring and summer could alert researchers that something is awry.

Doctors, however, are unlikely to request influenza A tests for patients with respiratory symptoms outside of flu season, in part because health insurers may not cover them except in limited circumstances, said Alex Greninger, assistant director of the clinical virology laboratory at the University of Washington.

That’s a solvable problem, he added. At the peak of the covid pandemic, the government overcame billing issues by mandating that insurance companies cover tests, and set a lucrative price to make it worthwhile for manufacturers. “You ran into a testing booth on every other block in Manhattan because companies got $100 every time they stuck a swab in someone’s nose,” Greninger said.

Another obstacle is that the FDA has yet to allow companies to run their influenza A tests using eye swabs, although the CDC and public health labs are permitted to do so. Notably, the bird flu virus was detected only in an eye swab from one farmworker infected this year — and not in samples drawn from the nose or throat.

Overcoming such barriers is essential, Chu said, to ramp up influenza A testing in regions with livestock. “The biggest bang for the buck is making sure that these tests are routine at clinics that serve farmworker communities,” she said, and suggested pop-up testing at state fairs, too.

In the meantime, novel tests that detect the H5N1 virus, specifically, could be brought up to speed. The CDC’s current test isn’t very sensitive or simple to use, researchers said.

Stanford, the University of Washington, the Mayo Clinic, and other diagnostic laboratories that serve hospital systems have developed alternatives to detecting the virus circulating now. However, their reach is limited, and researchers stress a need to jump-start additional capacity for testing before a crisis is underway.

“How can we make sure that if this becomes a public health emergency we aren’t stuck in the early days of covid, where things couldn’t move quickly?” Pinsky said.

A recent rule that gives the FDA more oversight of lab-developed tests may bog down authorization. In a statement to KFF Health News, the FDA said that, for now, it may allow tests to proceed without a full approval process. The CDC did not respond to requests for comment.

But the American Clinical Laboratory Association has asked the FDA and the CDC for clarity on the new rule. “It’s slowing things down because it’s adding to the confusion about what is allowable,” said Susan Van Meter, president of the diagnostic laboratory trade group.

Labcorp, Quest Diagnostics, and other major testing companies are in the best position to manage a surge in testing demand because they can process hundreds per day, rather than dozens. But that would require adapting testing processes for their specialized equipment, a process that consumes time and money, said Matthew Binnicker, director of clinical virology at the Mayo Clinic.

“There’s only been a handful of H5N1 cases in humans the last few years,” he said, “so it’s hard for them to invest millions when we don’t know the future.”

The government could provide funding to underwrite its research, or commit to buying tests in bulk, much as Operation Warp Speed did to advance covid vaccine development.

“If we need to move to scale this, there would need to be an infusion of money,” said Kelly Wroblewski, director of infectious disease programs at the Association of Public Health Laboratories. Like an insurance policy, the upfront expense would be slight compared with the economic blow of another pandemic.

Other means of tracking the H5N1 virus are critical, too. Detecting antibodies against the bird flu in farmworkers would help reveal whether more people have been infected and recovered. And analyzing wastewater for the virus could indicate an uptick in infections in people, birds, or cattle.

As with all pandemic preparedness efforts, the difficulty lies in stressing the need to act before a crisis strikes, Greninger said.

“We should absolutely get prepared,” he said, “but until the government insures some of the risk here, it’s hard to make a move in that direction.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Biden Plan to Save Medicare Patients Money on Drugs Risks Empty Shelves, Pharmacists Say

Months into a new Biden administration policy intended to lower drug costs for Medicare patients, independent pharmacists say they’re struggling to afford to keep some prescription drugs in stock.

“It would not matter if the governor himself walked in and said, ‘I need to get this prescription filled,’” said Clint Hopkins, a pharmacist and co-owner of Pucci’s Pharmacy in Sacramento, California. “If I’m losing money on it, it’s a no.”

A regulation that took effect in January changes prescription prices for Medicare beneficiaries. For years, prices included pharmacy performance incentives, possible rebates, and other adjustments made after the prescription was filled. Now the adjustments are made first, at the pharmacy counter, reducing the overall cost for patients and the government. But the new system means less money for pharmacies that acquire and stock medications, pharmacists say.

Pharmacies are already struggling with staff shortages, drug shortages, fallout from opioid lawsuits, and rising operating costs. While independent pharmacies are most vulnerable, some big chain pharmacies are also feeling a cash crunch — particularly those whose parent firms don’t own a pharmacy benefit manager, companies that negotiate drug prices between insurers, drug manufacturers, and pharmacies.

A top official at the Centers for Medicare & Medicaid Services said it’s a matter for pharmacies, Medicare insurance plans, and PBMs to resolve.

“We cannot interfere in the negotiations that occur between the plans and pharmacy benefits managers,” Meena Seshamani, director of the Center for Medicare, said at a conference on June 7. “We cannot tell a plan how much to pay a pharmacy or a PBM.”

Nevertheless, CMS has reminded insurers and PBMs in several letters that they are required to provide the drugs and other benefits promised to beneficiaries.

Several independent pharmacists told KFF Health News they’ll soon cut back on the number of medications they keep on shelves, particularly brand-name drugs. Some have even decided to stop accepting certain Medicare drug plans, they said.

As he campaigns for reelection, President Joe Biden has touted his administration’s moves to make prescription drugs more affordable for Medicare patients, hoping to appeal to voters troubled by rising health care costs. His achievements include a law, the Inflation Reduction Act, that caps the price of insulin at $35 a month for Medicare patients; caps Medicare patients’ drug spending at $2,000 a year, beginning next year; and allows the program to bargain down drug prices with manufacturers.

More than 51 million people have Medicare drug coverage. CMS officials estimated the new rule reducing pharmacy costs would save beneficiaries $26.5 billion from 2024 through 2032.

Medicare patients’ prescriptions can account for at least 40% of pharmacy business, according to a February survey by the National Community Pharmacists Association.

Independent pharmacists say the new rule is causing them financial trouble and hardship for some Medicare patients. Hopkins, in Sacramento, said that some of his newer customers used to rely on a local grocery pharmacy but came to his store after they could no longer get their medications there.

The crux of the problem is cash flow, the pharmacists say. Under the old system, pharmacies and PBMs reconciled rebates and other behind-the-scenes transactions a few times a year, resulting in pharmacies refunding any overpayments.

Now, PBM clawbacks happen immediately, with every filled prescription, reducing pharmacies’ cash on hand. That has made it particularly difficult, pharmacists say, to stock brand-name drugs that can cost hundreds or thousands of dollars for a month’s supply.

Some patients have been forced to choose between their pharmacy and their drug plan. Kavanaugh Pharmacy in Little Rock, Arkansas, no longer accepts Cigna and Wellcare Medicare drug plans, said co-owner and pharmacist Scott Pace. He said the pharmacy made the change because the companies use Express Scripts, a PBM that has cut its reimbursements to pharmacies.

“We had a lot of Wellcare patients in 2023 that either had to switch plans to remain with us, or they had to find a new provider,” Pace said.

Pace said one patient’s drug plan recently reimbursed him for a fentanyl patch $40 less than his cost to acquire the drug. “Because we’ve had a long-standing relationship with this particular patient, and they’re dying, we took a $40 loss to take care of the patient,” he said.

Conceding that some pharmacies face cash-flow problems, Express Scripts recently decided to accelerate payment of bonuses for meeting the company’s performance measures, said spokesperson Justine Sessions. She declined to answer questions about cuts in pharmacy payments.

Express Scripts, which is owned by The Cigna Group, managed 23% of prescription claims last year, second to CVS Health, which had 34% of the market.

In North Carolina, pharmacist Brent Talley said he recently lost $31 filling a prescription for a month’s supply of a weight control and diabetes drug.

To try to cushion such losses, Talley’s Hayes Barton Pharmacy sells CBD products and specialty items like reading glasses, bath products, and books about local history. “But that’s not going to come close to making up the loss generated by the prescription sale,” Talley said.

His pharmacy also delivers medicines packaged by the dose to Medicare patients at assisted living facilities and nursing homes. Reimbursement arrangements with PBMs for that business are more favorable than for filling prescriptions in person, he said.

When Congress added drug coverage to Medicare in 2003, lawmakers privatized the benefit by requiring the government to contract with commercial insurance companies to manage the program.

Insurers offer two options: Medicare Advantage plans, which usually cover medications, in addition to hospital care, doctor visits, and other services; as well as stand-alone drug plans for people with traditional Medicare. The insurers then contract with PBMs to negotiate drug prices and pharmacy costs with drug manufacturers and pharmacies.

The terms of PBM contracts are generally secret and restrict what pharmacists can tell patients — for example, if they’re asked why a drug is out of stock. (It took an act of Congress in 2018 to eliminate restrictions on disclosing a drug’s cash price, which can sometimes be less than an insurance plan’s copayment.)

The Pharmaceutical Care Management Association, a trade group representing PBMs, warned CMS repeatedly “that pharmacies would likely receive lower payments under the new Medicare Part D rule,” spokesperson Greg Lopes said. His group opposes the change.

Recognizing the new policy could cause cash-flow problems for pharmacies, Medicare officials had delayed implementation for a year before the rule took effect, giving them more time to adjust.

“We have heard pharmacies saying that they have concerns with their reimbursement,” Seshamani said.

But the agency isn’t doing enough to help now, said Ronna Hauser, senior vice president of policy and pharmacy affairs at the National Community Pharmacists Association. “They haven’t taken any action even after we brought potential violations to their attention,” she said.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Heat Rules for California Workers Would Also Help Keep Schoolchildren Cool

Kaiser Health News:States - June 10, 2024

SACRAMENTO, Calif. — Proposed rules to protect California workers from extreme heat would extend to schoolchildren, requiring school districts to find ways to keep classrooms cool.

If the standards are approved this month, employers in the nation’s most populous state will have to provide relief to indoor workers in sweltering warehouses, steamy kitchens, and other dangerously hot job sites. The rules will extend to schools, where teachers, custodians, cafeteria workers, and other employees may work without air conditioning — like their students.

“Our working conditions are students’ learning conditions,” said Jeffery Freitas, president of the California Federation of Teachers, which represents more than 120,000 teachers and other educational employees. “We’re seeing an unprecedented change in the environment, and we know for a fact that when it’s too hot, kids can’t learn.”

A state worker safety board is scheduled to vote on the rules June 20, and they would likely take effect this summer. The move, which marks Democratic Gov. Gavin Newsom’s latest effort to respond to the growing impacts of climate change and extreme heat, would put California ahead of the federal government and much of the nation in setting heat standards.

The standards would require indoor workplaces to be cooled below 87 degrees Fahrenheit when employees are present and below 82 degrees in places where workers wear protective clothing or are exposed to radiant heat, such as furnaces. Schools and other worksites that don’t have air conditioning could use fans, misters, and other methods to bring the room temperature down.

The rules allow workarounds for businesses, including the roughly 1,000 school districts in the state, if they can’t cool their workplaces sufficiently. In those cases, employers must provide workers with water, breaks, areas where they can cool down, cooling vests, or other means to keep employees from overheating.

“Heat is a deadly hazard no matter what kind of work you do,” said Laura Stock, a member of the Occupational Safety and Health Standards Board. “If you have an indoor space that is both populated by workers and the public, or in this case by children, you would have the same risks to their health as to workers.”

Heat waves have historically struck outside of the school year, but climate change is making them longer, more frequent, and more intense. Last year was the hottest on record and schools across the U.S. closed sporadically during spring and summer, unable to keep students cool.

Scientists say this year could be even hotter. School officials in Vicksburg, Mississippi, last month ended the school year early when air conditioners had issues. And California’s first heat wave of the season is hitting while some schools are still in session, with temperatures reaching 105 in the Central Valley.

Several states, including Arizona and New Mexico, require schools to have working air conditioners, but they aren’t required to run them. Mississippi requires schools to be air-conditioned but doesn’t say to what temperature. Hawaii schools must have classrooms at a “temperature acceptable for student learning,” without specifying the temperature. And Oregon schools must try to cool classrooms, such as with fans, and provide teachers and other employees ways to cool down, including water and rest breaks, when the heat index indoors reaches 80 degrees.

When the sun bakes the library at Bridges Academy at Melrose, a public school in East Oakland with little shade and tree cover, Christine Schooley closes the curtains and turns off the computers to cool her room. She stopped using a fan after a girl’s long hair got caught in it.

“My library is the hottest place on campus because I have 120 kids through here a day,” Schooley said. “It stays warm in here. So yeah, it makes me grouchy and irritable as well.”

A 2021 analysis by the Center for Climate Integrity suggests nearly 14,000 public schools across the U.S. that did not need air conditioning in 1970 now do, because they annually experience 32 days of temperatures more than 80 degrees — upgrades that would cost more than $40 billion. Researchers found that same comparison produces a cost of $2.4 billion to install air conditioning in 678 California schools.

It’s not clear how many California schools might need to install air conditioners or other cooling equipment to comply with the new standards because the state doesn’t track which ones already have them, said V. Kelly Turner, associate director of the Luskin Center for Innovation at the University of California-Los Angeles.

And a school district in the northern reaches of the state would not face the same challenges as a district in the desert cities of Needles or Palm Springs, said Naj Alikhan, a spokesperson for the Association of California School Administrators, which has not taken a position on the proposed rules.

An economic analysis commissioned for the board provided cost estimates for a host of industries — such as warehousing, manufacturing, and construction — but lacked an estimate for school districts, which make up one of the largest public infrastructure systems in the state and already face a steep backlog of needed upgrades. The state Department of Education hasn’t taken a position on the proposal and a spokesperson, Scott Roark, declined to comment on the potential cost to schools.

Projections of a multibillion-dollar cost to state prisons were the reason the Newsom administration refused to sign off on the indoor heat rules this year. Since then, tens of thousands of prison and jail employees — and prisoners — have been exempted.

It’s also unclear whether the regulation will apply to school buses, many of which don’t have air conditioning. The Department of Industrial Relations, which oversees the worker safety board, has not responded to queries from school officials or KFF Health News.

Libia Garcia worries about her 15-year-old son, who spends at least an hour each school day traveling on a hot, stuffy school bus from their home in the rural Central Valley community of Huron to his high school and back. “Once my kid arrives home, he is exhausted; he is dehydrated,” Garcia said in Spanish. “He has no energy to do homework or anything else.”

The California Federation of Teachers is pushing state lawmakers to pass a climate-resilient schools bill that would require the state to develop a master plan to upgrade school heating and air conditioning systems. Newsom last year vetoed similar legislation, citing the cost.

Campaigns to cool schools in other states have yielded mixed results. Legislation in Colorado and New Hampshire failed this year, while a bill in New York passed on June 7 and was headed to the governor for approval. A New Jersey proposal was pending as of last week. Last month, a teachers union in New York brought a portable sauna to the state Capitol to demonstrate how hot it can get inside classrooms, only a quarter of which have air conditioning, said Melinda Person, president of New York State United Teachers.

“We have these temperature limits for animal shelters. How is it that we don’t have it for classrooms?” said Democratic New York Assembly member Chris Eachus, whose bill would require schools to take relief measures when classrooms and buildings reach 82 degrees. “We do have to protect the health and safety of the kids.”

Extreme heat is the No. 1 weather-related killer in the U.S. — deadlier than hurricanes, floods, and tornadoes. Heat stress can cause heatstroke, cardiac arrest, and kidney failure. The Centers for Disease Control and Prevention reported 1,600 heat-related deaths occurred in 2021, which is likely an undercount because health care providers are not required to report them. It’s not clear how many of these deaths are related to work, either indoors or outdoors.

California has had heat standards on the books for outdoor workers since 2005, and rules for indoor workplaces have been in development since 2016 — delayed, in part, because of the covid pandemic.

At the federal level, the Biden administration has been slow to release a long-awaited regulation to protect indoor and outdoor workers from heat exposure. Although an official said a draft is expected this year, its outlook could hinge on the November presidential election. If former President Donald Trump wins, it is unlikely that rules targeting businesses will move forward.

The Biden White House held a summit on school sustainability and climate change in April, at which top officials encouraged districts to apply an infusion of new federal dollars to upgrade their aging infrastructure. The administration also unveiled an 18-page guide for school districts to tap federal funds.

“How we invest in our school buildings and our school grounds, it makes a difference for our students’ lives,” Roberto Rodriguez, an assistant secretary at the U.S. Department of Education, said at the summit. “They are on the front line in terms of feeling those impacts.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Nursing Homes Are Left in the Dark as More Utilities Cut Power To Prevent Wildfires

Kaiser Health News:States - June 10, 2024

When powerful wind gusts created threatening wildfire conditions one day near Boulder, Colorado, the state’s largest utility cut power to 52,000 homes and businesses — including Frasier, an assisted living and skilled nursing facility.

It was the first time Xcel Energy preemptively switched off electricity in Colorado as a wildfire prevention tool, according to a company official. The practice, also known as public safety power shut-offs, has taken root in California and is spreading elsewhere as a way to keep downed and damaged power lines from sparking blazes and fueling the West’s more frequent and intense wildfires.

In Boulder, Frasier staff and residents heard about the planned outage from news reports. A Frasier official called the utility to confirm and was initially told the home’s power would not be affected. The utility then called back to say the home’s power would be cut, after all, said Tomas Mendez, Frasier’s vice president of operations. The home had just 75 minutes before Xcel Energy shut off the lights on April 6.

Staff rushed to prepare the 20-acre campus home to nearly 500 residents. Generators kept running the oxygen machines, most refrigerators and freezers, hallway lights, and Wi-Fi for phones and computers. But the heating system and some lights stayed off as the overnight temperature dipped into the 30s.

Power was restored to Frasier after 28 hours. During the shut-off, staff tended to nursing home and assisted living residents, many with dementia, Mendez said.

“These are the folks that depend on us for everything: meals, care, and medications,” he said.

Not knowing when power would be restored, even 24 hours into the crisis, was stressful and expensive, including the next-day cost of refilling fuel for two generators, Mendez said.

“We’re lucky we didn’t have any injuries or anything major, but it is likely these could happen when there are power outages — expected or unexpected. And that puts everyone at risk,” Mendez said.

As preemptive power cuts become more widespread, nursing homes are being forced to evaluate their preparedness. But it shouldn’t be up to the facilities alone, according to industry officials and academics: Better communication between utilities and nursing homes, and including the facilities in regional disaster preparedness plans, is critical to keep residents safe.

“We need to prioritize these folks so that when the power does go out, they get to the front of the line to restore their power accordingly,” said David Dosa, chief of geriatrics and professor of medicine at UMass Chan Medical School in Worcester, Massachusetts, of nursing home residents.

Restoring power to hospitals and nursing homes was a priority throughout the windstorm, wrote Xcel Energy spokesperson Tyler Bryant in an email. But, he acknowledged, public safety power shut-offs can improve, and the utility will work with community partners and the Colorado Public Utilities Commission to help health facilities prepare for extended power outages in the future.

When the forecast called for wind gusts of up to 100 mph on April 6, Xcel Energy implemented a public safety power shut-off. Nearly 275,000 customers were without power from the windstorm.

Officials had adapted after the Marshall Fire killed two people and destroyed or damaged more than 1,000 homes in Boulder and the neighboring communities of Louisville and Superior two and a half years ago. Two fires converged to form that blaze, and electricity from an Xcel Energy power line that detached from its pole in hurricane-force winds “was the most probable cause” of one of them.

“A preemptive shutdown is scary because you don’t really have an end in mind. They don’t tell you the duration,” said Jenny Albertson, director of quality and regulatory affairs for the Colorado Health Care Association and Center for Assisted Living.

More than half of nursing homes in the West are within 3.1 miles of an area with elevated wildfire risk, according to a study published last year. Yet, nursing homes with the greatest risk of fire danger in the Mountain West and Pacific Northwest had poorer compliance with federal emergency preparedness standards than their lower-risk counterparts.

Under federal guidelines, nursing homes must have disaster response plans that include emergency power or building evacuation. Those plans don’t necessarily include contingencies for public safety power shut-offs, which have increased in the past five years but are still relatively new. And nursing homes in the West are rushing to catch up.

In California, a more stringent law to bring emergency power in nursing homes up to code is expected by the California Association of Health Facilities to cost over $1 billion. But the state has not allocated any funding for these facilities to comply, said Corey Egel, the association’s director of public affairs. The association is asking state officials to delay implementation of the law for five years, to Jan. 1, 2029.

Most nursing homes operate on a razor’s edge in terms of federal reimbursement, Dosa said, and it’s incredibly expensive to retrofit an old building to keep up with new regulations.

Frasier’s three buildings for its 300 residents in independent living apartments each have their own generators, in addition to two generators for assisted living and skilled nursing, but none is hooked up to emergency air conditioning or heat because those systems require too much energy.

Keeping residents warm during a minus-10-degree night or cool during two 90-degree days in Boulder “are the kinds of things we need to think about as we consider a future with preemptive power outages,” Mendez said.

Federal audits of emergency preparedness at nursing homes in California and Colorado found facilities lacking. In Colorado, eight of 20 nursing homes had deficiencies related to emergency supplies and power, according to the report. These included three nursing homes without plans for alternate energy sources like generators and four nursing homes without documentation showing generators had been properly tested, maintained, and inspected.

For Debra Saliba, director of UCLA’s Anna and Harry Borun Center for Gerontological Research, making sure nursing homes are part of emergency response plans could help them respond effectively to any kind of power outage. Her study of nursing homes after a magnitude 6.7 earthquake that shook the Los Angeles area in 1994 motivated LA County to integrate nursing homes into community disaster plans and drills.

Too often, nursing homes are forgotten during emergencies because they are not seen by government agencies or utilities as health care facilities, like hospitals or dialysis centers, Saliba added.

Albertson said she is working with hospitals and community emergency response coalitions in Colorado on disaster preparedness plans that include nursing homes. But understanding Xcel Energy’s prioritization plan for power restoration would also help her prepare, she said.

Bryant said Xcel Energy’s prioritization plan for health facilities specifies not whether their electricity will be turned off during a public safety power shut-off — but how quickly it will be restored.

Julie Soltis, Frasier’s director of communications, said the home had plenty of blankets, flashlights, and batteries during the outage. But Frasier plans to invest in headlamps for caregivers, and during a town hall meeting, independent living residents were encouraged to purchase their own backup power for mobile phones and other electronics, she said.

Soltis hopes her facility is spared during the next public safety power shut-off or at least given more time to respond.

“With weather and climate change, this is definitely not the last time this will happen,” she said.

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Residencias de adultos mayores quedan a oscuras en la lucha contra los incendios forestales

Kaiser Health News:States - June 10, 2024

Un día, cerca de Boulder, Colorado, cuando las fuertes ráfagas de viento amenazaron con crear un incendio forestal, la mayor empresa de servicios públicos del estado cortó la electricidad a 52,000 hogares y empresas, incluida Frasier, una residencia para adultos mayores y centro de enfermería especializada.

Era la primera vez que Xcel Energy cortaba la electricidad en Colorado como medida para prevenir incendios forestales, según un responsable de la empresa.

Esta práctica, también conocida como cortes de energía de seguridad pública, se ha arraigado en California y se está extendiendo a otros lugares como forma de evitar que los tendidos eléctricos caídos y dañados provoquen llamas y alimenten los incendios forestales más frecuentes e intensos del oeste del país.

En Boulder, el personal y los residentes de Frasier se enteraron del apagón por las noticias. Un funcionario de Frasier llamó a la compañía eléctrica para confirmarlo y en un primer momento le dijeron que el suministro no se vería afectado. Tomás Méndez, vicepresidente de operaciones de Frasier, explicó que la compañía volvió a llamar para informar que la residencia iba a sufrir un apagón. Aquel 6 de abril, les dijeron que tenían 75 minutos antes de que Xcel Energy cortara la luz.

El personal se apresuró a preparar el campus de 20 acres que alberga a casi 500 residentes. Los generadores mantuvieron en funcionamiento las máquinas de oxígeno, la mayoría de los frigoríficos y congeladores, las luces de los pasillos y la conexión de Wi-Fi para teléfonos y computadoras.

Pero el sistema de calefacción y algunas luces permanecieron apagados mientras la temperatura nocturna bajaba hasta los 30 grados fahrenheit.

El suministro eléctrico se restableció en Frasier al cabo de 28 horas. Durante el apagón, el personal cuidó a los residentes del centro y de la residencia asistida de mayores, muchos de ellos con demencia, explicó Méndez.

“Estas personas dependen de nosotros para todo: comidas, cuidados y medicamentos”, dijo.

No saber cuándo volvería la luz, incluso 24 horas después de la crisis, fue estresante y costoso, incluyendo el costo de recargar combustible para dos generadores, agregó Méndez.

«Nos sentimos afortunados porque nadie sufrió ningún tipo de daño ni ninguna dolencia grave, algo que puede ocurrir cuando se producen cortes de electricidad, esperados o inesperados. Y eso pone en peligro a todos”, apuntó Méndez.

A medida que se generalizan los cortes de electricidad preventivos, las residencias de adultos mayores se ven obligadas a evaluar cómo prepararse. Pero no debería depender sólo de las residencias, según autoridades del sector y académicos.

Una mejor comunicación entre las compañías de electricidad y estas residencias, y su inclusión en los planes regionales de preparación ante catástrofes, son fundamentales para mantener la seguridad de los residentes.

“Tenemos que priorizar a estas personas para que, cuando se vaya la luz, sean de los primeros a los que se les restablezca la electricidad”, afirmó David Dosa, jefe de geriatría y profesor de medicina de la Facultad de Medicina de la Universidad de Massachussetts (UMass).

Restablecer el suministro eléctrico a hospitales y residencias de adultos mayores fue una prioridad durante el vendaval, escribió el vocero de Xcel Energy, Tyler Bryant, en un correo electrónico. Sin embargo, reconoció, los cortes de energía de seguridad pública pueden mejorar, y la empresa de servicios públicos trabajará la comunidad y la Comisión de Servicios Públicos de Colorado para ayudar a los centros de salud a prepararse adecuadamente para cortes de energía prolongados en el futuro.

Cuando el pronóstico del tiempo anunciaba ráfagas de viento de hasta 100 millas por hora el 6 de abril, Xcel Energy puso en marcha un corte de energía de seguridad pública. Casi 275,000 clientes se quedaron sin electricidad a causa del vendaval.

Las autoridades estaban preparadas, después que el incendio de Marshall matara a dos personas y destruyera o dañara más de 1,000 viviendas en Boulder y las comunidades vecinas de Louisville y Superior, hace dos años y medio. Dos incendios convergieron en esa catástrofe, y una línea eléctrica de Xcel Energy que se desprendió de su poste a causa de los vientos huracanados “fue la causa más probable” de uno de ellos.

“Un apagón preventivo causa temor porque no sabes cuándo se restablecerá el suministro eléctrico. No te dicen la duración”, explicó Jenny Albertson, directora de calidad y asuntos regulatorios de la Colorado Health Care Association and Center for Assisted Living.

Según un estudio publicado el año pasado, más de la mitad de las residencias de mayores del oeste del país se encuentran a unas 3 millas de una zona de alto riesgo de incendios forestales. Sin embargo, las residencias con mayor riesgo de incendio en las regiones de las Montañas del Oeste y del Pacífico Noroeste fueron las que peor cumplían con las normas federales de preparación ante emergencias.

Las directrices federales establecen que las residencias deben contar con planes de respuesta ante catástrofes que incluyan el suministro eléctrico de emergencia o la evacuación del edificio. Estos planes no incluyen necesariamente contingencias para los cortes de energía de seguridad pública, que han aumentado en los últimos cinco años, pero siguen siendo relativamente nuevos. Y las residencias del oeste del país se apresuran para ponerse al día.

La Asociación de Centros de Salud de California estima que una ley más estricta para adecuar el suministro eléctrico de emergencia de las residencias de mayores costará más de $1,000 millones. Pero el estado no ha asignado fondos para que estos centros cumplan la ley, según Corey Egel, director de asuntos públicos de la asociación. La asociación ha pedido a las autoridades estatales que retrasen la aplicación de la ley cinco años, hasta el 1 de enero de 2029.

La mayoría de estos centros operan al filo de la navaja en términos de reembolso federal, indicó Dosa, y resulta increíblemente caro adaptar un edificio antiguo para estar al día con las nuevas regulaciones.

Los tres edificios de Frasier para sus 300 residentes en apartamentos independientes, tienen cada uno sus propios generadores, además de dos generadores para la vida asistida y la enfermería especializada, pero ninguno está conectado al aire acondicionado o la calefacción de emergencia porque esos sistemas requieren demasiada energía.

Mantener a los residentes en un ambiente cálido durante una noche a 10 grados bajo cero o que estén frescos durante dos días a 90 grados en Boulder “son el tipo de cosas en las que tenemos que pensar cuando nos planteamos un futuro con cortes de energía preventivos”, dijo Méndez.

Las auditorías federales sobre la preparación ante emergencias en residencias de mayores de California y Colorado detectaron deficiencias en las instalaciones.

En Colorado, ocho de 20 residencias presentaban deficiencias relacionadas con los suministros de emergencia y la energía, según el informe. Entre ellas había tres sin planes para fuentes de energía alternativa, como generadores, y cuatro sin documentación que demostrara que los generadores habían sido debidamente probados, mantenidos e inspeccionados.

Para Debra Saliba, directora del Centro Anna y Harry Borun de Investigación Gerontológica de la UCLA, asegurarse de que las residencias de mayores forman parte de los planes de respuesta a emergencias podría ayudarles a reaccionar eficazmente ante cualquier tipo de apagón. Su estudio sobre las residencias de mayores tras un terremoto de magnitud 6,7 que sacudió la zona de Los Angeles en 1994 motivó al condado de Los Angeles a integrar las residencias de mayores en los planes y simulacros de catástrofes de la comunidad.

Con demasiada frecuencia, las residencias de mayores caen en el olvido durante las emergencias porque las agencias gubernamentales, o los servicios públicos, no las consideran centros de salud, como los hospitales o los centros de diálisis, agregó Saliba.

En Colorado, Albertson señaló que trabaja con los hospitales y las coaliciones de respuesta de emergencia de la comunidad en los planes de preparación para desastres que incluyen a las residencias de adultos mayores.

Bryant indicó que el plan de Xcel Energy para los centros de salud no especifica si sufrirán un apagón durante un corte de energía de seguridad pública; sino la rapidez con que se restablecerá.

Julie Soltis, directora de comunicaciones de Frasier, contó que la residencia dispuso de suficientes mantas, linternas y baterías durante el apagón. Pero Frasier planea invertir en linternas frontales para los cuidadores, y durante una reunión comunal, se animó a los residentes de vida independiente a comprar su propia energía de reserva para teléfonos móviles y otros aparatos electrónicos, dijo.

Soltis espera que su centro se salve en el próximo corte de suministro de seguridad pública o que, al menos, tenga más tiempo para reaccionar.

“Con el tiempo y el cambio climático, no será la última vez que esto ocurra”, afirmó.

Esta historia fue producida por KFF Health News, una redacción nacional enfocada en el tratamiento en profundidad de temas de salud, que es uno de los principales programas de KFF, la fuente independiente de investigación de políticas de salud, encuestas y periodismo.

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Journalists Discuss Abortion Laws, Pollution, and Potential Changes to Obamacare Subsidies

KFF Health News senior fellow and editor-at-large for public health Céline Gounder discussed the consequences of restrictive and unclear abortion laws on CBS’ “CBS Mornings” on June 4. Gounder also discussed a recent report that found pollution is a greater health threat than war, terrorism, addiction, or disease on CBS News 24/7’s “The Daily Report” on June 3.

KFF Health News contributor Andy Miller discussed Affordable Care Act subsidy changes on WUGA’s “The Georgia Health Report” on May 31.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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A miles de niños les hicieron pruebas de plomo con dispositivos defectuosos: qué deben saber los padres

Una empresa que fabrica pruebas para la detección de envenenamiento por plomo ha acordado resolver cargos criminales por haber ocultado durante años un mal funcionamiento que generó resultados bajos e inexactos.

Es el último capítulo de una larga saga que involucra a Magellan Diagnostics, con sede en Massachusetts, que pagará $42 millones en multas, según el Departamento de Justicia (DOJ).

Aunque muchos de los dispositivos propensos a fallas se utilizaron desde 2013 hasta 2017, algunos fueron retirados del mercado recién en 2021. El DOJ dijo que este mal funcionamiento produjo resultados inexactos para “potencialmente decenas de miles” de niños y otros pacientes.

Los médicos no consideran seguro ningún nivel de plomo en sangre, especialmente en niños.

Varias ciudades de Estados Unidos, incluyendo Washington, DC, y Flint, en Michigan, han luchado con una contaminación generalizada de plomo en sus suministros de agua en las últimas dos décadas, lo que hace que las pruebas precisas sean críticas para la salud pública.

Es posible que se hayan utilizado kits defectuosos de Magellan para analizar la exposición al plomo en niños hasta principios de la década de 2020, basándose en el retiro del mercado en 2021.

Esto es lo que los padres deben saber.

¿Cuáles pruebas eran defectuosas?

Los resultados inexactos provinieron de tres dispositivos de Magellan: LeadCare Ultra, LeadCare II y LeadCare Plus. Uno de ellos, el LeadCare II, utiliza principalmente muestras de punción en el dedo y representó más de la mitad de todas las pruebas de plomo en sangre realizadas en el país desde 2013 hasta 2017, según el DOJ.

A menudo se usaba en consultorios médicos para verificar los niveles de plomo en los niños.

Los otros dos también podían usarse extrayendo sangre de una vena y pueden haber sido más comunes en laboratorios que en consultorios médicos. La empresa “se enteró por primera vez de que un mal funcionamiento en su dispositivo LeadCare Ultra podría causar resultados inexactos de pruebas de plomo, específicamente, resultados de pruebas de plomo que eran falsamente bajos” en junio de 2013 mientras buscaba la aprobación regulatoria para vender el producto, dijo el DOJ.

Pero, según el acuerdo, no divulgó esa información y siguió comercializando las pruebas.

La agencia dijo que las pruebas de 2013 indicaron que el mismo defecto afectaba al dispositivo LeadCare II. Un retiro del mercado en 2021 incluyó la mayoría de los tres tipos de kits para pruebas distribuidos desde el 27 de octubre de 2020.

En un comunicado de prensa para anunciar la resolución, la empresa dijo que “los problemas subyacentes que afectaron los resultados de algunos de los productos de Magellan de 2013 a 2018 han sido completa y eficazmente solucionados” y que las pruebas que actualmente venden son seguras.

¿Qué significa un resultado “falsamente bajo”?

A menudo se realiza la prueba a los niños durante las visitas al pediatra al año y nuevamente a los 2 años. Los niveles elevados de plomo pueden poner a los niños en riesgo de retraso en el desarrollo, menor coeficiente intelectual y otros problemas. Y los síntomas, como dolor de estómago, falta de apetito o irritabilidad, pueden no aparecer hasta que se alcancen niveles altos.

Los resultados de pruebas falsamente bajos podrían significar que los padres y los médicos no eran conscientes del problema.

Eso es preocupante porque el tratamiento para la intoxicación por plomo es, al principio, principalmente preventivo. Los resultados que muestran niveles elevados deberían llevar a los padres y a los funcionarios de salud a determinar las fuentes de plomo y tomar medidas para prevenir una ingesta continua de este metal, dijo Janine Kerr, educadora de salud del Programa de Prevención de la Intoxicación por Plomo en la Infancia del Departamento de Salud de Virginia.

Los niños pueden estar expuestos al plomo de diversas maneras, incluyendo el consumo de agua contaminada con plomo de tuberías viejas, como en Flint y Washington; la ingestión de escamas de pintura a base de plomo que a menudo se encuentran en casas antiguas; o, como se informó recientemente, comiendo algunas marcas de puré de manzana con sabor a canela.

¿Qué deben hacer los padres ahora?

“Los padres pueden contactar al pediatra para determinar si su hijo tuvo una prueba de plomo en sangre con un dispositivo LeadCare” y discutir si es necesario repetirla, dijo Maida Galvez, pediatra y profesora en la Escuela de Medicina Icahn en Mount Sinai en Nueva York.

Durante un retiro anterior de algunos dispositivos de Magellan, en 2017, los Centros para el Control y Prevención de Enfermedades (CDC) recomendaron que se les hiciera otra prueba a los pacientes si estaban embarazadas, amamantando o eran niños menores de 6 años y tenían un nivel de plomo en sangre de menos de 10 microgramos por decilitro según lo determinado por un dispositivo Magellan de una extracción de sangre venosa.

El retiro de dispositivos Magellan en 2021 recomendó repetir la prueba a los niños cuyos resultados fueran inferiores al nivel de referencia actual de los CDC de 3.5 microgramos por decilitro. Muchas de esas pruebas eran del tipo de punción en el dedo.

Kerr, del Departamento de Salud de Virginia, dijo que su agencia no ha recibido muchas llamadas sobre ese retiro.

Las pruebas de punción en el dedo “no se utilizan tan ampliamente en Virginia”, explicó Kerr, agregando que “recibimos muchas preguntas sobre el retiro del puré de manzana”.

En cualquier caso, dijo, el “mejor curso de acción para los padres es hablar con un proveedor de atención médica”.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Weight-Loss Drugs Are So Popular They’re Headed for Medicare Negotiations

Kaiser Health News:States - June 07, 2024

The steep prices — and popularity — of Ozempic and similar weight-loss and diabetes drugs could soon make them a priority for Medicare drug price negotiations. List prices for a month’s supply of the drugs range from $936 to $1,349, according to the Peterson-KFF Health System Tracker.

The Inflation Reduction Act President Biden signed in 2022 paved the way for the federal program to negotiate prices directly with drugmakers for the first time. But for now, the high price of Ozempic, Trulicity and other drugs in the class known as GLP-1 agonists have put them out of reach for many low-income patients.

Novo Nordisk’s Ozempic and Wegovy could be eligible for negotiation as early as 2025, said Juliette Cubanski, deputy director of the Program on Medicare Policy at KFF. Lilly’s Trulicity may follow the next year.

Medicare shelled out $5.7 billion in 2022 for three popular GLP-1 drugs, up from $57 million in 2018, according to research by KFF. The “outrageously high” prices have “the potential to bankrupt Medicare, Medicaid, and our entire health care system,” Sen. Bernie Sanders (I-Vt.), who chairs the Senate Committee on Health, Education, Labor and Pensions, wrote in a letter to Novo Nordisk in April.

That spending will continue to skyrocket as the benefits of these drugs pile up. Medicare can’t cover the drugs for weight loss alone, but the program does cover them when prescribed to treat diabetes. Wegovy, a version of Ozempic, has also been approved to treat heart disease and the compound has shown promise in treating kidney disease.

The drugs are likely choices for Medicare haggling, according to the Congressional Budget Office.

But just how much will prices come down?

We’ll learn whether Medicare is a good bargainer in September, when the negotiated prices of the first 10 drugs selected for the process are published, Cubanski said.

While the negotiations will initially help only Medicare beneficiaries, other patients could see a benefit once prices are made public and drugmakers start feeling pressure. That’s what happened after the Inflation Reduction Act capped insulin prices for Medicare enrollees at $35 a month.

Another wild card? The winner of the November election. Biden’s been touting Medicare drug price negotiations on the campaign trail.

Trump talked a lot about driving down drug prices in his first term, but he eventually backed off letting Medicare negotiate. It’s unclear whether Trump would take on drugmakers — or his own party — during a second term.

Congressional Republicans voted against the IRA and some have put forward proposals to repeal it.

This article is not available for syndication due to republishing restrictions. If you have questions about the availability of this or other content for republication, please contact NewsWeb@kff.org.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Biden-Harris Administration Releases Data Showing Historic Gains in Health Care Coverage in Minority Communities

HHS Gov News - June 07, 2024
(HHS) issued five new reports today showing historic gains in health care coverage and highlighting increases in coverage among minority communities since the implementation of the ACA

Thousands of Children Got Tested for Lead With Faulty Devices: What Parents Should Know

A company that makes tests for lead poisoning has agreed to resolve criminal charges that it concealed for years a malfunction that resulted in inaccurately low results.

It’s the latest in a long-running saga involving Massachusetts-based Magellan Diagnostics, which will pay $42 million in penalties, according to the Department of Justice.

While many of the fault-prone devices were used from 2013 to 2017, some were being recalled as late as 2021. The Justice Department said the malfunction produced inaccurate results for “potentially tens of thousands” of children and other patients.

Doctors don’t consider any level of lead in the blood to be safe, especially for children. Several U.S. cities, including Washington, D.C., and Flint, Michigan, have struggled with widespread lead contamination of their water supplies in the last two decades, making accurate tests critical for public health.

It’s possible faulty Magellan kits were used to test children for lead exposure into the early 2020s, based on the recall in 2021. Here’s what parents should know.

What tests were affected?

The inaccurate results came from three Magellan devices: LeadCare Ultra, LeadCare II, and LeadCare Plus. One, the LeadCare II, uses finger-stick samples primarily and accounted for more than half of all blood lead tests conducted in the U.S. from 2013 to 2017, according to the Justice Department. It was often used in physician offices to check children’s lead levels.

The other two could also be used with blood drawn from a vein and may have been more common in labs than doctor’s offices. The company “first learned that a malfunction in its LeadCare Ultra device could cause inaccurate lead test results – specifically, lead test results that were falsely low” in June 2013 while seeking regulatory clearance to sell the product, the DOJ said. But it did not disclose that information and went on to market the tests, according to the settlement.

The agency said 2013 testing indicated the same flaw affected the LeadCare II device. A 2021 recall included most of all three types of test kits distributed since October 27, 2020.

The company said in a press release announcing the resolution that “the underlying issues that affected the results of some of Magellan’s products from 2013 to 2018 have been fully and effectively remediated,” and that the tests it currently sells are safe.

What does a falsely low result mean?

Children are often tested during pediatrician visits at age 1 and again at age 2. Elevated lead levels can put kids at risk of developmental delay, lower IQ, and other problems. And symptoms, such as stomachache, poor appetite, or irritability, may not appear until high levels are reached.

Falsely low test results could mean parents and physicians were unaware of the problem.

That’s a concern because treatment for lead poisoning is, initially, mainly preventive. Results showing elevated levels should prompt parents and health officials to determine the sources of lead and take steps to prevent continued lead intake, said Janine Kerr, health educator with the Virginia Department of Health’s Childhood Lead Poisoning Prevention Program.

Children can be exposed to lead in a variety of ways, including by drinking water contaminated with lead from old pipes, such as in Flint and Washington; ingesting lead-based paint flakes often found in older homes; or, as reported recently, eating some brands of cinnamon-flavored applesauce.

What should parents do now?

“Parents can contact their child’s pediatrician to determine if their child had a blood lead test with a LeadCare device” and discuss whether a repeat blood lead test is needed, said Maida Galvez, a pediatrician and professor at the Icahn School of Medicine at Mount Sinai in New York.

During an earlier recall of some Magellan devices, in 2017, the Centers for Disease Control and Prevention recommended that patients be retested if they were pregnant, nursing, or children younger than 6 and had a blood lead level of less than 10 micrograms per deciliter as determined by a Magellan device from a venous blood draw.

The 2021 recall of Magellan devices recommended retesting children whose results were less than the current CDC reference level of 3.5 micrograms per deciliter. Many of those tests were of the finger-stick variety.

Kerr, at the Virginia health department, said her agency has not had many calls about that recall.

The finger-stick tests “are not that widely used in Virginia,” said Kerr, adding that “we did get a lot of questions about the applesauce recall.”

In any case, she said, the “best course of action for parents is to talk with a health care provider.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Investigan si los armadillos son responsables de la propagación de la lepra en Florida

Kaiser Health News:States - June 07, 2024

GAINESVILLE, Fla. — En un granero al aire libre en el borde de la Universidad de Florida, el veterinario Juan Campos Krauer examina las pezuñas y las orejas de un armadillo muerto en busca de signos de infección.

Sus garras están apretadas y cubiertas de sangre. Campos Krauer cree que lo golpearon en la cabeza mientras cruzaba una carretera cercana.

Luego, corta con un bisturí la parte inferior del animal y extrae todos los órganos importantes: corazón, hígado, riñones. Coloca las muestras embotelladas en un congelador ultra frío, en su laboratorio de la universidad.

Campos Krauer planea examinar el armadillo para detectar lepra, un antiguo mal también conocido como enfermedad de Hansen que puede provocar daño a los nervios y desfiguración en humanos. Junto con otros científicos están tratando de resolver un misterio médico: por qué Florida central se ha convertido en una zona crítica para las antiguas bacterias que la causan.

La lepra sigue siendo rara en Estados Unidos. Pero Florida, que a menudo informa el mayor número de casos de cualquier estado, ha visto un aumento en pacientes. El epicentro está al este de Orlando. El condado de Brevard informó un asombroso 13% de los 159 casos de lepra del país en 2020, según un análisis del Tampa Bay Times de datos estatales y federales.

Muchas preguntas sobre el fenómeno siguen sin respuesta. Pero expertos en lepra creen que los armadillos juegan un papel en la propagación de la enfermedad a las personas. Para comprender mejor quién está en riesgo y prevenir infecciones, unos 10 científicos se unieron el año pasado para investigar.

El grupo incluye investigadores de la Universidad de Florida, la Universidad Estatal de Colorado y la Universidad de Emory, en Atlanta.

“Realmente no sabemos cómo está ocurriendo esta transmisión”, dijo Ramanuj Lahiri, jefe de la rama de investigación de laboratorio del Programa Nacional de Enfermedad de Hansen, que estudia las bacterias involucradas y cuida a los pacientes con lepra en todo el país.

“Nada encajaba”

Se cree que la lepra es la infección humana más antigua de la historia. Probablemente ha estado enfermando a las personas durante al menos 100,000 años. Es fuertemente estigmatizada: en la Biblia, se describía como un castigo por pecar. En tiempos más modernos, los pacientes eran aislados en “colonias” alrededor del mundo, incluyendo en Hawaii y Louisiana.

En casos leves, las bacterias de crecimiento lento causan algunas lesiones. Si no se trata, pueden paralizar las manos y los pies.

Pero en realidad es difícil enfermarse de lepra, ya que la infección no es muy contagiosa. Los antibióticos pueden curar la enfermedad en uno o dos años. Están disponibles de forma gratuita a través del gobierno federal y de la Organización Mundial de la Salud (OMS), que lanzó una campaña en la década de 1990 para eliminar la lepra como problema de salud pública.

En 2000, los casos reportados en EE.UU. cayeron a su nivel más bajo en décadas, con 77 infecciones. Pero luego aumentaron, promediando alrededor de 180 por año desde 2011 hasta 2020, según datos del Programa Nacional de Enfermedad de Hansen.

Durante ese tiempo, surgió una tendencia curiosa en Florida.

En la primera década del siglo XXI, el estado registró 67 casos. El condado de Miami-Dade tuvo 20 infecciones, la mayoría de cualquier condado de Florida. La gran mayoría de esos casos fueron adquiridos fuera del país, según un análisis del Times de datos del Departamento de Salud de Florida.

Pero durante los siguientes 10 años, los casos registrados en el estado fueron más del doble, 176, y el condado de Brevard tomó el protagonismo.

El condado, cuya población es aproximadamente una quinta parte del tamaño de Miami-Dade, registró 85 infecciones durante ese tiempo, con mucho, la mayoría de cualquier condado en el estado y casi la mitad de todos los casos de Florida. En la década anterior, Brevard solo registró cinco casos.

De manera notable, al menos una cuarta parte de las infecciones de Brevard fueron adquiridas dentro del estado, no mientras los individuos estaban en el extranjero.

India, Brasil e Indonesia diagnostican más casos de lepra que en cualquier otro lugar, reportando más de 135,000 infecciones combinadas solo en 2022.

Las personas se estaban enfermando a pesar de no haber viajado a esas áreas ni haber estado en contacto cercano con pacientes con lepra, dijo Barry Inman, ex epidemiólogo del departamento de salud de Brevard que investigó los casos y se retiró en 2021.

“Nada encajaba”, dijo Inman. Algunos pacientes recordaron haber tocado armadillos, que se sabe que portan las bacterias. Pero la mayoría no, dijo. Muchos pasaron mucho tiempo al aire libre, incluidos trabajadores de jardines y ávidos jardineros. Los casos eran generalmente leves.

Era difícil determinar dónde contrajeron la enfermedad, agregó. Debido a que las bacterias crecen tan lentamente, pueden pasar entre nueve meses y 20 años para que comiencen los síntomas.

¿Amoeba o insectos culpables?

Concientizar sobre la lepra podría desempeñar un papel en el aumento de casos en Brevard. Los médicos deben reportar la lepra al Departamento de Salud. Sin embargo, Inman dijo que muchos en el condado no lo sabían, por lo que trató de educarlos después de notar los casos a fines de la década de 2000.

Pero ese no es el único factor en juego, dijo Inman. “No creo que haya ninguna duda en mi mente de que está ocurriendo algo nuevo”, dijo.

Otras partes en el centro de Florida también han registrado más infecciones. De 2011 a 2020, el condado de Polk registró 12 casos, triplicando su número en comparación con los 10 años anteriores. El condado de Volusia registró 10 casos. No reportó ninguno en la década anterior.

Los científicos se están enfocando en los armadillos. Sospechan que estos animales que son cavadores pueden causar indirectamente infecciones a través de la contaminación del suelo.

Los armadillos, que están protegidos por caparazones duros, sirven como buenos huéspedes para las bacterias, a las que no les gusta el calor y pueden prosperar en los animales cuyos rangos de temperatura corporal son de 86 a 95 grados Fahrenheit.

Los colonos probablemente trajeron la enfermedad al Nuevo Mundo hace cientos de años, y de alguna manera los armadillos se infectaron, dijo Lahiri, el científico del Programa Nacional de Enfermedad de Hansen.

Estos mamíferos nocturnos pueden desarrollar lesiones por la enfermedad igual que los humanos. Hay más de un millón de armadillos en Florida, estimó Campos Krauer, profesor asistente en el Departamento de Ciencias Clínicas de Animales Grandes de la Universidad de Florida.

Cuántos portan lepra no está claro. Un estudio publicado en 2015 con más de 600 armadillos en Alabama, Florida, Georgia y Mississippi encontró que aproximadamente el 16% mostraban evidencia de infección. Expertos en salud pública creen que la lepra anteriormente estaba confinada a los armadillos al oeste del río Mississippi y luego se extendió hacia el este.

Manipular los animales es un peligro conocido. La investigación de laboratorio muestra que las amebas unicelulares, que viven en el suelo, también pueden portar las bacterias.

Los armadillos aman desenterrar y comer lombrices, lo que frustra a los propietarios de viviendas cuyos jardines dañan. Los animales pueden eliminar las bacterias mientras buscan comida, pasándolas a las amebas, que podrían infectar a las personas más tarde.

Los expertos en lepra también se preguntan si los insectos ayudan a propagar la enfermedad. Las garrapatas que chupan sangre también podrían ser culpables, según muestra la investigación de laboratorio.

“Algunas personas que están infectadas tienen poca o ninguna exposición al armadillo”, dijo Norman Beatty, profesor asistente de medicina en la Universidad de Florida. “Probablemente hay otra fuente de transmisión en el medio ambiente”.

Campos Krauer, que ha estado buscando armadillos muertos en las calles de Gainesville, quiere reunir animales infectados y dejarlos descomponer en un área cercada, permitiendo que los restos se empapen en una bandeja con tierra mientras las moscas ponen huevos. Espera examinar la tierra y las larvas para ver si recogen las bacterias.

Agregando intriga hay una cepa de lepra encontrada solo en Florida, según los científicos. En el estudio de 2015, los investigadores descubrieron que siete armadillos del Refugio Nacional de Vida Silvestre de Merritt Island, que está mayormente en Brevard pero cruza a Volusia, portaban una versión del patógeno no vista anteriormente.

Diez pacientes en la región también se vieron afectados por esta cepa. A nivel genético, es similar a otro tipo encontrado en armadillos en el país, dijo Charlotte Avanzi, investigadora de la Universidad Estatal de Colorado que se especializa en lepra. No se sabe si la cepa causa una enfermedad más grave, dijo Lahiri.

Reduciendo el riesgo

El público no debe entrar en pánico por la lepra, ni las personas deben apresurarse a sacrificar armadillos, advierten los investigadores.

Los científicos estiman que más del 95% de la población humana mundial tiene una capacidad natural para resistir la enfermedad. Creen que se necesitan meses de exposición a gotitas respiratorias para que ocurra la transmisión de persona a persona.

Pero cuando ocurren infecciones, pueden ser devastadoras. “Si lo entendemos mejor”, dijo Campos Krauer, “podremos aprender a vivir con él y reducir el riesgo”.

La nueva investigación también puede proporcionar información para otros estados del sur. Los armadillos, que no hibernan, se han estado moviendo hacia el norte, dijo Campos Krauer, alcanzando áreas como Indiana y Virginia.

Podrían ir más lejos debido al cambio climático.

Las personas preocupadas por la lepra pueden tomar precauciones simples, dicen los expertos médicos. Aquellos que trabajan en tierra deben usar guantes y lavarse las manos después. Elevar las camas de jardín o rodearlas con una cerca puede limitar las posibilidades de contaminación del suelo.

Si se desentierra una madriguera de armadillo, es mejor usar una mascarilla, dijo Campos Krauer. No jugar con los animales ni comerlos, agregó John Spencer, científico de la Universidad Estatal de Colorado que estudia la transmisión de la lepra en Brasil. Es legal cazarlos todo el año en Florida sin una licencia.

Hasta ahora, el equipo de Campos Krauer ha examinado 16 armadillos muertos encontrados en carreteras del área de Gainesville, a más de 100 millas del epicentro de la lepra del estado, tratando de obtener una idea preliminar de cuántos portan las bacterias.

Todavía ninguno ha dado positivo.

Este artículo fue producido por una asociación entre KFF Health News y el Tampa Bay Times.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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KFF Health News' 'What the Health?': Nursing Home Staffing Rules Prompt Pushback

The Host Julie Rovner KFF Health News @jrovner Read Julie's stories. Julie Rovner is chief Washington correspondent and host of KFF Health News’ weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.

It’s not surprising that the nursing home industry is filing lawsuits to block new Biden administration rules requiring minimum staffing at facilities that accept federal dollars. What is slightly surprising is the pushback against the rules from members of Congress. Lawmakers don’t appear to have the votes to disapprove the rule, but they might be able to force a floor vote, which could be embarrassing for the administration.

Meanwhile, Senate Democrats aim to force Republicans who proclaim support for contraceptive access to vote for a bill guaranteeing it, which all but a handful have refused to do.

This week’s panelists are Julie Rovner of KFF Health News, Rachel Cohrs Zhang of Stat, Alice Miranda Ollstein of Politico, and Sandhya Raman of CQ Roll Call.

Panelists Rachel Cohrs Zhang Stat News @rachelcohrs Read Rachel's stories. Alice Miranda Ollstein Politico @AliceOllstein Read Alice's stories. Sandhya Raman CQ Roll Call @SandhyaWrites Read Sandhya's stories.

Among the takeaways from this week’s episode:

  • In suing to block the Biden administration’s staffing rules, the nursing home industry is arguing that the Centers for Medicare & Medicaid Services lacks the authority to implement the requirements and that the rules, if enforced, could force many facilities to downsize or close.
  • Anthony Fauci, the retired director of the National Institute of Allergy and Infectious Diseases and the man who advised both Presidents Donald Trump and Joe Biden on the covid-19 pandemic, testified this week before the congressional committee charged with reviewing the government’s pandemic response. Fauci, the subject of many conspiracy theories, pushed back hard, particularly on the charge that he covered up evidence that the pandemic began because dangerous microbes escaped from a lab in China partly funded by the National Institutes of Health.
  • A giant inflatable intrauterine device was positioned near Union Station in Washington, D.C., marking what seemed to be “Contraceptive Week” on Capitol Hill. Republican senators blocked an effort by Senate Majority Leader Chuck Schumer to force a vote on consideration of legislation to codify the federal right to contraception. Immediately after, Schumer announced a vote for next week on codifying access to in vitro fertilization services.
  • Hospitals in London appear to be the latest, high-profile cyberattack victims, raising the question of whether it might be time for some sort of international cybercrime-fighting agency. In the United States, health systems and government officials are still in the very early stages of tackling the problem, and it is not clear whether Congress or the administration will take the lead.
  • An FDA advisory panel this week recommended against the formal approval of MDMA, a psychedelic also known as ecstasy, to treat post-traumatic stress disorder. Members of the panel said there was not enough evidence to recommend its use. But the discussion did provide more guidance about what companies need to present in terms of trials and evidence to make their argument for approval more feasible.

Also this week, Rovner interviews KFF Health News’ Bram Sable-Smith, who reported and wrote the latest KFF Health News-NPR “Bill of the Month” feature about a free cruise that turned out to be anything but. If you have an outrageous or baffling bill you’d like to send us, you can do that here.

Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:

Credits Francis Ying Audio producer Stephanie Stapleton Editor

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Biden Wants Hospitals To Report Data on Gunshot Wounds

The Biden administration is enlisting America’s doctors to help combat gun violence.

About 160 health-care executives and officials have been invited to the White House today and Friday to promote public health solutions to the epidemic. A top priority, I’m told: The White House wants hospital emergency departments to collect more data about gunshot injuries their physicians treat, as well as routinely counsel patients about the safe use of firearms.

It’s part of the president’s strategy to build support for gun-safety measures outside the Capitol, where legislation to more strictly regulate firearms can’t overcome mainly Republican opposition. Biden’s already recruited educators to talk to parents about safe gun storage and community workers to help at-risk youth.

“The president has been clear: This is a public health crisis. So, to solve it, we need the leaders from the health-care sector,” Rob Wilcox, a deputy director of the White House Office of Gun Violence Prevention, told me in a phone interview. “Those are the leaders that run the health systems and hospitals that we go to for treatment, and it’s those doctors, nurses, practitioners on the front lines.”

Health experts have long described gun violence as a public health crisis, one that disproportionately affects Black and Hispanic residents in poor neighborhoods. Biden’s election opponent, former president Donald Trump, has assailed his gun policies and warned the National Rifle Association in May that “if the Biden regime gets four more years, they are coming for your guns.”

In 2022, more than 48,000 people were killed by guns in the United States, or about 132 people a day, according to the Centers for Disease Control and Prevention. An additional 200-plus Americans are injured each day, according to estimates.

Surveys show most Americans — across political affiliations and regardless of gun ownership — support policies that could reduce violence.

Biden’s initiative isn’t just about messaging. It’s also about money. Unlike America’s other deadly health threats — such as cancer, HIV and automobile crashes — limited federal dollars fund gun violence research, in part because of politics.

In 1996, a Republican-controlled Congress cut federal funding for gun safety research at the CDC, essentially shifting the burden to the private sector and academia — with a fraction of the previous budget. In 2019, Congress reversed course and has since agreed every year to allocate $25 million to the CDC and the National Institutes of Health for gun research.

Health researchers say more timely and comprehensive data about gun injuries and deaths would give them a better understanding of trends behind gun violence — and what policies might prevent it.

The White House is asking state and local health departments, health systems and hospitals to increase timely data collection on emergency department visits for firearm-related injuries to “support state and local jurisdictions in identifying and responding to emerging public health problems,” Wilcox said.

The goal is “to inform prevention efforts,” he said.

The data will cover fatal and nonfatal injuries. Existing CDC data focuses on deaths, while its data on injuries is limited. For instance, one person was killed in the Feb. 14 shooting at the Kansas City Chiefs Super Bowl victory parade, but the CDC data probably will not count the roughly two dozen other people who were injured.

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White House Enlists Doctors and Hospitals To Combat Gun Violence

The White House is calling on hospital executives, doctors, and other health care leaders to take bolder steps to prevent gun violence by gathering more data about gunshot injuries and routinely counseling patients about safe use of firearms.

Biden administration officials are hosting back-to-back events Thursday and Friday at the White House for about 160 health care officials, calling gun violence a “public health crisis” that requires them to act.

The strategy also reflects a stark political reality: Congress has been deadlocked on most gun-related legislation for years, with a deep divide between Republicans and Democrats. If Democratic President Joe Biden wants to get anything done quickly, he will need to look outside the Capitol. He has already enlisted educators to talk to parents about safe gun storage and community workers to help at-risk youth.

“The president has been clear: This is a public health crisis. So, to solve it, we need the leaders from the health care sector,” Rob Wilcox, a deputy director of the White House Office of Gun Violence Prevention, told KFF Health News. “Those are the leaders that run the health systems and hospitals that we go to for treatment, and it’s those doctors, nurses, practitioners on the front lines.”

Health experts have long described gun violence as a public health crisis, one that disproportionately affects Black and Hispanic residents in poor neighborhoods.

In 2022, more than 48,000 people were killed by guns in the U.S., or about 132 people a day, and suicides accounted for more than half of those deaths, according to the Centers for Disease Control and Prevention. An additional 200-plus Americans are injured each day, according to estimates from Johns Hopkins University research.

Guns are the leading cause of death for children and teens.

Gun violence prevention advocates applauded the Biden administration for attempting to depoliticize the issue by focusing on its health impacts. The health-centric message also resonates with the public, said Fatimah Loren Dreier, executive director of the Health Alliance for Violence Intervention, who planned to attend the June 6 event.

“The idea that there can be a bipartisan-driven, apolitical way to address the gun violence problem has created tremendous opportunity,” she said.

But the initiative isn’t just about messaging. It’s about numbers and statistics. Relative to America’s other deadly threats — such as cancer, HIV, and automobile crashes — fewer federal dollars fund gun violence research, mostly because of politics.

In 1996, Congress cut federal funding for gun control research by the CDC, essentially shifting the responsibility for funding and conducting the research to the private sector and academia — and with a fraction of the previous budget. In 2019, Congress reversed course and has since agreed every year to allocate $25 million to the CDC and the National Institutes of Health for gun research, but public health experts say it’s not nearly enough. By comparison, roughly three times that amount was earmarked for research on the prevention and treatment of underage drinking in fiscal year 2023, and 10 times as much to Parkinson’s disease research.

Slashing CDC research funding for firearms created decades-long gaps in data — and hamstrung efforts to respond to the crisis, researchers and health officials say. For instance, there’s little government data available to researchers on firearms, even basic statistics such as firearm ownership by city and which guns are used in shootings.

More timely and comprehensive data could give researchers a better understanding of the trends behind gun violence — and the steps to take to prevent it, said Bechara Choucair, a senior vice president and the chief health officer at Kaiser Permanente, who planned to attend the June 6 White House event.

“Anytime you want to address a problem with a public health lens, you have to understand the data,” he said. “You have to understand the data at a granular level so you can design interventions and test interventions and see if it works or if it doesn’t work.”

The White House is asking state and local health departments, health systems, and hospitals to boost timely data collection on emergency room visits for firearm-related injuries to “support state and local jurisdictions in identifying and responding to emerging public health problems,” Wilcox said.

The goal is “to inform prevention efforts,” he said.

The data will cover fatal and nonfatal injuries. Existing CDC data focuses on deaths, while its data on injuries is limited. For instance, one person was killed in the Feb. 14 shooting at the Kansas City Chiefs Super Bowl victory parade, but the CDC data likely will not count the roughly two dozen other people who were injured.

Collecting more detailed data could be costly for hospitals, whose ERs see most gunshot injuries, said Garen Wintemute, an ER physician and the head of a violence prevention program at the University of California-Davis. Right now, hospitals gather medical information about gunshot wounds and usually don’t get into other details, such as what type of gun or ammunition might have been used.

It’s not clear exactly what data hospitals will be asked to collect.

“It’s an intensive process,” Wintemute said. “The clinicians are going to gather the data that they need in order to treat the patient, and that may not include all the data that a researcher later would want to know about what happened.”

Some of this data is already being collected on a limited basis. The CDC collects near-real-time reporting of gunshot injuries from ERs in about a dozen states. The White House wants data from across the nation.

Wilcox added that federal grant dollars are available to health systems to conduct gun data collection through the Bipartisan Safer Communities Act, which Biden signed in 2022.

This year, Biden asked Congress to again boost funding for CDC firearm research in his proposed fiscal 2025 budget, but his previous efforts have failed in the GOP-controlled House of Representatives.

Lawmakers have yet to release a draft of their spending proposal for the Department of Health and Human Services.

“We should focus our CDC resources on infectious diseases, transmittable diseases, and certainly chronic diseases rather than controversial, political-charged activities,” Rep. Robert Aderholt (R-Ala.) said of Biden’s 2024 funding proposal.

Surveys show most Americans — across political affiliations and regardless of gun ownership — support policies that could reduce violence.

At this week’s meetings with health leaders, White House officials will also encourage doctors to talk with patients and the public about gun safety and securing guns.

When Wintemute talks with patients in the ER, he sits beside them and asks about their safety and the safety of others in their home, a practice he said many doctors already use to address an array of potential risks in a person’s life. The White House’s call for physicians to talk about gun violence legitimizes that, he said.

“A health professional can do what we do about tobacco and alcohol and other sorts of potentially risky behaviors, and talk with patients about how do we minimize the risk,” Wintemute said.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

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Wins at the Ballot Box for Abortion Rights Still Mean Court Battles for Access

Kaiser Health News:States - June 06, 2024

Before Ohio voters amended their constitution last year to protect abortion rights, the state’s attorney general, an anti-abortion Republican, said that doing so would upend at least 10 state laws limiting abortions.

But those laws remain a hurdle and straightforward access to abortions has yet to resume, said Bethany Lewis, executive director of the Preterm abortion clinic in Cleveland. “Legally, what actually happened in practice was not much,” she said.

Today, most of those laws limiting abortions — including a 24-hour waiting period and a 20-week abortion ban — continue to govern Ohio health providers, despite the constitutional amendment’s passage with nearly 57% of the vote. For abortion rights advocates, it’s going to take time and money to challenge the laws in the courts.

Voters in as many as 13 states could also weigh in this year on abortion ballot initiatives. But the seven states that have voted on abortion-related ballot measures since the Supreme Court overturned federal abortion protections two years ago in Dobbs v. Jackson Women’s Health Organization show that an election can be just the beginning.

The state-by-state patchwork of constitutional amendments, laws, and regulations that determine where and how abortions are available across the country could take years to crystallize as old rules are reconciled with new ones in legislatures and courtrooms. And even though a ballot measure result may seem clear-cut, the residual web of older laws often still needs to be untangled. Left untouched, the statutes could pop up decades later, like an Arizona law from 1864 did this year.

Michigan was one of the first states where voters weighed in on abortion rights following the Dobbs decision in June 2022. In November of that year, Michigan voters approved by 13 percentage points an amendment to add abortion rights to the state constitution. It would be an additional 15 months, however, before the first lawsuit was filed to unwind the state’s existing abortion restrictions, sometimes called “targeted regulation of abortion providers,” or TRAP, laws. Michigan’s include a 24-hour waiting period.

The delay had a purpose, according to Elisabeth Smith, state policy and advocacy director at the Center for Reproductive Rights, which filed the lawsuit: It’s preferable to change laws through the legislature than through litigation because the courts can only strike down a law, not replace one.

“It felt really important to allow the legislative process to go forward, and then to consider litigation if there were still statutes that were on the books the legislature hadn’t repealed,” Smith said.

Michigan’s Democratic-led legislature did pass an abortion rights package last year that was signed into law by the state’s Democratic governor in December. But the package left some regulations intact, including the mandatory waiting period, mandatory counseling, and a ban on abortions by non-doctor clinicians, such as nurse practitioners and midwives.

Smith’s group filed the lawsuit in February on behalf of Northland Family Planning Centers and Medical Students for Choice. Smith said it’s unclear how long the litigation will take, but she hopes for a decision this year.

Abortion opponents such as Katie Daniel, state policy director for Susan B. Anthony Pro-Life America, are critical of the lawsuit and such policy unwinding efforts. She said abortion rights advocates used “deceptive campaigns” that claimed they wanted to restore the status quo in place before the Dobbs decision left abortion regulation up to the states.

“The litigation proves these amendments go farther than they will ever admit in a 30-second commercial,” Daniel said. “Removing the waiting period, counseling, and the requirement that abortions be done by doctors endangers women and limits their ability to know about resources and support available to them.”

A lawsuit to unwind most of the abortion restrictions in Ohio came from Preterm and other abortion providers four months after that state’s ballot measure passed. A legislative fix was unlikely because Republicans control the legislature and governor’s office. Preterm’s Lewis said she anticipated the litigation would take “quite some time.”

Dave Yost, the Ohio attorney general, is one of the defendants named in the suit. In a motion to dismiss the case, Yost argued that the abortion providers — which include several clinics as well as a physician, Catherine Romanos — lacked standing to sue.

He argued that Romanos failed to show she was harmed by the laws, explaining that “under any standard, Dr. Romanos, having always complied with these laws as a licensed physician in Ohio, is not harmed by them.”

Jessie Hill, an attorney representing Romanos and three of the clinics in the case, called the argument “just very wrong.” If Romanos can’t challenge the constitutionality of the old laws because she is complying with them, Hill said, then she would have to violate those laws and risk felonies to honor the new amendment.

“So, then she’s got to go get arrested and show up in court and then defend herself based on this new constitutional amendment?” Hill said. “For obvious reasons, that is not a system that we want to have.”

This year, Missouri is among the states poised to vote on a ballot measure to write protections for abortion into the state constitution. Abortions in Missouri have been banned in nearly every circumstance since 2022, but they were largely halted years earlier by a series of laws seeking to make abortions scarce.

Over the course of more than three decades, Missouri lawmakers instituted a 72-hour waiting period, imposed minimum dimensions for procedure rooms and hallways in abortion clinics, and mandated that abortion providers have admitting privileges at nearby hospitals, among other regulations.

Emily Wales, president and chief executive of Planned Parenthood Great Plains, said trying to comply with those laws visibly changed her organization’s facility in Columbia, Missouri: widened doorways, additional staff lockers, and even the distance between recovery chairs and door frames.

Even so, by 2018 the organization had to halt abortion services at that Columbia location, she said, with recovery chairs left in position for a final inspection that never happened. That left just one abortion clinic operating in the state, a separate Planned Parenthood affiliate in St. Louis. In 2019, that organization opened a large facility about 20 miles away in Illinois, where lawmakers were preserving abortion access rather than restricting it.

By 2021, the last full year before the Dobbs decision opened the door for Missouri’s ban, the number of recorded abortions in the state had dwindled to 150, down from 5,772 in 2011.

“At that point, Missourians were generally better served by leaving the state,” Wales said.

Both of Missouri’s Planned Parenthood affiliates have vowed to restore abortion services in the state as swiftly as possible if voters approve the proposed ballot measure. But the laws that diminished abortion access in the state would still be on the books and likely wouldn’t be overturned legislatively under a Republican-controlled legislature and governor’s office. The laws would surely face challenges in court, yet that could take a while.

“They will be unconstitutional under the language that’s in the amendment,” Wales said. “But it’s a process.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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End of Pandemic Internet Subsidies Threatens a Health Care Lifeline for Rural America

Kaiser Health News:States - June 05, 2024

FORT HALL RESERVATION, Idaho — Myrna Broncho realized just how necessary an internet connection can be after she broke her leg.

In fall 2021, the 69-year-old climbed a ladder to the top of a shed in her pasture. The roof that protects her horses and cows needed to be fixed. So, drill in hand, she pushed down.

That’s when she slipped.

Broncho said her leg snapped between a pair of ladder rungs as she fell, “and my bone was sticking out, and the only thing was holding it was my sock.”

Broncho arm-crawled back to her house to reach her phone. She hadn’t thought to take it with her because, she said, “I never really dealt with phones.”

Broncho needed nine surgeries and rehabilitation that took months. Her hospital was more than two hours away in Salt Lake City and her home internet connection was vital for her to keep track of records and appointments, as well as communicate with her medical staff.

During the covid-19 pandemic, federal lawmakers launched the Affordable Connectivity Program with the goal of connecting more people to their jobs, schools, and doctors. More than 23 million low-income households, including Broncho’s, eventually signed on. The program provided $30 monthly subsidies for internet bills, or $75 discounts in tribal or high-cost areas like Broncho’s.

Now, the ACP is out of money.

In early May, Sen. John Thune (R-S.D.) challenged an effort to continue funding the program, saying during a commerce committee hearing that the program needed to be revamped.

“As is currently designed, ACP does a poor job of directing support to those who truly need it,” Thune said, adding that too many people who already had internet access used the subsidies.

There has been a flurry of activity on Capitol Hill, with lawmakers first attempting and failing to attach funding to the must-pass Federal Aviation Administration reauthorization. Afterward, Sen. Peter Welch (D-Vt.) traveled to his home state to tell constituents in tiny White River Junction that Congress was still working toward a solution.

As the program funding dwindled, both Democrats and Republicans pushed for new legislative action with proposals trying to address concerns like the ones Thune raised.

On May 31, as the program ended, President Joe Biden’s administration continued to call on Congress to take action. Meanwhile, the administration announced that more than a dozen companies — including AT&T, Verizon, and Comcast — would offer low-cost plans to ACP enrollees, and the administration said those plans could affect as many as 10 million households.

According to a survey of participants released by the Federal Communications Commission, more than two-thirds of households had inconsistent or no internet connection before enrolling in the program.

Broncho had an internet connection before the subsidy, but on this reservation in rural southeastern Idaho, where she lives, about 40% of the 200 households enrolled in the program had no internet before the subsidy.

Nationwide, about 67% of nonurban residents reported having a broadband connection at home, compared with nearly 80% of urban residents, said John Horrigan, a national expert on technology adoption and senior fellow at the Benton Institute for Broadband & Society. Horrigan reviewed the data collected by a 2022 Census survey.

The FCC said on May 31 that ending the program will affect about 3.4 million rural and more than 300,000 households in tribal areas.

The end of federal subsidies for internet bills will mean “a lot of families who will have to make the tough choice not to have internet anymore,” said Amber Hastings, an AmeriCorps member serving the Shoshone-Bannock Tribes on the reservation. Some of the families Hastings enrolled had to agree to a plan to pay off past-due bills before joining the program. “So they were already in a tough spot,” Hastings said.

Matthew Rantanen, director of technology for the Southern California Tribal Chairmen’s Association, said the ACP was “extremely valuable.”

“Society has converted everything online. You cannot be in this society, as a societal member, and operate without a connection to broadband,” Rantanen said. Not being connected, he said, keeps Indigenous communities and someone like “Myrna at a disadvantage.”

Rantanen, who advises tribes nationwide about building broadband infrastructure on their land, said benefits from the ACP’s subsidies were twofold: They helped individuals get connected and encouraged providers to build infrastructure.

“You can guarantee a return on investment,” he said, explaining that the subsidies ensured customers could pay for internet service.

Since Broncho signed up for the program last year, her internet bill had been fully paid by the discount.

Broncho used the money she had previously budgeted for her internet bill to pay down credit card debt and a loan she took out to pay for the headstones of her mother and brother.

As the ACP’s funds ran low, the program distributed only partial subsidies. So, in May, Broncho received a bill for $46.70. In June, she expected to pay the full cost.

When asked if she would keep her internet connection without the subsidy, Broncho said, “I’m going to try.” Then she added, “I’m going to have to” even if it means taking a lesser service.

Broncho said she uses the internet for shopping, watching shows, banking, and health care.

The internet, Broncho said, is “a necessity.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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