How a Proposed Federal Heat Rule Might Have Saved These Workers’ Lives
On a sweltering afternoon in July 2020, Belinda Ramones got a call that her brother was in the hospital. The call was from a woman at the Florida landscaping business that he had joined that week, the Davey Tree Expert Co., Ramones said. By the time she arrived, she said, “My brother was swollen up from hands to toes.”
Two days later, her brother, Jose Leandro-Barrera, died at age 45 with acute kidney failure caused by heatstroke, according to a report from the Hillsborough County medical examiner. His temperature in the ambulance had been 108 F, said the report.
It described the circumstances preceding his death, as recorded by a nurse. At the jobsite, Leandro-Barrera had advised his supervisor that he was not feeling well, and the supervisor told him to sit in a vehicle until he felt better. While there, he “urinated himself, had seizure like activity” and became unresponsive.
“Employee suffers from heat exhaustion while doing landscaping,” said an investigation into the incident from the Occupational Safety and Health Administration. The agency issued a $9,639 fine to the Davey Tree Expert Co. The company did not respond to requests for comment.
Without national regulations on preventing heat-related illness and death, OSHA has difficulty, in general, protecting workers before it’s too late, said Paloma Rentería, a Department of Labor spokesperson.
Laborers have suffered as summers have grown progressively hotter with climate change. But health policy and occupational health researchers say that worker deaths are not inevitable. Employers can save lives by providing ample water and breaks and building in time for new workers to adjust to extreme heat.
This is the logic behind proposed national rules that President Joe Biden set in motion in 2021, aiming to protect an estimated 36 million workers exposed to extreme heat. The Bureau of Labor Statistics counts about 480 worker deaths from heat exposure each year, on average. But these are “vast underestimates,” according to OSHA, because heat stress is an underlying factor often unaccounted for in medical records.
The advocacy organization Public Citizen estimates that as many as 2,000 U.S. workers die of heat annually, based on extrapolations from heat injury data.
Both estimates are upsetting, said Linda McCauley, dean of the nursing school at Emory University and an occupational health researcher. “No one should go to work expecting that they might die,” she said.
The proposed rules — a heat standard from OSHA — reaches a milestone Dec. 30, when the public comment period closes. But it’s unlikely to be finalized before Biden leaves office.
Vice President Kamala Harris would likely carry the heat rules forward if she wins the presidency next month, said Jordan Barab, who was OSHA’s deputy assistant secretary during the Obama administration. She advanced heat regulations in California in 2020.
Should Donald Trump win, the rules would stall, Barab predicts. In general, Republicans have opposed workplace safety regulations over the past 20 years, saying they are costly to businesses and consumers. And during the first Trump administration, the number of OSHA inspectors tasked with monitoring workplace safety hit an all-time low across the agency’s 48-year history. Workplace inspections regarding heat stress dropped by half on Trump’s watch, according to an analysis by the National Employment Law Project.
OSHA’s rules would require employers to provide ample, cool drinking water, and shade or air conditioning for breaks, when temperatures exceed 80 degrees. Above 90 degrees, employers would need to provide paid 15-minute breaks every two hours.
Two additional aspects of the standard confront overlooked problems that contribute to heat deaths at work. More than 70% of workers who die of heat do so within their first week on the job. And delayed medical care is a common theme.
“We need to stop telling people who complain of being about to pass out to go sit in the car or take a break,” McCauley said. “Rest breaks are needed to prevent the problem, but once someone has symptoms, they need help fast.”
The proposed rules require employers to allow new workers time to acclimate to high temperatures and to institute protocols, like a buddy system, so that workers get rapid medical care as soon as they show signs of heat illness, like dizziness, confusion, and cramps.
By the time an emergency medical team arrived to help one laborer in July 2021, he had stopped breathing, according to one Department of Labor press release. A supervisor at the ecological restoration company EarthBalance had seen him earlier that day, it said, and he was “sweating heavily, his hands were trembling, and he seemed confused,” He rested. “Only 30 minutes later, the supervisor returned to the man finding him unresponsive.”
That evening, Gilberto Macario-Gimenez died at the hospital, said a medical examiner case report. It noted “the decedent had overheated” and attributed his death to heart disease and hypertension. Heat can exacerbate those conditions.
OSHA investigated the situation. It fined EarthBalance $9,216, finding that “the employer failed to ensure that a person adequately trained to provide first aid to employees [was] working in an area where there was no infirmary.”
EarthBalance did not respond to requests for comment.
OSHA has received at least 12,980 comments on its proposals posted to the federal register. One woman wrote about her cousin who died while clearing shrubs for a rancher in Texas when temperatures exceeded 100 degrees: “He was only 34. There was no water or rest breaks.”
After the comment period ends in December, OSHA will hold a public hearing, incorporate changes, and finalize the rule. If Harris is president, Barab said, the agency may finish the process by 2026. For the rule to work, Congress would need to fund OSHA adequately, so that it can hire staffers to teach employers how to implement the standards, and enough investigators to enforce them.
Several industry groups have opposed the standard. The Associated General Contractors of America called it “unnecessary, unworkable, and impractical.” A single set of rules isn’t fair when climates and jobs vary widely, in addition to workers’ abilities to tolerate heat, the group wrote in an online statement.
Some Republican lawmakers have called the rule government overreach. Rick Roth, a Republican Florida state representative, told Al Jazeera that workers are pushing for paid breaks because they “don’t want to work so hard.” If they didn’t feel safe, they could change jobs. “Go work for somebody else,” he said.
Critics also say that the regulations will cost employers. But a UCLA analysis of workers’ compensation claims in California suggests that a national heat standard saves money overall. The study estimated the cost of heat-related injuries between $750 million and $1.25 billion a year in California alone, including medical bills, lost wages, and disability claims.
Because six states have varying sets of rules to reduce heat-related illness — California, Colorado, Maryland, Minnesota, Oregon, and Washington — researchers and union representatives have been able to see where policies need strengthening. One issue with enforcement is that OSHA largely relies on employees to report hazards. One study found that just 14% of nearly 600 farmworkers surveyed in California knew about acclimatization and how much water they needed when temperatures were high.
Although Florida doesn’t have specific heat regulations, Dominique O’Connor of the Farmworker Association of Florida said the biggest obstacle in ensuring occupational safety is that workers are afraid of getting fired for filing a complaint with OSHA.
This is especially true for farmworkers with H-2A visas, which permit noncitizens to fill temporary jobs. Because these workers depend on their employers not only to remain in the country but often for transportation and housing, retaliation from employers would be life-altering. “This summer we talked with H-2A workers who were only given dirty water on the job,” she said. “They were told to just pretend it was coffee.”
Leaders in several Republican-led states are likely to push back against the federal standard if it’s issued. Last April, Florida Gov. Ron DeSantis approved legislation that blocks local governments from requiring employers to offer workers water and shade when temperatures rise.
And the Supreme Court’s decision to overturn the “Chevron doctrine” this year may embolden employers to challenge OSHA’s ability to enforce the rules. For decades, the Chevron doctrine had required courts to defer to expertise at regulatory agencies when interpreting regulations, but the high court’s ruling ended that. “We are in uncharted territory,” Barab said.
Jeremy Young, senior producer at Fault Lines on Al Jazeera English, contributed to this report.
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Crackdown on Homeless Encampments Raises Public Health Questions
As states turn to the health-care system to help address homelessness, experiments with housing and other social services aimed at getting people healthier and off the streets are running up against new, aggressive crackdowns — with some cities ratcheting up enforcement of existing anticamping laws and others passing new restrictions.
From Florida to California, elected officials and law enforcement agencies have launched widespread operations targeting homeless people following the U.S. Supreme Court’s ruling in June that makes it easier for states, cities and counties to fine and arrest those living outside — even if there is no shelter or housing available.
“These tactics cause chaos, not order. They are not a solution to homelessness, and in fact, they will make the problem worse,” said Ann Oliva, CEO of the National Alliance to End Homelessness.
The sweeps are a response to rising public frustration over the proliferation of homeless encampments and the public health hazards that often accompany them.
But a growing body of evidence indicates that housing services and health care can help get people off the streets while stabilizing their health. What to do about homelessness has become a rising political issue.
“Voters believe mental health and physical health care are important parts of the solution,” said Celinda Lake, a national Democratic pollster. “They feel if you just arrest people and move them around, you’re just going to make the situation worse. Voters want real solutions. That’s what we’ve heard from Minnesota to Tulsa, to Omaha, Nebraska, and even Great Falls, Montana.”
Politicians are responding to the visibility of homelessness by clearing encampments, but in doing so, they are thwarting efforts to stabilize people and make them healthier.
Those sweeps are breaking crucial connections to street medicine providers, housing navigators and case managers funded by Medicaid and through other state and national programs, including the federal Health Care for the Homeless program launched in 1987 to improve the health of those living outside.
As law enforcement operations expand, health-care providers on the ground say the efforts are making people sicker. Homeless people are skipping medical appointments, losing their medications, and having their IDs, birth certificates and other vital documents thrown away, slowing efforts to get them indoors.
Health and social service providers in cities across the West, where there has been a surge in people living outdoors, also report an uptick among homeless people in substance use, thoughts of suicide and other mental health issues such as anxiety and depression.
“There’s all this health-care money to try to stabilize people and get them to a place where they can get healthy, but if they’re constantly being forced to move, we can’t find them,” said Beth Rittenhouse-Dhesi, a longtime street medicine provider in San Francisco.
“People are losing their medications or getting them thrown away, and all of a sudden, conditions like diabetes, hypertension, HIV, asthma, opioid use … are becoming significantly worse,” because they are left untreated.
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Marylanders To Vote on Expansive ‘Right to Reproductive Freedom’
Voters in 10 states will consider whether or not to protect or expand abortion rights in November. That includes battleground states such as Arizona and Nevada and such Republican strongholds as South Dakota and Missouri.
In Maryland, where abortion is legal, a proposed amendment is much broader than many abortion-related ballot questions in other states. Called the Right to Reproductive Freedom amendment, it would enshrine in the state constitution a right “to make and effectuate decisions to prevent, continue, or end one’s own pregnancy.”
“What we’re saying with this amendment is that the right to reproductive freedom is central to an individual’s liberty and equality,” said Joseline Peña-Melnyk, a Democrat who chairs the Health and Government Operations Committee in the Maryland House of Delegates. She helped draft the amendment.
Reproductive freedom, Peña-Melnyk said, includes birth control, fertility treatment, tubal ligation, abortion care, and vasectomies. “It’s not just for women; it’s for everyone,” she said.
Maryland already has some of the strongest protections for reproductive health care in the country. In 1998, it became the first state to mandate that insurance companies cover birth control, more than a decade before the Affordable Care Act did so nationwide. And, in 2016, it became one of the first states to require insurance companies and Medicaid to pay for the entire cost of male sterilization procedures and over-the-counter emergency contraception.
The state’s agencies are prohibited from providing information to other states for investigations of “legally protected health care,” including reproductive health care services, provided by Maryland-based physicians.
Democratic lawmakers, who control the state legislature and now hold the governor’s mansion, have methodically passed laws to bolster reproductive health rights. Enshrining those rights in the state constitution will protect Marylanders regardless of which party is in power, Peña-Melnyk said.
“The measure guarantees that future changes — for example, in state politics — will not easily overturn these rights,” she said.
Putting an abortion rights amendment on the state ballot could also boost turnout for the Nov. 5 election — a potential lift for Democratic U.S. Senate candidate Angela Alsobrooks, who is in a competitive race against former Gov. Larry Hogan, a Republican.
Jeffrey Trimbath, president of the Maryland Family Institute, an anti-abortion group that describes its work, in part, as protecting life and parental rights, said the amendment is unnecessary because there is no serious discussion of rolling back abortion rights in the state capital.
The measure “uses this undefined term ‘reproductive freedom’ and it says ‘including but not limited to,’” Trimbath said. And, he said, the reproductive freedom amendment would undermine parents’ rights.
“The first two words, ‘Every person’ — there is no constraint on who that is. Every single person, whether you’re 6 months old, 6 years old, 16 years old, or 100 years old,” Trimbath said. “Every person is entitled to this right. We think that includes children.”
Maryland law does require that one parent or guardian be notified before a person under 18 can receive abortion care, although the law provides several exceptions, including if a doctor determines that the notification could harm the patient. State lawmakers who drafted the amendment and legal experts say it will not alter existing abortion laws in Maryland, including requirements for minors.
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Residentes de Maryland votarán por un amplio “derecho a la libertad reproductiva”
En noviembre, los votantes de 10 estados decidirán si protegerán o ampliarán, o no, el derecho al aborto. Entre ellos, se encuentran estados que son terreno fuerte de la batalla electoral como Arizona y Nevada, y bastiones republicanos como Dakota del Sur y Missouri.
En Maryland, donde el aborto es legal, una enmienda propuesta es mucho más amplia que muchas de las cuestiones electorales relacionadas con el aborto en otros estados. Llamada enmienda del Derecho a la Libertad Reproductiva, consagraría en la constitución estatal un derecho “a tomar y hacer efectivas decisiones para prevenir, continuar o terminar el propio embarazo”.
“Lo que estamos diciendo con esta enmienda es que el derecho a la libertad reproductiva es central para la libertad y la igualdad de un individuo”, dijo Joseline Peña-Melnyk, demócrata que preside el Comité de Salud y Operaciones Gubernamentales en la Cámara de Delegados de Maryland, quien ayudó a redactar la enmienda.
La libertad reproductiva, dijo Peña-Melnyk, incluye el control de la natalidad, el tratamiento de fertilidad, la ligadura de trompas, la atención del aborto y las vasectomías. “No es sólo para las mujeres; es para todos”, dijo.
Maryland ya cuenta con algunas de las protecciones más sólidas para la atención de salud reproductiva en el país. En 1998, se convirtió en el primer estado en obligar a las compañías de seguros a cubrir los métodos anticonceptivos, más de una década antes de que la Ley de Cuidado de Salud a Bajo Precio (ACA) lo hiciera a nivel nacional. Y, en 2016, se convirtió en uno de los primeros estados en exigir a las aseguradoras y a Medicaid que pagaran el costo total de los procedimientos de esterilización masculina, y los anticonceptivos de emergencia de venta libre.
Las agencias del estado tienen prohibido proporcionar información a otros estados para investigaciones de “atención médica protegida legalmente”, incluidos los servicios de atención médica reproductiva, proporcionados por médicos con sede en Maryland.
Los legisladores demócratas, que controlan la Legislatura estatal y ahora tienen la mansión del gobernador, han aprobado metódicamente leyes para reforzar los derechos de salud reproductiva. Consagrar esos derechos en la constitución estatal protegerá a los habitantes de Maryland independientemente del partido que esté en el poder, dijo Peña-Melnyk.
“La medida garantiza que los cambios futuros, por ejemplo, en la política estatal, no anularán fácilmente estos derechos”, dijo.
La inclusión de una enmienda sobre el derecho al aborto en la boleta electoral estatal también podría impulsar la participación en las elecciones del 5 de noviembre, un posible impulso para la candidata demócrata al Senado de Estados Unidos, Angela Alsobrooks, que se encuentra en una carrera competitiva contra el ex gobernador, el republicano Larry Hogan.
Jeffrey Trimbath, presidente del Maryland Family Institute, un grupo antiabortista que describe su trabajo, en parte, como la protección de la vida y los derechos de los padres, dijo que la enmienda es innecesaria porque no hay una discusión seria sobre la eliminación del derecho al aborto en la capital del estado.
La medida “usa este término indefinido ‘libertad reproductiva’ y dice ‘incluyendo, pero no limitado a’”, dijo Trimbath. Y, agregó, la enmienda sobre la libertad reproductiva socavaría los derechos de los padres.
“Las primeras dos palabras, ‘Toda persona’, no hay ninguna restricción sobre quién es. Cada persona, ya sea que tenga 6 meses, 6 años, 16 años o 100 años”, dijo Trimbath. “Toda persona tiene derecho a este derecho. Creemos que eso incluye a los niños”.
La ley de Maryland exige que se notifique a uno de los padres o tutores antes de que una persona menor de 18 años pueda recibir atención para un aborto. Aunque la ley prevé varias excepciones, por ejemplo, si un médico determinara que la notificación podría perjudicar a la paciente.
Los legisladores estatales que redactaron la enmienda y los expertos legales dicen que no alterará las leyes de aborto existentes en Maryland, incluidos los requisitos para menores de edad.
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Mothering Over Meds: Docs Say Common Treatment for Opioid-Exposed Babies Isn’t Necessary
On learning last year she was pregnant with her second child, Cailyn Morreale was overcome with fear and trepidation.
“I was so scared,” said Morreale, a resident of the small western North Carolina town of Mars Hill. In that moment, her joy about being pregnant was eclipsed by fear she would have to stop taking buprenorphine, a drug used to treat opioid withdrawal that had helped counter her addiction.
Morreale’s fear was compounded by the rigidity of the most common approach to treating babies born after being exposed in the womb to opioids or some medications used to treat opioid addiction.
For decades throughout the opioid crisis, most doctors have relied on medication-heavy regimens to treat babies who are born experiencing neonatal opioid withdrawal syndrome. Those protocols often meant separating newborns from their mothers, placing them in neonatal intensive care units, and giving them medications to treat their withdrawal.
But research has since indicated that in many, if not most, cases, those extreme measures are unnecessary. A newer, simpler approach that prioritizes keeping babies with their families called Eat, Sleep, Console is being increasingly embraced.
In recent years, doctors and researchers have found that keeping babies with their mothers and ensuring they’re comfortable often works better and gets them out of the hospital faster.
Despite her worst fears, Morreale was never separated from her son. She was able to begin breastfeeding immediately. In fact, she was told, the trace of buprenorphine in her breast milk would help her son withdraw from it.
Her experience was different because she had found her way to Project CARA, an Asheville, North Carolina-based program, administered through the Mountain Area Health Education Center, that supports pregnant people and parents with substance use disorders. Morreale’s care team assured her she did not need to discontinue buprenorphine and that her baby would be assessed and monitored using the Eat, Sleep, Console approach. The protocol deems babies OK to be sent home so long as they’re eating, sleeping, and consolable when upset.
“By the grace of God, he was awesome,” Morreale said of her son.
David Baltierra, former director of West Virginia University’s Rural Family Medicine Residency Program, chair of WVU’s Department of Family Medicine – Eastern Division, and a family physician, suggests this protocol could simply be called “parenting.”
The method is increasingly being used instead of the long-embraced approach to treating opioid-affected newborns called the Finnegan Neonatal Abstinence Scoring System. That tool includes a list of 21 questions (is the baby crying excessively, sweating, experiencing tremors, sneezing, etc.), the answers to which determine whether the newborn should get medication to counteract withdrawal symptoms, which would then require an extended stay in a neonatal ICU.
Baltierra, though, has issues with the Finnegan method. For example, it often results in a soundly sleeping baby being awakened to be scored. That didn’t make sense to Baltierra. If the baby is sleeping, she’s likely doing fine.
Instead, health professionals should look for the telltale signs of a baby experiencing opioid withdrawal syndrome, he said. “Their body is in tension, they have a high pitch, they don’t calm down.”
Baltierra and his colleagues have been training residents to use an Eat, Sleep, Console approach for a decade, progressively more so in the past six years. The results are persuading more health professionals to adopt the method.
A 2023 study found babies treated this way were discharged from the hospital in nearly half the time and less likely to receive medication than those receiving Finnegan-based care.
Matthew Grossman, an associate professor of pediatrics at the Yale School of Medicine, refers to the introduction of the model of treatment he has helped pioneer as “the least innovative” undertaking imaginable.
Research shows that optimal care for pregnant women who’ve experienced opioid use disorder includes treatment with buprenorphine or methadone, which carries the risk their newborn will have withdrawal symptoms. Grossman and colleagues found a non-pharmacological-first approach works best.
He said the Finnegan tool is useful but often too rigid. Under its scoring, one sneeze too many could send a baby to the NICU for weeks.
Grossman said he observed that some babies receiving medications did well for a few days but began to decline when their mothers were sent home without them. Those observations made him ask, “Did the kid need more medicine, or more mom?”
Research by Leila Elder and Madison Humerick, who each did their residency in WVU’s rural program, found that median stays for newborns in withdrawal dropped from 13 days in 2016 to three in 2020.
Elder said babies born at the 25-bed rural hospital where they performed deliveries received medications to treat their withdrawal symptoms only when unrelated issues sent them to other hospitals for NICU care.
The simpler treatment also means more babies born in rural communities can receive care closer to home and has reduced the likelihood a mother will be released before her baby is cleared to go home.
Grossman suggested that rural hospitals are better suited to employ the Eat, Sleep, Console approach than big-city institutions, given the latter’s generally easier access to a NICU and propensity to choose that option.
Sarah Peiffer recalls the first time, as a medical student, she witnessed a nurse administering the Finnegan protocol, discussing it in clinical terms at a new mother’s bedside.
“And I remember being kind of horrified,” she said. The process was clearly distressing to both mother and child. “I felt like there was almost a punitive feeling to it, like we were telling this mom, ‘Look what you did to your baby.’”
Peiffer is now a Project CARA practitioner and family health physician at Blue Ridge Health in western North Carolina and a vocal proponent of ESC and its approach to partnering with families. “You look at all the nonpharmacologic stuff you’re supposed to be doing — like keeping the lights low in the room, keeping the baby swaddled, doing as much skin-to-skin with mom as possible — and you really treat mom as medicine.”
Research suggests immediate postbirth skin‐to‐skin contact offers “vital advantages” to short‐ and long‐term health and bonding.
That contact, Elder said, “releases endorphins for mom,” which helps lower the risk of postpartum depression.
Grossman said developing the Eat, Sleep, Console protocol was simply a matter of pausing to reassess.
The original intent of the Finnegan tool wasn’t to render the process so rigid. But “everybody is excited to have a tool, and then this approach calcified around it,” he said.
Grossman said the objective of the simpler approach was to place the family at the core of care, and shorter hospital stays for babies was simply a fortuitous outcome. The shift in approach fits into a wider move toward judgment-free, family-centered care for those who’ve experienced addiction and for their children.
Now, he said, after five days, mothers often say “‘Can we go home? I think I got this,’” and they’re treated “with the same respect as any other mom.”
Peiffer said she has witnessed this mother-centric care counter “that sense of shame that people feel instead of families feeling empowered to care for their infant.” It represents “such a major shift in how we think about neonatal withdrawal both medically and culturally.”
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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Watch: ‘Silence in Sikeston & The Effects of Racial Violence’
KFF Health News Midwest correspondent Cara Anthony appeared in a two-part special of Nine PBS’ “Listen, St. Louis with Carol Daniel” to discuss her reporting for the “Silence in Sikeston” project.
The first conversation, which aired Oct. 9, explores the connections between a 1942 lynching and a 2020 police shooting in a rural Missouri community — and what those killings say about the nation’s silencing of racial trauma. The second episode, which premiered Oct. 16, explores the health effects of such trauma with mental health counselor Lekesha Davis.
These conversations stem from the “Silence in Sikeston” multimedia project by KFF Health News, Retro Report, and WORLD, which includes a documentary film, educational videos, digital articles, and a limited-series podcast.
Explore more of the “Silence in Sikeston”project:
LISTEN: The limited-series podcast is available on PRX, Apple Podcasts, Spotify, iHeart, or wherever you get your podcasts.
- Episode 1: “Racism Can Make You Sick”
- Episode 2: “Hush, Fix Your Face”
- Episode 3: “Trauma Lives in the Body”
- Episode 4: “Is There a Cure for Racism”
WATCH: The documentary film “Silence in Sikeston,” a co-production of KFF Health News and Retro Report, is available to stream on WORLD’s YouTube channel, WORLDchannel.org, and the PBS app.
READ: KFF Health News Midwest correspondent Cara Anthony wrote an essay about what her reporting for this project helped her learn about her own family’s hidden past.
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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Mountain Town Confronts an Unexpected Public Health Catastrophe
Before Hurricane Helene, had you stopped by one of the many breweries, art galleries, or award-winning restaurants in Asheville, North Carolina, and spoken with anyone who lives in these parts — including me — most would have told you they felt pretty safe from climate disasters.
The mountains of western North Carolina have been known to flood: The area is bursting with creeks and rivers and enjoys an abundance of rain. There are occasionally wildfires. But the ravages of the climate crisis’s worst impacts — including increasingly powerful hurricanes — felt like a problem for another place. Asheville sits almost 250 miles from the nearest coastline.
After Hurricane Helene roared across the state, causing historic flooding, downing trees, snapping power lines, decimating water infrastructure, and leading to the deaths of at least 72 people in Buncombe County alone, communities are still shaking off the shock of a storm they never thought could touch these mountains.
“People relocate to Asheville not just because it’s beautiful, but because it isn’t prone to natural disasters,” said Katie Gebely, an artist in Asheville. “But that sense of safety is gone.”
I live in Beech, a historic community in Weaverville, North Carolina, at the eastern end of a two-lane road called Reems Creek, which is named after the waterway running parallel to it. The town of Weaverville, just north of Asheville, is five miles down the road.
Helene’s destruction created a major problem for people dependent on insulin, power wheelchairs, oxygen CPAP machines for sleep apnea, or home dialysis equipment. Without electricity, their health is at risk.
To get to Weaverville from Beech in the days immediately after the storm, cars had to thump over dozens of downed power lines. Other lines were propped up with large, downed tree limbs or tied up with rope so cars could get under them. Utility poles were snapped in two. A transformer lay on the side of the road, as did a rather large boat, washed up from who knows where. Just last week, power crews arrived on Reems Creek Road, but there’s still no word on when everyone will regain electricity.
Jackie Martin of Canton, North Carolina, relies on supplemental oxygen for chronic obstructive pulmonary disease and emphysema. When the storm hit, she had four hours’ worth left. Because of her condition, Martin and her husband, David, have an electrical generator, which David checks every month to make sure it works.
“We keep enough gas to run about eight hours,” Jackie Martin said. But the Martins were without power for nearly a week. When they ran out of gasoline, their neighbors gave them the gas from their lawn mower. Then another neighbor evacuated and offered his propane generator. The Martins’ daughter came through with four tanks of propane.
“We went through tons of gas and propane,” Jackie Martin said. “Never did I think I would need every drop and then some. Thank goodness we got power back after a week.”
In Buncombe County, population 275,000, there were still more than 50,000 customers without electricity almost two weeks after the storm. Duke Energy reported that outages were down to about 1,600 customers in the Asheville area as of Wednesday.
In most places, the debris that littered the road has been cleared. Cars, trucks, and military vehicles can make their way through. But huge piles of trash still line the roadways. Buncombe County is asking residents not to burn it out of concern for air quality.
In a scene out of biblical end-times, yellow jackets swarmed in the days after the storm — displaced after falling trees and floodwaters destroyed their nests. Three or four days after the storm hit, an EMT drove through my neighborhood looking for Benadryl. My husband handed over what we had: a half-full bottle.
Overhead, helicopters fly day and night. The Federal Emergency Management Agency arrived in my neighborhood two Sundays ago to deliver bottled water and food rations. Potable water in some areas of western North Carolina, including Asheville, may take weeks or months to restore.
Weaverville’s residents were under a boil-water advisory until Oct. 11.
“We had sewer and water line breaks,” said Patrick Fitzsimmons, Weaverville’s mayor. “We had a lot of infrastructure destruction.”
Households with wells have fared no better. Well pumps don’t work without electricity. And storm-damaged or flooded wells may be compromised. Officials are urging residents to disinfect their wells before consuming water. The federal Environmental Protection Agency has given residents kits to test their well water.
A physical therapist at Asheville Specialty Hospital, who asked not to be identified out of concern for losing their job, told me that in the first days after the storm, crews hauled trash cans full of water into the facility so that staff could flush toilets with buckets.
“The water got shut off and we managed. We took care of people the best we could,” the therapist said. “But the amount of water that it takes to run a hospital is unsustainable for the length of time they think we’ll be out of water.”
The hospital is a 34-bed long-term acute care facility down the street from Asheville’s Mission Hospital. Nancy Lindell, a spokesperson for Mission Health, which operates both hospitals, said in a statement that fewer than 100 “low acuity patients in stable condition” at the organization’s facilities were transferred “to hospitals outside of the areas hardest hit by this disaster.”
“This decision, which was made in collaboration with more than 50 physicians and nursing leaders, helps ensure we have the capacity to meet the most critical needs of our region,” she said. “It also provides relief for our caregivers, who have been working around the clock in the wake of the storm.”
U.S. Rep. Chuck Edwards, who represents North Carolina’s 11th District, said FEMA has shipped 6 million liters of water and 4 million individual meals to western North Carolina. FEMA has promised 120 truckloads a day of food and water with no specified end date, the Republican congressman said.
The Biden administration has also opened an emergency program for uninsured North Carolinians to replace lost prescriptions and medical equipment.
Fitzsimmons, Weaverville’s mayor, said he’s concerned about the impact of the storm on mental health. “People are going for an extended period of time without power or water,” he said. “Their nerves are frayed.”
Richard Zenn, chief medical officer at North Carolina-based Vaya Health, said the recovery will be long.
“We’re now in the phase where we have to deal with the effects of this ongoing trauma we’ve all suffered,” Zenn said. “Connect with others. Don’t get too isolated. Eat. Sleep. Try to get back into a normal routine. Do whatever reduces stress for you.”
For me, that has always been hiking or running through these ancient mountains. But there are too many uprooted trees to safely do that now. Instead I take solace on my porch and give thanks that I still have a porch to sit on. It’s a near-perfect day in Appalachia. The sky is painfully blue. I listen for the songs of birds, but all I can hear are generators.
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.
USE OUR CONTENTThis story can be republished for free (details).
Víctimas del tiroteo del desfile del Super Bowl reconstruyen sus vidas, pero la violencia con armas de fuego sigue atormentándolas
KANSAS CITY, Mo. – Veinticuatro minutos antes del tiroteo masivo en el desfile del Super Bowl de los Kansas City Chiefs, en febrero, que dejó un muerto y al menos 24 heridos, Jenipher Cabrera sintió cómo una bala le perforaba la parte posterior del muslo derecho.
La joven de 20 años y su familia estaban a solo cuatro cuadras de Union Station, en medio de una multitud de fanáticos de los Chiefs que, con camisetas rojas, caminaban hacia la multitudinaria concentración después del desfile en ese cálido Día de San Valentín.
La bala, disparada por unos adolescentes que se peleaban en la calle, lanzó el cuerpo de Cabrera hacia adelante.
Ella tomó a su madre por el hombro y, en pánico, sin decirle una sola palabra, con sus grandes ojos marrones le señaló la pierna que sangraba. Cuando Cabrera estaba siendo atendida en una ambulancia escuchó los informes que resonaban en la radio de la policía.
“Mi madre intentaba subir conmigo a la ambulancia”, contó Cabrera. “Recuerdo que se lo impidieron, le dijeron algo así como: ‘No puedes subir. Puede que haya otras víctimas que tengamos que recoger’”.
El tiroteo que hirió a Cabrera ocurrió minutos antes del que acaparó los grandes titulares ese día y forma parte de los cientos de disparos de armas de fuego que, cada año, hieren o matan a residentes del área de Kansas City.
Esa incesante oleada de violencia con armas de fuego —desde incidentes puntuales hasta tiroteos masivos— ha terminado aniquilando la sensación de seguridad de quienes sobreviven.
Mientras las víctimas y sus familias intentan superar la experiencia y seguir adelante, las referencias a los hechos de violencia armada son inevitables en los medios de comunicación, en sus comunidades y en su propia vida cotidiana.
“Miro a la gente de otra manera”, afirma James Lemons, que también recibió un disparo en el muslo durante el desfile. Ahora, cuando está rodeado de desconocidos, no puede evitar preguntarse si alguno tendrá un arma y si sus hijos están a salvo.
La nueva temporada de la NFL se inauguró aquí con un minuto de silencio por Lisa López-Galván, la única persona asesinada en el desfile del Super Bowl.
Kansas City ha registrado al menos 124 homicidios este año. La policía local afirma que ha habido otras 476 “víctimas heridas con armas de fuego”, es decir, personas que recibieron disparos y sobrevivieron. Y hasta mediados de septiembre habían ocurrido por lo menos 50 tiroteos en escuelas de todo el país.
Toda esta situación está dejando huellas colectivas.
Quienes han sobrevivido a situaciones de este tipo sufren ataques de pánico, tienen una mayor sensación de peligro en grandes aglomeraciones y padecen una profunda ansiedad ante la posibilidad de que irrumpa la violencia en cualquier lugar de Kansas City.
Cada sobreviviente de un tiroteo responde de manera diferente a la violencia armada e incluso a la amenaza de que surja, explicó LJ Punch, cirujano traumatólogo y el fundador de la Bullet Related Injury Clinic en St. Louis.
Para algunos, haber sido baleados significa que siempre se mantendrán alerta, tal vez incluso armados. Otros prefieren alejarse de las armas de fuego para siempre.
“¿Pero qué es lo que todos tienen en común? Que esas personas quieren desesperadamente sentirse seguras”, afirma Punch.
El intento de Cabrera por entender lo que le sucedió la impulsó a colaborar con un legislador local frustrado que busca cambiar las leyes sobre armas, algo que parece casi imposible, ya que la legislación del estado de Missouri prácticamente prohíbe cualquier restricción local sobre armas de fuego.
Enterarse de otros tiroteos por teléfono
En la mente de Cabrera,el 14 de febrero es una película en cámara lenta, que avanza fotograma por fotograma. Y la banda sonora es su propia voz, que habla y habla. Ve a un grupo de adolescentes revoltosos, que corren alrededor de ella y de su familia. Luego, dos estallidos: ¿son fuegos artificiales? Otro estallido. Finalmente, un cuarto.
“Creo que fue entonces cuando entré en shock y agarré a mi madre”, recordó Cabrera. “No le dije nada. Simplemente la miré y sentí los ojos muy abiertos. Recuerdo que le hice una especie de señal con los ojos para que me mirara la pierna”.
Cabrera cayó al suelo y otros aficionados corrieron a socorrerla, llamaron al 911 y empezaron a cortarle las calzas. Cuatro hombres se quitaron el cinturón para hacerle un torniquete. Recordó que en ese momento pensó que, si perdía el conocimiento, podría morir. Así que habló y habló sin parar. O eso creía.
Uno de los rescatistas le contó más tarde que en realidad ella no dijo ni una sola palabra, ni siquiera cuando él le preguntó cuántos dedos tenía levantados.
“Me dijo que yo tenía los ojos enormes, como naranjas, y que todo lo que hice fue mirar hacia arriba y hacia abajo cuatro veces, porque él tenía cuatro dedos levantados”, dijo Cabrera.
Cabrera recuerda que después la sacaron del servicio de urgencias de University Health para hacerles sitio a otras 12 personas que habían llegado desde el tiroteo que había ocurrido en la manifestación. Ocho de esas personas tenían heridas de bala. En ese momento miró las redes sociales en su teléfono: ¿había otro tiroteo? Era increíble. Finalmente, sus padres la encontraron. Pasó siete días en el hospital.
Cabrera agradece estar viva. Pero ahora se siente inquieta cuando se cruza con grupos de adolescentes insultando y jugando, o cuando ve camisetas rojas de los Chiefs. Oír cuatro estallidos seguidos —algo habitual en su barrio del noreste de Kansas City— hace que a Cabrera se le oprima el pecho y sepa que está por tener un ataque de pánico.
“En mi mente, lo sucedido se repite una y otra vez”, dijo.
¿Una creciente sensación de amenaza?
Aunque el cirujano general de EE.UU. declaró en junio que la violencia con armas de fuego es una crisis de salud pública, en Missouri casi cualquier intento de regular el uso de armas es un fracaso político.
De hecho, hubo una ley estatal de 2021 —firmada en la misma armería de Kansas City donde se compró una de las armas utilizadas en el tiroteo del desfile— que tenía como objetivo prohibir que la policía local aplicara las leyes federales sobre armas de fuego.
Esa ley fue anulada por un tribunal federal de apelaciones en agosto.
Missouri no tiene restricciones respecto de la edad para el uso y la posesión de armas, aunque la ley federal prohíbe en gran medida que los menores lleven pistolas.
Las encuestas realizadas entre los votantes de Missouri muestran su apoyo a que se exijan certificados de antecedentes y se establezcan límites de edad para la compra de armas, pero también revelan que casi la mitad de los encuestados está en contra de que los condados y las ciudades tengan facultades para aprobar sus propias normas sobre armas.
En una comparación por cantidad de habitantes, Kansas City, Missouri, se encuentra entre los lugares más violentos de la nación. En esta ciudad de 510.000 habitantes, entre 2014 y 2023 se produjeron al menos 2.175 tiroteos, que dejaron 1.275 muertos y 1.624 heridos.
Mientras que el año pasado las tasas de homicidio cayeron en más de un centenar de ciudades de todo el país, Kansas City vivió el año más mortífero jamás registrado.
Punch, del Bullet Related Injury Clinic, comparó la violencia con armas de fuego con un brote de una enfermedad que no se enfrenta y se propaga. Según Punch, la postura permisiva del estado hacia las armas de fuego podría agravar la situación en Kansas City, aunque no haya sido el origen del problema.
“Entonces, ¿está pasando algo? ¿La gente se siente cada vez más amenazada?”, se preguntó Punch.
Jason Barton, que creció en Kansas City, está familiarizado con ese tipo de violencia. Ahora, que vive en Osawatomie, Kansas, consideró detenidamente si debía llevar su propia pistola al desfile del Super Bowl como una forma de proteger a su familia.
Al final decidió no hacerlo, suponiendo que si ocurría algo y sacaba un arma, lo detendrían o le dispararían.
Barton reaccionó rápidamente ante el tiroteo, que se produjo justo delante de él y de su familia. Su mujer encontró una bala en su mochila. Su hijastra sufrió quemaduras en las piernas por las chispas de un rebote de bala.
A pesar de que sus peores temores se hicieron realidad, Barton opina que no llevar su arma ese día fue la decisión correcta.
“No es necesario llevar armas a lugares como ése”, afirmó.
Una peligrosa escopeta calibre 12
Los tiroteos masivos pueden deteriorar gravemente la sensación de seguridad de los sobrevivientes, según Heather Martin, ella misma sobreviviente del tiroteo en la secundaria Columbine en 1999.
Martin es cofundadora de The Rebels Project, una organización que brinda apoyo entre pares a quienes han sobrevivido a experiencias traumáticas masivas.
“En los años posteriores al evento es muy común que se intente encontrar la manera de volver a sentirse seguro”, explicó Martin.
James Lemons siempre había sentido recelo de volver a Kansas City, donde había crecido. Incluso llevó su pistola al desfile, pero, a instancias de su esposa, la dejó en el auto. Tenía a su hija de 5 años sobre los hombros cuando una bala le atravesó la parte posterior del muslo. Él impidió que se golpeara contra el suelo cuando caía.
¿Qué iba a hacer realmente con una pistola?
Y, sin embargo, no puede evitar preguntarse “qué hubiera pasado si…”. No puede quitarse de encima la sensación de que no protegió a su familia. Cuando sueña con el desfile, al despertarse, cuenta: “simplemente empiezo a llorar”.
Sabe que aún no lo ha procesado, pero no sabe cómo empezar a hacerlo. Ha puesto toda su energía en la seguridad de su familia.
Este verano compraron dos bulldogs americanos, por lo que ahora hay tres en casa, uno para cada niño. Lemons los describe como “tener un arma sin tener un arma”.
“Tengo un calibre 12 con dientes”, bromea Lemons, “un protector grande y suave”.
La mayoría de las noches sólo logra dormir unas horas de corrido porque se despierta para ver cómo están los niños. Por lo general, suele echarse en el sofá porque es más cómodo para su pierna, que aún se está curando. También porque lo ayuda a evitar las nerviosas patadas de su hija de 5 años, que se acuesta con sus padres desde el desfile.
Estar en el sofá también le asegura que sería él quien interceptara a cualquier intruso que irrumpiera en la casa.
Emily Tavis, que recibió un disparo en la pierna, encontró consuelo en su iglesia y en el terapeuta de una congregación hermana.
Pero el domingo por la mañana después del tiroteo en el mitín de Donald Trump, en julio, el sermón del predicador giró en torno a la violencia armada, y eso desató el pánico en su interior.
“Me sentí tan abrumada que me fui al baño”, dijo Tavis, “y me quedé allí durante el resto del sermón”. Ahora, incluso duda de ir a la iglesia.
Tavis se ha mudado recientemente a una nueva casa en Leavenworth, Kansas, que le alquiló a una amiga.
El marido de la amiga le advirtió que si Tavis iba a estar sola necesitaba un arma para protegerse. Ella le contestó que no podía lidiar con armas de fuego en ese momento.
“Y él le dijo: ‘OK, bueno, toma esto’. Y sacó un machete gigante”, recuerda Tavis riendo.
“Así que ahora tengo un machete”.
En busca de algo bueno
Cabrera, la joven que no podía hablar después de que la hirieron, intenta ahora utilizar su voz en la lucha contra la violencia armada.
Manny Abarca, legislador del condado de Jackson, Missouri, vive calle abajo. Una tarde fue a visitarla. Los padres de Cabrera tomaron la palabra; ella es tímida por naturaleza. Pero entonces él se volvió hacia ella y le preguntó directamente a Cabrera qué quería.
“Sólo quiero algo de justicia para mi caso”, dijo, “o que pase algo bueno”.
Antes del desfile, a la joven le habían ofrecido un puesto en la fábrica donde trabajaba su hermana, pero no pudo tomarlo porque su pierna aún estaba curándose. Así que Abarca le ofreció una pasantía y la ayudó a establecer una Oficina de Prevención de la Violencia Armada en el condado de Jackson, un plan que presentó en julio en respuesta a los tiroteos del desfile.
Abarca participó en el desfile de la victoria de los Chiefs con su hija Camila, de 5 años. Estaban en Union Station cuando se produjeron los disparos, y se acurrucaron en un baño de la planta baja.
“Solo dije: ‘Oye, ya sabes, solo mantén la calma. Solo estate quieta. Vamos a averiguar qué está pasando. Algo ha sucedido,’”, contó Abarca. “Y ella me contestó: ‘Esto es un simulacro.’ Y, oye, eso me desgarró el corazón por dentro, porque pensé que hacía alusión a su entrenamiento en la escuela”.
Finalmente salieron temblando pero a salvo, sólo para enterarse de que López-Galván había muerto. Abarca conocía a la popular DJ tejana, una madre de 43 años, a través de la unida comunidad hispana de la zona.
Abarca ha aprovechado la conmoción de este tiempo tenso tras los tiroteos del desfile del Super Bowl para trabajar en medidas contra la violencia, a pesar de que conoce las severas limitaciones que impone la ley estatal.
En junio, la asamblea legislativa del condado de Jackson aprobó una norma que da fuerza local a una ley federal contra la violencia doméstica que permite a los jueces retirar las armas de fuego a los delincuentes.
Pero Abarca no ha podido conseguir que se apruebe la creación de una oficina para la violencia armada, y los funcionarios del condado han rechazado considerar otra medida que establecería límites de edad para comprar o poseer armas, temiendo una demanda del fiscal general del estado, que es bastante agresivo.
Sin embargo, contrató a Cabrera, explicó, porque es bilingüe y quiere su ayuda como sobreviviente.
En cierto sentido, este trabajo hace que Cabrera se sienta más fuerte en su lucha por salir adelante tras el tiroteo. Aún así, la percepción de seguridad de su familia se ha hecho añicos, y nadie tiene pensado ir a los partidos o a un potencial desfile por ganar el Super Bowl en el futuro.
“Nunca esperamos que fuera a ocurrir algo así”, afirma. “Y por eso creo que ahora vamos a ser más precavidos y quizá nos limitemos a ver el desfile por la tele”.
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.
USE OUR CONTENTThis story can be republished for free (details).
Patients Are Relying on Lyft, Uber To Travel Far Distances to Medical Care
When Lyft driver Tramaine Carr transports seniors and sick patients to hospitals in Atlanta, she feels like both a friend and a social worker.
“When the ride is an hour or an hour and a half of mostly freeway driving, people tend to tell you what they’re going through,” she said.
Drivers such as Carr have become a critical part of the medical transportation system in Georgia, as well as in Washington, D.C., Mississippi, Arizona, and elsewhere. While some patients use transportation companies solely dedicated to medical rides or nonemergency ambulance rides to get to their appointments, the San Francisco-based ride-hailing companies Uber and Lyft are also ferrying people to emergency rooms, kidney dialysis, cancer care, physical therapy, and other medical visits.
But Georgia ride-hail drivers aren’t only serving patients living in Atlanta or its sprawling suburbs. When rural Georgians are too sick to drive themselves, Uber or Lyft is often one of the only ways to reach medical care in the state capital.
Rural hospital closures in Georgia have meant people battling cancer and other serious illnesses must now commute two or more hours to treatment facilities in Atlanta, said Bryan Miller, director of psychosocial support services at the Atlanta Cancer Care Foundation, a medical practice offshoot that seeks to alleviate financial burdens for cancer patients and their families.
From April 2022 to April 2024, Lyft drivers completed thousands of rides that were greater than 50 miles each way and that began or ended at Atlanta-area medical treatment centers, including the Winship Cancer Institute of Emory University and Emory University Hospital Midtown, according to Lyft.
While 75% of those trips were under 100 miles, the company said, 21% of them were between 100 and 200 miles and 4% were over 200, showing that even Georgians who live hours away from metro Atlanta rely on the ride-hail platform to reach medical care there.
Uber Health global head Zachary Clark declined to provide comparable ridership data. Uber Health is a division of Uber that organizes medical transportation for some Medicaid and Medicare recipients, health care workers, prescription drug delivery, and others seeking reimbursement for medical-related Uber rides, according to Uber’s website.
Lyft also has a health care division, offering programs such as Lyft Assisted and Lyft Concierge to coordinate rides for patients.
Nationwide, some insurance companies and cancer treatment centers, plus Medicare Advantage and state Medicaid plans, pay for such ride-hailing services, often with the goal of reducing missed appointments, according to Krisda Chaiyachati, an adjunct assistant professor at the University of Pennsylvania medical school.
In 2024, 36% of individual Medicare Advantage plans and 88% of special needs plans offered transportation services, said Jeannie Fuglesten Biniek, associate director of Medicare policy at KFF, the health policy research, polling, and news organization that includes KFF Health News. A special needs plan provides extra benefits to Medicare recipients who have severe and chronic diseases or certain other health care needs, or who also have Medicaid.
And Medicaid — the federal-state government safety net insurance plan for those with low incomes or disabilities — paid for up to 4 million beneficiaries to use nonemergency medical transportation services annually from 2018 through 2021, according to a Department of Health and Human Services report. Patients residing in rural areas used ride-hailing and other nonemergency transportation providers at the highest rates, the report said.
The estimated total federal and state investment in nonemergency medical transportation was approximately $5 billion in 2019, according to a study by the Texas A&M University Transportation Institute.
Even with some insurance covering trips or charities offering ride credits, social workers say, many ailing patients are still left without a ride. Nationwide, 21% of adults without access to a vehicle or public transit went without needed medical care in 2022, according to a study by the Robert Wood Johnson Foundation. People who lacked access to a vehicle but had access to public transit were less likely to skip needed care.
The data analytics company Geotab ranked Atlanta as tied for second worst in the nation when it comes to the accessibility of its public transportation network.
“The ability to get to a doctor’s appointment can be a barrier to care,” said Rochelle Schube, a cancer support group facilitator in Atlanta. “If I give a patient $250 in Uber cards and they live far away, that gets spent quickly.”
The fact that Uber and Lyft are harder to come by in rural America compounds the lack of medical access in those areas. “When you move to rural areas — which you could argue have a higher need — you see fewer services,” Chaiyachati said.
Finding drivers who are able and willing to provide medical transportation can be a challenge. The Atlanta-based start-up MedTrans Go connects patients and health care providers with vetted drivers, many offering wheelchair or stretcher rides, in Georgia and 16 other states. Many of its drivers have medical training, walk patients to and from medical facilities or their homes, and can handle complex situations for vulnerable patients, said Dana Weeks, the company’s co-founder and CEO.
The company’s app can also dispatch directly to Uber or Lyft for patients who do not need specialized assistance, she said.
Uber and Lyft trips can save patients and insurers money, costing a fraction of the typical fee for an ambulance ride, said David Slusky, an economics professor at the University of Kansas who has studied the impact of ride-hailing services on medicine.
But instead of all of that, argued Timothy Crimmins, a history professor emeritus at Georgia State University and a former director of the school’s neighborhood-studies center, the best solution would be for Georgia to expand Medicaid, so more rural hospitals would be able to remain open and Georgians could seek medical care close to home.
The decision by Georgia lawmakers to not accept a federally funded expansion of Medicaid has left more than 1.4 million Georgians without health insurance, according to KFF — and that hurts rural hospitals when those patients use the medical facilities and cannot pay their bills. In Georgia, 10 rural hospitals have either closed or ceased their inpatient care operations since 2010, according to a 2024 report from health care consultant Chartis, and 18 more are in danger of shuttering.
Until more patients are insured, Crimmins said, the state should subsidize Uber and Lyft trips for less prosperous Georgians who need help reaching medical care in Atlanta. “We might be talking about $100 to $150 round-trip,” he said. “That can be subsidized.”
Still, ferrying around patients is not for every ride-hail driver. Damian Durand said his Chevrolet Equinox SUV is large enough to accommodate a medical passenger requiring a wheelchair, but he isn’t paid extra to transport those with medical needs. He said some of his recent passengers in Atlanta have been Medicaid recipients with mental health conditions or disabilities.
“It can be stressful,” he said. “I do feel like Uber and Lyft are trying to catch me off guard. When I can see that the ride is going to the hospital, I try to avoid or cancel the ride.”
While Durand’s experience with medical transport has been mostly negative, Carr loves the work and appreciates being able to help older Georgians, who she said often tip her well. For her, ride-hail work remains a good option even when it entails medical calls.
“It’s not stressful for me,” she said. “I worked a good 20 years in customer service. For me, human connection is important. I tried to work from home, and I really didn’t like it. I prefer this because I can connect with people.”
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.
USE OUR CONTENTThis story can be republished for free (details).
Super Bowl Rally Shooting Victims Pick Up Pieces, but Gun Violence Haunts Their Lives
KFF Health News and KCUR are following the stories of people injured during the Feb. 14 mass shooting at the Kansas City Chiefs Super Bowl celebration. Listen to how survivors are seeking a sense of safety.
KANSAS CITY, Mo. — Twenty-four minutes before the mass shooting at the Kansas City Chiefs Super Bowl victory parade in February left one person dead and at least 24 people injured, Jenipher Cabrera felt a bullet pierce the back of her right thigh.
The 20-year-old and her family were just four blocks from Union Station, in a river of red-shirted Chiefs fans walking toward the massive rally after the parade that warm Valentine’s Day. The bullet — fired by teen boys fighting in the street — thrust Cabrera forward.
She grabbed her mom by the shoulder and signaled in panic to her bleeding leg with her large brown eyes, not saying a word. Cabrera was being treated in an ambulance when she heard reports blasting from the police radio.
“My mom was trying to get on the ambulance,” Cabrera said. “I remember them saying, like, ‘You can’t get on. There might be other victims that we need to pick up.’”
Cabrera’s shooting happened before the one that garnered the big headlines that day and is one of hundreds that kill or injure Kansas City-area residents each year. That endless drumbeat of gun violence — from one-off incidents to mass shootings — has shattered the sense of safety for those who survive. As victims and their families try to move forward, reminders of gun violence are inescapable in the media, in their communities, in their daily lives.
“I look at people differently,” said James Lemons, who was shot in the thigh at the rally. Now when he’s around strangers he can’t help but wonder if they have a gun and if his kids are safe.
The new NFL season opened here with a moment of silence for Lisa Lopez-Galvan, the only person killed at the parade. Kansas City has recorded at least 124 homicides this year. Local police say there have been an additional 476 “bullet-to-skin victims” — people who were shot and survived. And there were at least 50 school shootings nationwide by mid-September.
Collectively it is all taking a toll.
Survivors suffer panic attacks and feel a heightened sense of danger in crowds and deep anxieties about the threat of violence anywhere in Kansas City.
Every shooting survivor responds in their own way to gun violence and even the threat of it, according to LJ Punch, a trauma surgeon by training and founder of the Bullet Related Injury Clinic in St. Louis.
For some, getting shot ensures they will always be on guard, perhaps even armed. Others want nothing to do with guns ever again.
“But what’s the common ground? That people desperately want to be safe,” Punch said.
Cabrera’s search to make meaning out of what happened has led her to work with a frustrated local lawmaker seeking new gun laws — something akin to impossible given Missouri state law, which prohibits nearly any local restrictions on firearms.
Learning of Other Shootings on the Phone
Feb. 14 is a movie in Cabrera’s mind, in slow motion, frame by frame, and the soundtrack is her voice, talking and talking. She sees a group of rowdy teenage boys running around her and her family. Then two pops — fireworks? Another pop. Finally, a fourth.
“I think that’s where the shock kicked in, and I grabbed my mom,” Cabrera remembered. “I didn’t say anything to her. I just, like, looked at her, and I had, like, my eyes were widened, and I kind of signaled with my eyes to look down at my leg.”
Cabrera fell and other fans rushed to her rescue, calling 911, and began cutting off her leggings. Four men instantly pulled off their belts when asked for a tourniquet. She remembers thinking that if she lost consciousness, she could die. So she talked and talked. Or so she thought.
One of her rescuers later said she actually didn’t say a word even when he asked how many fingers he was holding up.
“He told me [that] my eyes were huge, like oranges, and that all I was basically doing was, like, looking up and down four times since he had four fingers up,” Cabrera said.
Cabrera remembers being moved out of the emergency room at University Health to make room for 12 people who came in from the shooting at the rally, including eight with gunshot wounds. She checked social media on her phone — another shooting? Unreal. Finally her parents found her. She spent seven days in the hospital.
Cabrera is grateful to be alive. But she is triggered now when she sees groups of teenage boys cursing and playing, or when she sees red Chiefs shirts. Hearing four pops in a row — a regular occurrence in her northeast Kansas City neighborhood — makes Cabrera’s chest swell and she braces for a panic attack.
“It runs over and over and over and over in my mind,” she said.
‘An Increasing Sense of Threat?’
The U.S. surgeon general declared gun violence a public health crisis in June, but nearly any new regulation on guns is a political nonstarter in Missouri. In fact, a 2021 state law — signed at the Kansas City-area gun store where one of the weapons used in the parade shooting was purchased — would have barred local police from enforcing federal gun laws. The law was struck down by a federal appeals court in August.
Missouri has no age restrictions on gun use and possession, although federal law largely prohibits juveniles from carrying handguns.
Polling of Missouri voters shows support for requiring background checks and instituting age restrictions for gun purchases, but also nearly half were opposed to allowing counties and cities to pass their own gun rules.
Per capita, Kansas City, Missouri, is among the more violent places in the nation. From 2014 to 2023, there were at least 2,175 shootings in this city of 510,000, leaving 1,275 people dead and 1,624 injured. And while murder rates fell in more than 100 cities across the country last year, Kansas City recorded its deadliest year on record.
Shared with permission from The Trace.
Punch, of the Bullet Related Injury Clinic, likened the violence to a disease outbreak that goes unaddressed and spreads. The state’s permissive posture toward guns might supercharge the reality in Kansas City, Punch said, but it didn’t start it.
“So is there something going on? Is there an increasing sense of threat?” Punch asked.
Jason Barton was familiar with that violence growing up in Kansas City. Now settled in Osawatomie, Kansas, he thought long and hard about bringing his own gun for protection when he drove his family to the Super Bowl parade.
Ultimately he decided against it, surmising that if something happened and he pulled out a gun, he would be arrested or shot.
Barton responded quickly to the shooting, which happened right in front of him and his family. His wife found a bullet in her backpack. His stepdaughter’s legs were burned by sparks from a bullet ricochet.
Despite his worst fears coming true, Barton said not bringing his gun that day was the right decision.
“Guns don’t need to be brought into places like that,” he said.
‘A 12-Gauge With Teeth’
Mass shootings can derail survivors’ sense of safety, according to Heather Martin, a survivor of the Columbine High School shooting in 1999 and co-founder of The Rebels Project, which provides peer support to survivors of mass trauma.
“Trying to find a way to feel safe again is very common,” Martin said, “in the years following it.”
James Lemons had always felt trepidation about returning to Kansas City, where he grew up. He even brought his gun with him to the parade but left it in the car at the urging of his wife. His 5-year-old daughter was on his shoulders when a bullet entered the back of his thigh. He shielded her from the ground as he fell. What was he realistically going to do with a gun?
And yet he can’t help but wonder “what if.” He can’t shake the feeling that he failed to protect his family. Waking up from dreams about the parade, “I just start crying,” he said. He knows he hasn’t processed it yet but he doesn’t know how to start. He has focused on his family’s safety.
They got two American bulldogs this summer, making three total in the house now — one for each kid. Lemons described them as “like having a gun without having a gun.”
“I’ve got a 12-gauge with teeth,” Lemons joked, “just a big, softy protector.”
Most nights he sleeps only a few hours at a time before waking up to check on the kids. Usually he’s on the couch. It’s more comfortable for his leg that is still healing, and it helps him avoid the restless kicks of his 5-year-old, who has slept with her parents since the parade.
It also ensures he’ll be the one to intercept an intruder who breaks into the house.
Emily Tavis, who was shot through the leg, found solace at her church and from a sister congregation’s in-house therapist.
But then, the Sunday morning after the Donald Trump rally shooting in July, the preacher’s sermon turned to gun violence — triggering panic inside her.
“And it just, like, overwhelmed me so much, where I just went to the bathroom,” Tavis said, “and I just stayed in the bathroom for the rest of the sermon.” Now even attending church gives her pause.
Tavis recently moved into a new house in Leavenworth, Kansas, that she is renting from a friend. The friend’s husband cautioned that if Tavis was going to be alone she needed a gun for protection. She told him she just can’t deal with guns right now.
“And he’s like, ‘OK, well, take this.’ And he pulls out this giant machete,” Tavis recalled, laughing.
“So I have a machete now.”
A Search for Something Good
Cabrera, the young woman who couldn’t speak after being shot, is now trying to use her voice in the fight against gun violence.
Manny Abarca, a Jackson County, Missouri, legislator, lives down the street. One evening, he came to visit. Cabrera’s parents did most of the talking; she’s shy by nature. But then he turned and asked her directly: What did she want?
“I just want, like, some justice for my case,” she said, “or something good to happen.”
Before the parade, Cabrera was offered a factory job where her sister worked, but she hadn’t started because her leg was still healing. So Abarca offered her an internship, helping him establish a Jackson County Office of Gun Violence Prevention, a plan he introduced in July in response to the parade shootings.
Abarca was in the Chiefs victory parade with his 5-year-old daughter, Camila. They were in Union Station when shots were fired — and they huddled in a downstairs bathroom.
“I just said, ‘Hey, you know, just be calm. Just be quiet. Let’s just find out what’s going on. Something’s happened,’” Abarca said. “And then she said, ‘This is a drill.’ And hey, it tore everything out of me, because I was like, she’s referring to her training” at school.
They emerged shaken but safe, only to learn that Lopez-Galvan had died. Abarca knew the 43-year-old mother and popular Tejano DJ through the area’s tight-knit Hispanic community.
Abarca has taken advantage of this heated time after the Super Bowl parade shootings to work on anti-violence measures, despite knowing the severe limitations posed by state law.
In June, the Jackson County Legislature passed a measure that gives local teeth to a federal domestic violence law that allows judges to remove firearms from offenders.
But Abarca hasn’t been able to get the gun violence office approved, and county officials have refused to take up another measure that would establish age limits for purchasing or possessing firearms, fearing a lawsuit from a combative state attorney general. He hired Cabrera, he said, because she is bilingual and he wants her help as a survivor.
In a sense, the work makes Cabrera feel stronger in her fight to move forward from the shooting. Still, her family’s perception of safety has been shattered, and no one will be attending games or a possible Super Bowl victory parade anytime soon.
“We just never expected something like that to happen,” she said. “And so I think we’re gonna be more cautious now and maybe just watch it through TV.”
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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More Mobile Clinics Are Bringing Long-Acting Birth Control to Rural Areas
Twice a month, a 40-foot-long truck transformed into a mobile clinic travels the Rio Grande Valley to provide rural Texans with women’s health care, including birth control.
The clinic, called the UniMóvil, is part of the Healthy Mujeres program at the University of Texas Rio Grande Valley School of Medicine.
The U.S. has about 3,000 mobile health programs. But Saul Rivas, an OB-GYN, said he wasn’t aware of any that shared the specific mission of Healthy Mujeres when he helped launch the initiative in 2017. “Mujeres” means “women” in Spanish.
It’s now part of a small but growing number of mobile programs aimed at increasing rural access to women’s health services, including long-acting reversible contraception.
There are two kinds of these highly effective methods: intrauterine devices, known as IUDs, and hormonal implants inserted into the upper arm. These birth control options can be especially difficult to obtain — or have removed — in rural areas.
“Women who want to prevent an unintended pregnancy should have whatever works best for them,” said Kelly Conroy, senior director of mobile and maternal health programs at the University of Arkansas for Medical Sciences.
The school is launching a mobile women’s health and contraception program in rural parts of the state this month.
Rural areas have disproportionately fewer doctors, including OB-GYNs, than urban areas. And rural providers may not be able to afford to stock long-acting birth control devices or may not be trained in administering them, program leaders say.
Mobile clinics help shrink that gap in rural care, but they can be challenging to operate, said Elizabeth Jones, a senior director at the National Family Planning & Reproductive Health Association.
Money is the greatest obstacle, Jones said. The Texas program costs up to $400,000 a year. A 2020 study of 173 mobile clinics found they cost an average of more than $630,000 a year. Mobile dental programs were the most expensive, averaging more than $1 million.
While many programs launch with the help of grants, they can be difficult to sustain, especially with over a decade of decreased or stagnant funding to Title X, a federal money stream that helps low-income people receive family planning services.
For example, a mobile contraception program serving rural Pennsylvania lasted less than three years before closing in 2023. It shut down after losing federal funding, said a spokesperson for the clinic that ran it.
Rural mobile programs aren’t as efficient or profitable as brick-and-mortar clinics. That’s because staff members may have to make hours-long trips to reach towns where they’ll probably see fewer patients than they would at a traditional site, Jones said.
She said organizations that can’t afford mobile programs can consider setting up “pop-up clinics” at existing health and community sites in rural areas.
Maria Briones is a patient who has benefited from the Healthy Mujeres program in southern Texas. The 41-year-old day care worker was concerned because she wasn’t getting her menstrual period with her IUD.
She considered going to Mexico to have the device removed because few doctors take her insurance on the U.S. side of the Rio Grande Valley.
But Briones learned that the UniMóvil was visiting a small Texas city about 20 minutes from her home. She told the staff there that she doesn’t want more kids but was worried about the IUD.
Briones decided to keep the device after learning it’s safe and normal not to have periods while using an IUD. She won’t get billed for her appointment with the mobile clinic, even though the university health system doesn’t take her insurance.
“They have a lot of patience, and they answered all the questions that I had,” Briones said.
IUDs and hormonal implants are highly effective and can last up to 10 years. But they’re also expensive — devices can cost more than $1,000 without insurance — and inserting an IUD can be painful.
Patient-rights advocates are also concerned that some providers pressure people to use these devices.
They say ethical birth control programs aim to empower patients to choose the contraceptive method — if any — that is best for them, instead of promoting long-acting methods in an attempt to lower birth and poverty rates. They point to the history of eugenics-inspired sterilization and even more recent incidents.
For example, an investigation by Time magazine found doctors are more likely to push Black, Latina, young, and low-income women than other patients to use long-acting birth control — and to refuse to remove the devices.
Rivas said Healthy Mujeres staffers are trained on this issue.
“Our goal isn’t necessarily to place IUDs and implants,” he said. It’s to “provide education and help patients make the best decisions for themselves.”
David Wise, a spokesperson for the University of Arkansas for Medical Sciences, said staff members with the university’s mobile program will ask patients if they want to get pregnant in the next year, and will support their choice. The Arkansas and Texas programs also remove IUDs and hormonal arm implants if patients aren’t happy with them.
The Arkansas initiative will visit 14 rural counties with four vehicles the size of food trucks that were used in previous mobile health efforts. Staffing and equipment will be covered by a two-year, $431,000 grant from an anonymous donor, Wise said.
In addition to contraception, faculty and medical residents staffing the vehicles will offer women’s health screenings, vaccinations, prenatal care, and testing and treatment for sexually transmitted infections.
Rivas said the Texas program was inspired by a study that found that, six months after giving birth, 34% of surveyed Texas mothers said long-acting contraception is their preferred birth control option — but only 13% were using that method.
“We started thinking about ways to address that gap,” Rivas said.
Healthy Mujeres, which is funded through multiple grants, started with a focus on contraception. It later expanded to services such as pregnancy ultrasounds, cervical cancer screenings, and testing for sexually transmitted infections.
While the Texas and Arkansas programs can bill insurance, they also have funding to help uninsured and underinsured patients afford their services. Both use community health workers — called promotoras in largely Spanish-speaking communities like the Rio Grande Valley — to connect patients with food, transportation, additional medical services, and other needs.
They partner with organizations that locals trust, such as food pantries and community colleges, which let the mobile units set up in their parking lots. And to further increase the availability of long-acting contraception in rural areas, the universities are training their students and local providers on how to insert, remove, and get reimbursed for the devices.
One difference between the programs is dictated by state laws. The Arkansas program can provide birth control to minors without a parent or guardian’s consent. But in Texas, most minors need consent before receiving health care, including contraception.
Advocates say these initiatives might help lower the rates of unintended and teen pregnancies in both states, which are higher than the national average.
Rivas and Conroy said their programs haven’t received much pushback. But Rivas said some churches that had asked the UniMóvil to visit their congregations changed their minds after learning the services included birth control.
Catherine Phillips, director of the Respect Life Office at Arkansas’ Catholic diocese, said the diocese supports efforts to achieve health care equity and she’s personally interested in mobile programs that visit rural areas such as where she lives.
But Phillips said the Arkansas program’s focus on birth control, especially long-acting methods, violates the teachings of the Catholic Church. Offering these services to minors without parental consent “makes it more egregious,” she said.
Jones said that, while these programs have hefty costs and other challenges, they also have benefits that can’t be measured in numbers.
“Building community trust and making an impact in the communities most impacted by health inequities — that’s invaluable,” 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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Millions of Aging Americans Are Facing Dementia by Themselves
Sociologist Elena Portacolone was taken aback. Many of the older adults in San Francisco she visited at home for a research project were confused when she came to the door. They’d forgotten the appointment or couldn’t remember speaking to her.
It seemed clear they had some type of cognitive impairment. Yet they were living alone.
Portacolone, an associate professor at the University of California-San Francisco, wondered how common this was. Had anyone examined this group? How were they managing?
When she reviewed the research literature more than a decade ago, there was little there. “I realized this is a largely invisible population,” she said.
Portacolone got to work and now leads the Living Alone With Cognitive Impairment Project at UCSF. The project estimates that that at least 4.3 million people 55 or older who have cognitive impairment or dementia live alone in the United States.
About half have trouble with daily activities such as bathing, eating, cooking, shopping, taking medications, and managing money, according to their research. But only 1 in 3 received help with at least one such activity.
Compared with other older adults who live by themselves, people living alone with cognitive impairment are older, more likely to be women, and disproportionately Black or Latino, with lower levels of education, wealth, and homeownership. Yet only 21% qualify for publicly funded programs such as Medicaid that pay for aides to provide services in the home.
In a health care system that assumes older adults have family caregivers to help them, “we realized this population is destined to fall through the cracks,” Portacolone said.
Imagine what this means. As memory and thinking problems accelerate, these seniors can lose track of bills, have their electricity shut off, or be threatened with eviction. They might stop shopping (it’s too overwhelming) or cooking (it’s too hard to follow recipes). Or they might be unable to communicate clearly or navigate automated phone systems.
A variety of other problems can ensue, including social isolation, malnutrition, self-neglect, and susceptibility to scams. Without someone to watch over them, older adults on their own may experience worsening health without anyone noticing or struggle with dementia without ever being diagnosed.
Should vulnerable seniors live this way?
For years, Portacolone and her collaborators nationwide have followed nearly 100 older adults with cognitive impairment who live alone. She listed some concerns people told researchers they worried most about: “Who do I trust? When is the next time I’m going to forget? If I think I need more help, where do I find it? How do I hide my forgetfulness?”
Jane Lowers, an assistant professor at the Emory University School of Medicine, has been studying “kinless” adults in the early stages of dementia — those without a live-in partner or children nearby. Their top priority, she told me, is “remaining independent for as long as possible.”
Seeking to learn more about these seniors’ experiences, I contacted the National Council of Dementia Minds. The organization last year started a biweekly online group for people living alone with dementia. Its staffers arranged a Zoom conversation with five people, all with early-to-moderate dementia.
One was Kathleen Healy, 60, who has significant memory problems and lives alone in Fresno, California.
“One of the biggest challenges is that people don’t really see what’s going on with you,” she said. “Let’s say my house is a mess or I’m sick or I’m losing track of my bills. If I can get myself together, I can walk out the door and nobody knows what’s going on.”
An administrator with the city of Fresno for 28 years, Healy said she had to retire in 2019 “because my brain stopped working.” With her pension, she’s able to cover her expenses, but she doesn’t have significant savings or assets.
Healy said she can’t rely on family members who have troubles of their own. (Her 83-year-old mother has dementia and lives with Healy’s sister.) The person who checks on her most frequently is an ex-boyfriend.
“I don’t really have anybody,” she said, choking up.
David West, 62, is a divorced former social worker with Lewy body dementia, which can impair thinking and concentration and cause hallucinations. He lives alone in an apartment in downtown Fort Worth, Texas.
“I will not survive this in the end — I know that — but I’m going to meet this with resilience,” he said when I spoke with him by phone in June.
Since his diagnosis nearly three years ago, West has filled his life with exercise and joined three dementia support groups. He spends up to 20 hours a week volunteering, at a restaurant, a food bank, a museum, and Dementia Friendly Fort Worth.
Still, West knows that his illness will progress and that this period of relative independence is limited. What will he do then? Although he has three adult children, he said, he can’t expect them to take him in and become dementia caregivers — an extraordinarily stressful, time-intensive, financially draining commitment.
“I don’t know how it’s going to work out,” he said.
Denise Baker, 80, a former CIA analyst, lives in a 100-year-old house in Asheville, North Carolina, with her dog, Yolo. She has cognitive problems related to a stroke 28 years ago, Alzheimer’s disease, and serious vision impairment that prevents her from driving. Her adult daughters live in Massachusetts and Colorado.
“I’m a very independent person, and I find that I want to do everything I possibly can for myself,” Baker told me, months before Asheville was ravaged by severe flooding. “It makes me feel better about myself.”
She was lucky in the aftermath of Hurricane Helene: Baker lives on a hill in West Asheville that was untouched by floodwaters. In the week immediately after the storm, she filled water jugs every day at an old well near her house and brought them back in a wheelbarrow. Though her power was out, she had plenty of food and neighbors looked in on her.
“I’m absolutely fine,” she told me on the phone in early October after a member of Dementia Friendly Western North Carolina drove to Baker’s house to check in on her, upon my request. Baker is on the steering committee of that organization.
Baker once found it hard to ask for assistance, but these days she relies routinely on friends and hired help. A few examples: Elaine takes her grocery shopping every Monday. Roberta comes once a month to help with her mail and finances. Jack mows her lawn. Helen offers care management advice. Tom, a cab driver she connected with through Buncombe County’s transportation program for seniors, is her go-to guy for errands.
Her daughter Karen in Boston has the authority to make legal and health care decisions when Baker can no longer do so. When that day comes — and Baker knows it will — she expects her long-term care insurance policy to pay for home aides or memory care. Until then, “I plan to do as much as I can in the state I’m in,” she said.
Much can be done to better assist older adults with dementia who are on their own, said Elizabeth Gould, co-director of the National Alzheimer’s and Dementia Resource Center at RTI International, a nonprofit research institute. “If health care providers would just ask ‘Who do you live with?’” she said, “that could open the door to identifying who might need more help.”
We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care, and advice you need in dealing with the health care system. Visit kffhealthnews.org/columnists to submit your requests or tips.
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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Journalists Talk Obesity, Oximeters, and Severe Weather’s Impact on Public Health
KFF Health News senior fellow and editor-at-large for public health Céline Gounder discussed how best to prepare for a storm on “CBS News 24/7” on Oct. 9.
KFF Health News chief Washington correspondent Julie Rovner discussed obesity on WAMU and NPR’s “1A” on Oct. 9.
KFF Health News senior correspondent Arthur Allen discussed pulse oximeter bias on KCBS Radio on Oct. 7.
- Click here to hear Allen on KCBS Radio
- Read Allen’s “FDA’s Promised Guidance on Pulse Oximeters Unlikely To End Decades of Racial Bias”
KFF Health News contributor Andy Miller discussed the impact of climate change on human health and a potential new hospital in Atlanta for WUGA’s “The Georgia Health Report” on Oct. 4 and Sept. 27, respectively. He also spoke on a panel about climate and public health aired on Atlanta Video Network on Sept. 30.
- Click here to hear Miller talk climate change on “The Georgia Health Report”
- Click here to hear Miller discuss a potential new hospital in Atlanta on “The Georgia Health Report”
- Click here to watch Miller on Atlanta Video Network
KFF Health News correspondent Daniel Chang discussed vaccine misinformation in Florida on Radio Bilingüe’s “Línea Abierta” on Oct. 2.
- Click here to hear Chang on “Línea Abierta”
- Read “Florida’s New Covid Booster Guidance Is Straight-Up Misinformation,” which Chang co-authored with Arthur Allen and Sam Whitehead
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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El aborto es el tema electoral más importante para las mujeres jóvenes, según una encuesta
El aborto se ha convertido en el tema más importante de las elecciones de noviembre para las mujeres menores de 30 años, según una encuesta de KFF. Se trata de un cambio notable desde finales de la primavera, antes que la vicepresidenta Kamala Harris entrara en la carrera presidencial.Casi 4 de cada 10 mujeres menores de 30 años encuestadas en septiembre y principios de octubre dijeron que el aborto es la cuestión más importante a la hora de emitir su voto. Cuando KFF realizó una encuesta similar entre finales de mayo y principios de junio, sólo el 20% señaló el aborto como un tema muy importante.
La nueva encuesta encontró otros cambios entre las mujeres votantes que pueden beneficiar a Harris, incluyendo un aumento de 24 puntos porcentuales en el número de mujeres que afirmaron estar satisfechas con la elección de sus candidatos y un aumento de 19 puntos en el número de las que dijeron estar más motivadas para votar que en anteriores elecciones presidenciales.
Los cambios sugieren que las mujeres dejaron de apoyar de manera significativa al ex presidente Donald Trump en solo unos meses.
“La situación parece peor para Donald Trump que en junio”, dijo Ashley Kirzinger, directora de metodología de encuestas en KFF, una organización sin fines de lucro sobre información de salud que incluye a KFF Health News. “Que Harris se convirtiera en la candidata presidencial demócrata dinamizó a las mujeres votantes de una forma que la candidatura de Biden no había conseguido”.El presidente Joe Biden abandonó su candidatura a la reelección el 21 de julio, presionado por los líderes del Partido Demócrata y tras una actuación llena de tropiezos en el debate de junio contra Trump, que reavivó las dudas sobre la aptitud del presidente de 81 años para un segundo mandato.
Aunque las mujeres se muestran más entusiastas a la hora de votar por Harris que por Biden, la elección sigue siendo reñida. Harris tiene una ventaja de 2,5 puntos en las encuestas nacionales, según un análisis de FiveThirtyEight. Otros sondeos han detectado una gran división de género en la elección, con una mayoría de mujeres que apoyan a Harris, y una mayoría de hombres que respaldan a Trump.
Harris ha sido durante mucho tiempo una de las principales defensoras del derecho al aborto del Partido Demócrata, y ha atacado a Trump por nombrar para la Corte Suprema a tres jueces conservadores que se sumaron a la sentencia de 2022 que anuló el caso Roe v. Wade, el dictamen histórico de 1973 que garantizó el acceso al aborto a nivel nacional.
Desde entonces, 13 estados han prohibido el aborto con pocas excepciones, según KFF.
Trump defiende que el fallo simplemente devolvió el controversial tema a los estados, y aunque sus posiciones han cambiado a menudo, recientemente ha prometido no convertir en ley una prohibición nacional del aborto. Harris ha repetido que ella firmaría una ley que restableciera el derecho al aborto en todo el país.
El ex presidente ha hecho, en ocasiones, extraños e incómodos llamamientos a las mujeres votantes.
“Estarán protegidas, y yo seré su protector”, dijo Trump, dirigiéndose a las mujeres votantes, en un mitín el 23 de septiembre en Indiana, Pennsylvania. “Las mujeres serán felices, sanas, tendrán seguridad y serán libres. Ya no pensarán en el aborto”.
El sondeo de KFF reveló que Harris le está ganando terreno a Trump entre las mujeres no sólo en materia de aborto —un tema al que el ex presidente trata de restar importancia, reconociendo su peligro político—, sino también en temas económicos, que Trump y sus asesores consideran uno de sus argumentos más sólidos para su regreso a la Casa Blanca.
Múltiples sondeos han mostrado que la economía sigue siendo un tema prioritario en las elecciones, especialmente para las mujeres afroamericanas e hispanas. Un 75% de las encuestadas en el sondeo de KFF dijeron que se preocupan por los gastos del hogar “mucho” o “algo”.
La inflación fue el principal problema para el 36% de las encuestadas del KFF, mientras que el 13% señaló el aborto como su prioridad.
Alrededor del 46% de las mujeres votantes en la nueva encuesta dijeron que confían en Harris sobre Trump para abordar los gastos del hogar, mientras que el 39% confía más en el ex presidente. El 16% dijo que ninguno de los dos.
En la encuesta anterior de KFF realizada con mujeres en primavera, las encuestadas se dividieron casi por igual en cuanto a qué partido confiaban más para abordar el aumento de los costos domésticos. Un 40% dijo que no confiaba en ninguno de los dos partidos.
En cuanto a los costos de salud, Harris mantiene una ventaja significativa sobre Trump en la nueva encuesta, con un 50% que confía más en ella en esta cuestión, un 34% que confía más en Trump y un 16% que no confía en ninguno de los dos.
Kirzinger señaló que las mujeres afroamericanas prefieren especialmente a Harris en cuestiones económicas; por ejemplo, confían en la vicepresidenta 7 a 1 sobre Trump en materia de inflación, dijo.
Más de la mitad de los votantes estadounidenses han sido mujeres en las dos últimas elecciones nacionales, según la Oficina del Censo.
“Un candidato demócrata necesita ganar a las mujeres en tasas muy altas y necesita entusiasmar a la base, que en gran parte está formada por mujeres”, indicó Kirzinger. “Lo que vimos a principios de junio fue que la candidatura de Biden no lo estaba consiguiendo. Ahora parece que la campaña de Harris lo está logrando en una variedad de temas; no se trata sólo del aborto. Es ella como candidata la que entusiasma a las mujeres”.
La encuesta de KFF se realizó desde el 12 de septiembre al 1 de octubre entre 649 mujeres que habían sido encuestadas en primavera, e incluyó una muestra suplementaria de 29 mujeres afroamericanas votantes registradas. El margen de error fue de más o menos 5 puntos.
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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Extended-Stay Hotels, a Growing Option for Poor Families, Can Lead to Health Problems for Kids
STONE MOUNTAIN, Ga. — As principal of Dunaire Elementary School, Sean Deas has seen firsthand the struggles faced by children living in extended-stay hotels. About 10% of students at his school, just east of Atlanta, live in one.
The children, Deas said, often have been exposed to violence on hotel properties, exhibit aggression or anxiety from living in a crowded single room, and face food insecurity because some hotel rooms don’t have kitchens.
“Social trauma is the biggest challenge” when students first arrive, Deas said. “We hear a lot about sleep problems.” To meet students’ needs, Deas developed a schoolwide program featuring counselors, a food pantry, and special protocols for handling those who may fall asleep in class.
“Beyond the teaching, there’s a social part,” he said. “We have to find ways to support the families as well.”
Extended-stay hotels are often a last resort for low-income families trying to find housing. Nationally, more than 100,000 students lived in extended-stay hotels in 2022, according to the Department of Education, though officials say that is likely an undercount. Children living in hotels are considered homeless under federal law, and in some Atlanta-area counties about 40% of homeless students live in this kind of housing, according to local officials.
And with rising rents and evictions, and decreased access to federal public housing, the use of extended-stay hotels as a long-term option is becoming more frequent. Like other forms of homelessness, hotel living can lead to — or exacerbate — physical and mental health problems for children, say advocates for families and researchers who study homelessness.
In the Atlanta area, inspections of extended-stay hotels have revealed ventilation issues, insect infestations, mold, and other health threats. Children living there also can experience or witness crime and gun violence. The increasing use of extended-stay hotels is a warning sign, observers said, a reflection of the lack of sufficient affordable housing policy in the U.S.
And the crisis is having “lifelong consequences,” said Sarah Saadian of the National Low Income Housing Coalition. “The only way that we can really address that shortage is if there are significant federal resources at scale. Build more housing and bridge the gap between rents and wages.”
Often, evictions force families into hotels — and can keep them trapped there. Many landlords refuse to rent to people with evictions in their credit history, even if the tenant isn’t responsible for the displacement, said Joy Monroe, founder and CEO of the Single Parent Alliance & Resource Center, or SPARC, a nonprofit group in metro Atlanta that has helped hundreds of families move from hotels to apartments or rental homes.
Black women and other women of color, often with kids, are evicted at much higher rates and are more likely to find themselves living in extended-stay hotels, advocates say.
Some residents are also families fleeing domestic violence, they say.
Hotels often don’t require security deposits, application fees, or background checks, thus providing immediate relief for families seeking shelter. While there are higher-end options, the average rate for an economy-class extended-stay room was $56.68 a night during the first three months of 2024, according to the Highland Group, a research firm that focuses on the hotel sector — which works out to more than $1,700 a month.
And while the rooms offer respite from other forms of homelessness — like sleeping in a car or in a tent — a hotel “is no place to raise children,” said Michael Bryant, CEO of New Life Community Alliance, which helps families in South Dekalb, a part of metro Atlanta, move from hotels to homes.
Children living in hotels are often behind on vaccinations, and they may end up in the emergency room because of delays in care, said Gary Kirkilas, a pediatrician in Phoenix who helps children, teens, and families who are presently homeless or at risk of homelessness. About 75% of children with unstable housing whom he sees have at least one developmental delay, and others experience significant emotional and behavioral issues.
Tanazia Scott, who has bounced between two extended-stay hotels for several months, said her three children “feel depressed and upset” over hotel life.
An eviction sent Kassandra Norman, 58, and her two daughters into a months-long journey of staying in Atlanta-area hotels. For three months, they slept in a car outside a convenience store. “It’s hard to do homework in a car and in the hotel,” said 19-year-old Kazuri Taylor, Norman’s younger daughter.
Some hotels prohibit kids from playing outside in their parking lots, leading to additional stress, advocates say. That was the reason Yvonne Thomas, 45, and her family were evicted from an extended-stay hotel in DeKalb County, she said: “They put us out for nothing.”
And there are other problems. More than a dozen students at Dunaire Elementary live on an extended-stay property called Haven Hotel. In August, DeKalb County’s code enforcement division said the hotel had “not maintained minimum life safety standards.” Roaches and spiders live in rooms and breezeways, according to state health inspection reports. Residents say they have been charged $1 for a roll of toilet paper.
The hotel’s owner and manager could not be reached for comment after multiple attempts.
“No one is talking about these families,” said Sue Sullivan, a community advocate and a volunteer with the Motel to Home coalition in Atlanta, who brings toys, bookbags, food, and toiletries on her hotel visits.
A February public health inspection at another DeKalb County hotel found several rooms with poor ventilation, insect infestation, and mold, among other potential health threats. In May, two people were fatally shot there.
Children who witness violence can develop anxiety, depression, and other disorders, said Charles Moore, director of the Urban Health Initiative at Emory University School of Medicine. “They can feel emotional aftershocks,” said Moore, who has visited Atlanta-area hotels.
Closing such hotels, however, can hurt families, given the shortage of affordable housing, the absence of national federal renter protections, and a dearth of places to go, said Terri Lewinson, an associate professor at the Dartmouth Institute for Health Policy and Clinical Practice. Extended-stay hotels do “offer a low-barrier option for families who have no other options,” she said.
To alleviate the housing problem, county officials and nonprofit organizations around the country have been creatively filling the gap. In the Seattle area, for example, King County officials purchased hotels and converted them into affordable housing, said Mark Skinner of the Highland Group.
In metro Atlanta, SPARC and the local United Way’s Motel to Home offer funding to help people transition into an apartment.
In DeKalb County, where Dunaire Elementary School is located, more than a third of the 1,300 homeless students live in hotels, according to Commissioner Ted Terry.
“I hope we can rescue the children,” he said. “It’s not a safe environment for them.”
Advocates who seek to help people living in hotels propose the construction of more affordable housing and stronger protections for renters against eviction. The federal government has failed to invest in repairs needed to maintain current public housing units, and 25-year-old legislation effectively prohibits the construction of new public housing.
It’s also “extremely fast, easy, and cheap” to evict tenants in Georgia, said Taylor Shelton, an associate professor of geosciences at Georgia State University, whose research focuses on social inequalities and urban spaces. “The playing field is tilted heavily toward landlords.”
Under such circumstances, the cycle of poverty is difficult to break, said Jamie Rush, a senior staff attorney at the Southern Poverty Law Center. “Most parents would want their kids in a safe, stable home,” Rush said. “You can’t budget your way out of poverty.”
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Colorado’s Naloxone Fund Is Drying Up, Even as Opioid Settlement Money Rolls In
DENVER — On a bustling street corner one recent afternoon outside the offices of the Harm Reduction Action Center, employees of the education and advocacy nonprofit handed out free naloxone kits to passersby.
Distributing the opioid reversal medication is essential to the center’s work to reduce fatal overdoses in the community. But how long the group can continue doing so is in question. The center depends on Colorado’s Opioid Antagonist Bulk Purchase Fund, also known as the Naloxone Bulk Purchase Fund, which now lacks a recurring source of money — despite hundreds of millions of dollars in national opioid lawsuit settlement cash flowing into the state.
“Our concern is that we won’t have access to naloxone, and that means that more people will die of a very preventable overdose,” said Lisa Raville, executive director of the center.
The bulk fund was created in 2019 to provide free naloxone to organizations like the Harm Reduction Action Center. The fund’s annual budget grew from just over $300,000 in fiscal year 2019 to more than $8.5 million in fiscal 2022, according to legislative reports by the state’s Overdose Prevention Unit.
The fund has boosted the availability of the medication throughout Colorado, which passed a law in 2013 that gives legal immunity to medical providers who prescribe the drug and to any person who administers it to someone suffering an overdose. The fund currently provides more than $550,000 worth of naloxone kits to various entities each month.
Despite the increased availability of naloxone, fatal opioid overdoses continued to rise. In 2023, 1,292 people in Colorado died of an opioid overdose, according to data from the Colorado Department of Public Health and Environment. That was 132 more people than the year before.
And now, one of the fund’s major money sources, the American Rescue Plan passed by Congress in response to the covid-19 pandemic, is set to expire next year. As of September, the Colorado fund had $8.6 million left, according to Vanessa Bernal, a spokesperson for the state health department.
The fund got a boost in September when the state’s Behavioral Health Administration provided it with $3 million from a one-time Substance Use Prevention, Treatment, and Recovery Services Block Grant and nearly $850,000 through a State Opioid Response Grant. Colorado Attorney General Phil Weiser said his office will “ensure that the necessary budget remains in place for the next year.”
The amount of that funding and where it will come from has yet to be determined, and long-term solutions are still being weighed, as well. One option to shore up the fund beyond the next year is to use Colorado’s share of settlement funds from the national opioid lawsuits, said Mary Sylla, former director of overdose prevention policy and strategy at the National Harm Reduction Coalition.
“It’s just completely ironic that something that addresses the opioid overdose crisis is underfunded at the very same time that these settlement funds are flowing,” Sylla said. “There couldn’t be a better use for them.”
As of July, Colorado had received and distributed more than $110 million in opioid settlement money to regions, local governments, state entities, and infrastructure projects, according to the Colorado attorney general’s office, and the total is expected to reach more than $750 million by 2038.
However, more than half of the settlement money Colorado has received thus far has already been disbursed to its 19 Regional Opioid Abatement Councils, which have created their own plans to distribute money to programs such as substance abuse treatment centers, public education campaigns, and training for emergency providers.
For example, Denver’s council, which has received more than $18 million since 2022, has disbursed money to organizations in two- and three-year contracts, the majority not including the purchase of naloxone.
“We thought we could all continue to get [naloxone] from the state health department and the Naloxone Bulk Purchase Fund,” Raville said.
The Denver council is working on a plan for the coming years, expected to come out in mid-2025, and is considering the bulk fund’s dwindling money, said Marie Curran, program coordinator for Denver’s opioid abatement funds.
Lawrence Pacheco, a spokesperson for the attorney general’s office, which manages 10% of the state’s opioid settlement dollars, said the office “is working on options to ensure that this lifesaving medication can continue to be part of the state’s effort to abate the opioid crisis.” Those options have not yet been made public.
California, where Sylla works, has used settlement money for a distribution program that’s similar to Colorado’s. In Washington and Kentucky, as part of the states’ settlements with Teva Pharmaceuticals, tens of thousands of free naloxone kits will be available to residents. Each state uses its opioid settlement funds differently, and while many provide naloxone to residents in some manner, including via vending machines, there is no central tracking of naloxone distribution programs.
Over the past five years, Colorado’s fund has distributed more than half a million doses of the opioid reversal drug to hundreds of organizations and schools across the state. Last year, the Harm Reduction Action Center received 7,284 doses from the fund, which Raville estimates helped save more than 4,500 lives.
Unless additional money is found, the bulk fund runs the risk of having to further limit distribution, leaving the hundreds of organizations that rely on it with little or no access to free naloxone. While the medication became available over the counter nationally last fall, the $45 price tag per two-dose package means it can remain out of reach for some who need it most.
In May, the state announced a plan for prioritizing which groups get the medication from the bulk fund, with four categories, from “essential” to “low need,” based on how frequently an entity directly encounters people who are most at risk of experiencing or witnessing an overdose. The Harm Reduction Action Center has been classified in the “essential” category. School districts, as well as colleges and universities, are in the next-highest category.
Another organization, The Naloxone Project, said it was misclassified by not being put at the highest priority level. As a result, it said, it received just 1,200 naloxone doses from the fund this year, instead of the 6,000 it requested.
“We would argue that we would fall under ‘essential’ because many of our programs are public-facing and consistently provide naloxone for people who use drugs and who are at the highest risk of experiencing overdose,” said Rachael Duncan, associate director of The Naloxone Project.
The group, which has chapters in 12 states, provides nasal and injectable forms of naloxone to more than 90% of Colorado’s hospitals, to give to patients before they are discharged from the emergency department or from labor and delivery units. More than half of the 12,000 naloxone kits the project has distributed to Colorado medical entities have come from the bulk fund.
Another organization, UCHealth’s Center for Dependency, Addiction and Rehabilitation, known as CeDAR, which offers residential, outpatient, and telehealth treatment, is no longer eligible to receive free naloxone, because its patients typically are insured or can pay out-of-pocket.
Karli Yarnell, a CeDAR physician assistant, said that even when someone can pay for it, that doesn’t mean they can get to a pharmacy to pick up the medicine.
And Duncan is concerned about what the loss of doses will mean for organizations like The Naloxone Project and CeDAR.
“What I fear will happen is a scarcity mindset of organizations competing for funding,” Duncan said. “But I also worry about places that are used to getting it so reliably running out.”
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Abortion Emerges as Most Important Election Issue for Young Women, Poll Finds
Abortion has emerged as the most important issue in the November election for women under 30, according to a survey by KFF — a notable change since late spring, before Vice President Kamala Harris entered the presidential race.
Nearly 4 in 10 women under 30 surveyed in September and early October told pollsters that abortion is the most important issue to their vote. Just 20% named abortion as their top issue when KFF conducted a similar survey in late May and early June.
The new survey found other shifts among women voters that stand to benefit Harris, including an increase of 24 percentage points in the number of women who said they were satisfied with their choice of candidates and a 19-point increase in the number who said they were more motivated to vote than in previous presidential elections. The changes suggest a significant setback among women in just a few months for former President Donald Trump.
“It looks worse for Donald Trump than it did back in June,” said Ashley Kirzinger, director of survey methodology at KFF, a health information nonprofit that includes KFF Health News. “Harris becoming the Democratic presidential nominee energized women voters in a way that the Biden candidacy had not.”
President Joe Biden abandoned his reelection bid on July 21, under pressure from Democratic Party leaders, after a stumbling performance in a June debate against Trump that reignited concerns about the 81-year-old’s fitness for a second term.
While women are more enthusiastic about voting for Harris than they were for Biden, the election remains close. Harris has a 2.5-point edge in national polls, according to a FiveThirtyEight analysis. Other polls have found a large gender divide in the election, with a majority of women backing Harris and a majority of men backing Trump.
Harris has long been one of the Democratic Party’s foremost advocates for abortion rights, and she has assailed Trump for appointing three conservative justices to the Supreme Court who joined in the 2022 ruling that overturned Roe v. Wade, the landmark 1973 opinion that guaranteed abortion access nationally. Thirteen states have since banned abortion with few exceptions, according to KFF.
Trump says the ruling merely returned the issue to states, and though his positions have often shifted, he has recently promised not to sign a national abortion ban. Harris says she would sign a law restoring nationwide abortion rights.
The former president has made sometimes awkward appeals to women voters.
“You will be protected, and I will be your protector,” Trump told women voters at a rally Sept. 23 in Indiana, Pennsylvania. “Women will be happy, healthy, confident, and free. You will no longer be thinking about abortion.”
The KFF poll found that Harris is gaining on Trump among women not just on abortion — a subject the former president tries to downplay, acknowledging its political peril — but also on economic issues, which Trump and his advisers regard as among their strongest arguments for his return to the White House.
Multiple polls have shown that the economy remains a top issue in the election, especially for Black and Hispanic women. About 75% of respondents in the KFF survey said they worry about household expenses “a lot” or “some.”
Inflation was the top issue for 36% of KFF survey respondents overall, while 13% identified abortion as their priority.
About 46% of women voters in the new poll said they trust Harris over Trump to address household costs, while 39% trust the former president more. Sixteen percent said neither.
In KFF’s previous poll of women in the spring, respondents were nearly evenly split on which party they trusted more to address rising household costs. About 40% said they trusted neither party.
On health care costs, Harris holds a significant lead over Trump in the new poll, with 50% trusting her more on the issue, 34% trusting Trump more, and 16% trusting neither.
Kirzinger said Black women especially prefer Harris on economic issues; for example, they trust the vice president 7-to-1 over Trump on inflation, she said.
More than half of U.S. voters have been women in the last two national elections, according to the Census Bureau.
“A Democratic candidate needs to win women at very high rates and needs to enthuse the base — which largely consists of women,” Kirzinger said. “What we saw in early June was, the Biden candidacy was not doing that. Now it seems the Harris campaign is doing that in multiple different ways; it’s not just abortion. It’s her as a candidate making women more enthusiastic.”
The KFF poll was conducted Sept. 12 to Oct. 1 among 649 women who had been surveyed in the spring, as well as a supplemental sample of 29 Black women registered voters. The margin of error was plus or minus 5 points.
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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Watch: Biggest Dangers and Health Concerns From Hurricane Milton
Some Florida residents riding out Hurricane Milton as it batters the state have medical needs to account for during the storm, such as dialysis treatment or keeping insulin refrigerated amid power outages. On CBS News, Céline Gounder, editor-at-large for public health at KFF Health News, shared advice on how to prepare before a major weather event.
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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Incluso los rivales políticos coinciden en que es urgente resolver el problema de la deuda médica
Mientras temas candentes de atención médica como el aborto y la Ley de Cuidado de la Salud a Bajo Precio (ACA) agitan la carrera presidencial, silenciosamente, en las legislaturas estatales de todo el país, demócratas y republicanos han estado trabajando juntos para abordar la crisis de la deuda médica en la nación.
Desde 2021, en más de 20 estados se han promulgado nuevas leyes para frenar la facturación abusiva de los hospitales, ampliar la atención caritativa a los pacientes con ingresos más bajos y frenar a los recaudadores de deudas.
Los demócratas impulsaron la mayoría de las medidas. Pero estas iniciativas legislativas a menudo fueron aprobadas también con el apoyo de los republicanos. Incluso, en algunos estados, los legisladores republicanos lideraron los proyectos para ampliar la protección a los pacientes.
“Independientemente de cuál sea su partido político, independientemente de su origen… cualquier procedimiento médico importante puede llevar a las personas a la bancarrota”, dijo en una entrevista el presidente de la Cámara de Representantes de Florida, Paul Renner, un republicano conservador. “Este es un problema real”.
Renner, que ha liderado controversiales medidas para frenar el derecho al aborto y ampliar la pena de muerte en Florida, también encabezó este año un proyecto para limitar los casos en los que los hospitales podían enviar las cuentas impagas de los pacientes a agencias de cobros. Obtuvo el apoyo unánime de la Legislatura de Florida.
Las medidas bipartidistas adoptadas en otros estados han ido más lejos, prohibiendo que estas facturas médicas figuren en los informes crediticios de los consumidores y restringiendo la posibilidad de que los proveedores médicos embarguen las viviendas de los pacientes.
Según KFF Health News, unas 100 millones de personas en el país están agobiadas por algún tipo de deuda relacionada con la atención médica, lo que obliga a millones a utilizar sus ahorros, pedir segundas hipotecas o recortar los gastos en alimentos y otros artículos de primera necesidad. Una cuarta parte de quienes tienen deudas debían más de $5.000 en 2022.
“En la Legislatura, los republicanos parecen más abiertos a proteger a la gente de la deuda médica que de cualquier otro tipo de deuda”, opinó Marceline White, directora ejecutiva de Economic Action Maryland, una organización sin fines de lucro que ayudó a liderar los esfuerzos en ese estado para detener a los proveedores médicos que pretendían embargar los salarios de los pacientes de bajos ingresos. El proyecto de ley recibió el apoyo unánime de demócratas y republicanos.
“Parece existir un amplio consenso en que no se debe perder la casa o los ahorros de toda la vida por haberse enfermado”, dijo White. “Es un nivel básico de justicia”.
La deuda médica sigue siendo un tema controversial en Washington, donde la administración Biden ha impulsado varias iniciativas para abordar el problema, incluida una propuesta de reglamentación por parte de la Oficina de Protección Financiera del Consumidor (CFPB), que prohibiría que cualquier deuda médica aparezca en los informes de crédito de los consumidores.
La vicepresidenta Kamala Harris, que encabeza la iniciativa del gobierno contra la deuda médica, se ha referido a estas iniciativas en la campaña presidencial. Harris también ha pedido que se refuercen las medidas para ayudar a millones de estadounidenses a pagar su deuda médica.
El ex presidente Donald Trump no suele hablar de la deuda médica cuando hace campaña. Pero los congresistas republicanos han criticado la propuesta de la CFPB, que el presidente del Comité de Servicios Financieros de la Cámara, Patrick McHenry (del Comité Nacional Republicano), calificó de “extralimitación regulatoria”.
Sin embargo, el encuestador Michael Perry, que ha investigado ampliamente lo que opinan los estadounidenses sobre la atención médica, comentó que los votantes conservadores, que suelen desconfiar del gobierno, parecen ver la deuda médica de otra manera. “Creo que sienten que está todo tan en su contra que ellos, como pacientes, realmente no tienen voz”, explicó. “Las divisiones políticas que normalmente vemos, en esta cuestión simplemente no están presentes”.
Cuando los defensores de los consumidores de Arizona propusieron en las boletas electorales de 2022 una medida para limitar los tipos de interés de las deudas médicas, el 72% de los votantes se pronunció a favor de la iniciativa.
Del mismo modo, encuestas a nivel nacional han revelado que más del 80% de los republicanos y demócratas respaldan la implementación de límites en los cobros de deudas médicas y que se fijen requisitos más estrictos para que los hospitales ofrezcan ayuda financiera a los pacientes.
Perry sacó a relucir otro factor que puede estar impulsando el interés de ambos partidos por la deuda médica: la creciente desconfianza de los ciudadanos a medida que los sistemas de salud se hacen más grandes y actúan como grandes corporaciones. “Los hospitales ya no son lo que eran”, dijo. “Eso está dejando claro que el lucro y la codicia son los que están dirigiendo gran parte de la toma de decisiones”.
No obstante, no todos los esfuerzos estatales para hacer frente a la deuda médica han obtenido un amplio apoyo tanto de demócratas como de republicanos.
El año pasado, cuando Colorado se convirtió en el primer estado que prohibió la inclusión de las deudas médicas en los informes de crédito de los residentes, sólo un legislador republicano respaldó la medida.
Y en Minnesota un proyecto de ley similar se aprobó este año sin un solo voto del Partido Republicano.
En otros lugares, medidas igual de estrictas se han aprobado sin inconvenientes.
Por ejemplo en Illinois, este año, se votó por unanimidad en el senado estatal, y se aprobó por 109 votos a favor y dos en contra en la Cámara de Representantes, un proyecto de ley que prohíbe el reporte de deuda médica en los informes de crédito.
En Rhode Island ningún legislador del Partido Republicano se opuso a la prohibición del reporte de crédito.
Finalmente, cuando la Legislatura de California examinó un proyecto de ley de 2021 para exigir a los hospitales del estado que proporcionen más asistencia financiera a los pacientes, la propuesta fue aprobada por 72 votos a favor y ninguno en contra en la Asamblea estatal y por 39 a 0 en el Senado.
Incluso algunos estados conservadores, como Oklahoma, han tomado medidas, aunque más modestas. Una nueva ley prohíbe a los proveedores médicos reclamar deudas a los pacientes si no han hecho públicas sus tarifas. La resolución, firmada por el gobernador republicano del estado, fue apoyada por unanimidad.
Steve Neville, senador republicano por Nuevo México, que respaldó una ley para restringir los cobros abusivos a pacientes de bajos ingresos en ese estado, dijo que simplemente estaba siendo pragmático.
“No era muy beneficioso dedicar mucho tiempo a intentar cobrar a pacientes indigentes”, dijo Neville. “Si no tienen dinero, no tienen dinero”. Tres de los 12 senadores republicanos apoyaron la medida.
El tesorero estatal de Carolina del Norte, Dale Folwell, republicano que como legislador estatal encabezó en 2012 un intento para prohibir el matrimonio entre personas del mismo sexo, dijo que todos los funcionarios electos, sin que importe su partido, deberían preocuparse por el modo en que las deudas médicas están afectando a los pacientes.
“No importa si, como conservador, estoy diciendo estas cosas, o si Bernie Sanders está diciendo estas mismas cosas”, dijo Folwell, en referencia al senador liberal de Vermont. “Al fin y al cabo, todos deberíamos asumir la responsabilidad de defender a aquellos que permanecen invisibles ante la sociedad”.
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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Older Men’s Connections Often Wither When They’re on Their Own
At age 66, South Carolina physician Paul Rousseau decided to retire after tending for decades to the suffering of people who were seriously ill or dying. It was a difficult and emotionally fraught transition.
“I didn’t know what I was going to do, where I was going to go,” he told me, describing a period of crisis that began in 2017.
Seeking a change of venue, Rousseau moved to the mountains of North Carolina, the start of an extended period of wandering. Soon, a sense of emptiness enveloped him. He had no friends or hobbies — his work as a doctor had been all-consuming. Former colleagues didn’t get in touch, nor did he reach out.
His wife had passed away after a painful illness a decade earlier. Rousseau was estranged from one adult daughter and in only occasional contact with another. His isolation mounted as his three dogs, his most reliable companions, died.
Rousseau was completely alone — without friends, family, or a professional identity — and overcome by a sense of loss.
“I was a somewhat distinguished physician with a 60-page resume,” Rousseau, now 73, wrote in the Journal of the American Geriatrics Society in May. “Now, I’m ‘no one,’ a retired, forgotten old man who dithers away the days.”
In some ways, older men living alone are disadvantaged compared with older women in similar circumstances. Research shows that men tend to have fewer friends than women and be less inclined to make new friends. Often, they’re reluctant to ask for help.
“Men have a harder time being connected and reaching out,” said Robert Waldinger, a psychiatrist who directs the Harvard Study of Adult Development, which has traced the arc of hundreds of men’s lives over a span of more than eight decades. The men in the study who fared the worst, Waldinger said, “didn’t have friendships and things they were interested in — and couldn’t find them.” He recommends that men invest in their “social fitness” in addition to their physical fitness to ensure they have satisfying social interactions.
Slightly more than 1 in every 5 men ages 65 to 74 live alone, according to 2022 Census Bureau data. That rises to nearly 1 in 4 for those 75 or older. Nearly 40% of these men are divorced, 31% are widowed, and 21% never married.
That’s a significant change from 2000, when only 1 in 6 older men lived by themselves. Longer life spans for men and rising divorce rates are contributing to the trend. It’s difficult to find information about this group — which is dwarfed by the number of women who live alone — because it hasn’t been studied in depth. But psychologists and psychiatrists say these older men can be quite vulnerable.
When men are widowed, their health and well-being tend to decline more than women’s.
“Older men have a tendency to ruminate, to get into our heads with worries and fears and to feel more lonely and isolated,” said Jed Diamond, 80, a therapist and the author of “Surviving Male Menopause” and “The Irritable Male Syndrome.”
Add in the decline of civic institutions where men used to congregate — think of the Elks or the Shriners — and older men’s reduced ability to participate in athletic activities, and the result is a lack of stimulation and the loss of a sense of belonging.
Depression can ensue, fueling excessive alcohol use, accidents, or, in the most extreme cases, suicide. Of all age groups in the United States, men over age 75 have the highest suicide rate, by far.
For this column, I spoke at length to several older men who live alone. All but two (who’d been divorced) were widowed. Their experiences don’t represent all men who live alone. But still, they’re revealing.
The first person I called was Art Koff, 88, of Chicago, a longtime marketing executive I’d known for several years. When I reached out in January, I learned that Koff’s wife, Norma, had died the year before, leaving him hobbled by grief. Uninterested in eating and beset by unremitting loneliness, Koff lost 45 pounds.
“I’ve had a long and wonderful life, and I have lots of family and lots of friends who are terrific,” Koff told me. But now, he said, “nothing is of interest to me any longer.”
“I’m not happy living this life,” he said.
Nine days later, I learned that Koff had died. His nephew, Alexander Koff, said he had passed out and was gone within a day. The death certificate cited “end stage protein calorie malnutrition” as the cause.
The transition from being coupled to being single can be profoundly disorienting for older men. Lodovico Balducci, 80, was married to his wife, Claudia, for 52 years before she died in October 2023. Balducci, a renowned physician known as the “patriarch of geriatric oncology,” wrote about his emotional reaction in the Journal of the American Geriatrics Society, likening Claudia’s death to an “amputation.”
“I find myself talking to her all the time, most of the time in my head,” Balducci told me in a phone conversation. When I asked him whom he confides in, he admitted, “Maybe I don’t have any close friends.”
Disoriented and disorganized since Claudia died, he said his “anxiety has exploded.”
We spoke in late February. Two weeks later, Balducci moved from Tampa to New Orleans, to be near his son and daughter-in-law and their two teenagers.
“I am planning to help as much as possible with my grandchildren,” he said. “Life has to go on.”
Verne Ostrander, a carpenter in the small town of Willits, California, about 140 miles north of San Francisco, was reflective when I spoke with him, also in late February. His second wife, Cindy Morninglight, died four years ago after a long battle with cancer.
“Here I am, almost 80 years old — alone,” Ostrander said. “Who would have guessed?”
When Ostrander isn’t painting watercolors, composing music, or playing guitar, “I fall into this lonely state, and I cry quite a bit,” he told me. “I don’t ignore those feelings. I let myself feel them. It’s like therapy.”
Ostrander has lived in Willits for nearly 50 years and belongs to a men’s group and a couples’ group that’s been meeting for 20 years. He’s in remarkably good health and in close touch with his three adult children, who live within easy driving distance.
“The hard part of living alone is missing Cindy,” he told me. “The good part is the freedom to do whatever I want. My goal is to live another 20 to 30 years and become a better artist and get to know my kids when they get older.”
The Rev. Johnny Walker, 76, lives in a low-income apartment building in a financially challenged neighborhood on Chicago’s West Side. Twice divorced, he’s been on his own for five years. He, too, has close family connections. At least one of his several children and grandchildren checks in on him every day.
Walker says he had a life-changing religious conversion in 1993. Since then, he has depended on his faith and his church for a sense of meaning and community.
“It’s not hard being alone,” Walker said when I asked whether he was lonely. “I accept Christ in my life, and he said that he would never leave us or forsake us. When I wake up in the morning, that’s a new blessing. I just thank God that he has brought me this far.”
Waldinger recommended that men “make an effort every day to be in touch with people. Find what you love — golf, gardening, birdwatching, pickleball, working on a political campaign — and pursue it,” he said. “Put yourself in a situation where you’re going to see the same people over and over again. Because that’s the most natural way conversations get struck up and friendships start to develop.”
Rousseau, the retired South Carolina doctor, said he doesn’t think about the future much. After feeling lost for several years, he moved across the country to Jackson, Wyoming, in the summer of 2023. He embraced solitude, choosing a remarkably isolated spot to live — a 150-square-foot cabin with no running water and no bathroom, surrounded by 25,000 undeveloped acres of public and privately owned land.
“Yes, I’m still lonely, but the nature and the beauty here totally changed me and focused me on what’s really important,” he told me, describing a feeling of redemption in his solitude.
Rousseau realizes that the death of his parents and a very close friend in his childhood left him with a sense of loss that he kept at bay for most of his life. Now, he said, rather than denying his vulnerability, he’s trying to live with it. “There’s only so long you can put off dealing with all the things you’re trying to escape from.”
It’s not the life he envisioned, but it’s one that fits him, Rousseau said. He stays busy with volunteer activities — cleaning tanks and running tours at Jackson’s fish hatchery, serving as a part-time park ranger, and maintaining trails in nearby national forests. Those activities put him in touch with other people, mostly strangers, only intermittently.
What will happen to him when this way of living is no longer possible?
“I wish I had an answer, but I don’t,” Rousseau said. “I don’t see my daughters taking care of me. As far as someone else, I don’t think there’s anyone else who’s going to help me.”
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