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

Come January, Republicans will control the House of Representatives, Senate, and White House, regaining full power for the first time since 2018. That will give them significant clout to dramatically change health policy. But slim margins in Congress will leave little room for dissent.

Meanwhile, President-elect Donald Trump has vowed not to touch Medicare, though there are Medicare-related issues — including drug price negotiations and physician pay — that will soon demand attention.

This week’s panelists are Julie Rovner of KFF Health News, Anna Edney of Bloomberg News, Rachel Roubein of The Washington Post, and Lauren Weber of The Washington Post.

Panelists Anna Edney Bloomberg @annaedney Read Anna's stories. Rachel Roubein The Washington Post @rachel_roubein Read Rachel's stories. Lauren Weber The Washington Post @LaurenWeberHP Read Lauren's stories.

Among the takeaways from this week’s episode:

• Republicans will control the House and the Senate beginning next year, potentially offering Trump crucial votes in support of his nominees and agenda. However, the party will govern with only a narrow majority in both chambers, which could hamper its ability to make sweeping or controversial changes. Regardless, the GOP will steer legislative efforts, such as setting government spending levels and limits, and control committees that decide what to prioritize and oversee.
• Trump this week named several people he intends to nominate to his Cabinet. Yet many of his picks lack relevant experience or have staked out controversial policy positions — or both — raising the question: Can they clear the Senate confirmation process? Trump has suggested using recess appointments to get around that, a method that would largely bypass the Senate and limit his Cabinet secretaries’ authority.
• Meanwhile, among the issues on Robert F. Kennedy Jr.’s health agenda are some that resonate with Democrats, such as cracking down on ultra-processed foods and food dyes. Notably, those sorts of initiatives — which could tighten rules for businesses, for instance — have not been part of the traditional conservative playbook.
• And, looking ahead, there’s a lot the Trump administration could do to further erode abortion rights, and the GOP is likely to see this as a moment for trying things.

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

Julie Rovner: KFF Health News’ “In Vermont, Where Almost Everyone Has Insurance, Many Can’t Find or Afford Care,” by Phil Galewitz.

Anna Edney: The Atlantic’s “Throw Out Your Black Plastic Spatula,” by Zoë Schlanger.

Rachel Roubein: Politico’s “‘Been a Long Time Since I Felt That Way’: Sexually Transmitted Infection Numbers Provide New Hope,” by Alice Miranda Ollstein.

Lauren Weber: JAMA Network Open’s “Medical Board Discipline of Physicians for Spreading Medical Misinformation,” by Richard S. Saver.

Also mentioned in this week’s podcast:

• The Washington Post’s “RFK Jr. Faces Battles in Question To Change America’s Food,” by Rachel Roubein, Lauren Weber, Michael Scherer, and David Ovalle.
• CNN’s “Lunchables Removed From National School Lunch Program,” by Madeline Holcombe.
• Politico’s “Abortion Opponents Prepare To Undermine Just-Passed Ballot Measures,” by Alice Miranda Ollstein.
• The Wall Street Journal’s “The Sickest Patients Are Fleeing Private Medicare Plans — Costing Taxpayers Billions,” by Anna Wilde Mathews, Christopher Weaver, and Tom McGinty.

Credits Taylor Cook Audio producer Lonnie Ro Audio producer Emmarie Huetteman Editor

To hear all our podcasts, click here.

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HHS authorizes Colorado, Hawaii, Minnesota, New York & Pennsylvania to provide continuous health care coverage for children beyond the minimum 12 months

Many scientists at the federal health agencies await the second Donald Trump administration with dread as well as uncertainty over how the president-elect will reconcile starkly different philosophies among the leaders of his team.

Trump has promised he would allow Robert F. Kennedy Jr. to “go wild” on medicines, food, and health. With that, a radical antiestablishment medical movement with roots in past centuries could threaten the achievements of a science-based public health order painstakingly built since World War II, some of these scientists fear.

If Kennedy makes good on his vision for transforming public health, childhood vaccine mandates could wither. New vaccines might never win approval, even as the FDA allows dangerous or inefficient therapies onto the market. Agency websites could trumpet unproven or debunked health ideas. And if Trump’s plan to weaken civil service rights goes through, anyone who questions these decisions could be summarily fired.

“Never has anybody like RFK Jr. gotten anywhere close to the position he may be in to actually shape policy,” said Lewis Grossman, a law professor at American University and the author of “Choose Your Medicine,” a history of U.S. public health.

Kennedy and an adviser Calley Means, a health care entrepreneur, say dramatic changes are needed because of the high levels of chronic disease in the United States. Government agencies have corruptly tolerated or promoted unhealthy diets and dangerous drugs and vaccines, they say.

Means and Kennedy did not respond to requests for comment. Four conservative members of the first Trump health bureaucracy spoke on condition of anonymity. They eagerly welcomed the former president’s return but voiced few opinions about specific policies. Days after last week’s election, RFK Jr. announced that the Trump administration would immediately fire and replace 600 National Institutes of Health officials. He set up a website seeking crowdsourced nominees for federal appointments, with a host of vaccination foes and chiropractors among the early favorites.

At meetings last week at Mar-a-Lago involving Elon Musk, Tucker Carlson, Donald Trump Jr., Kennedy, and Means, according to Politico, some candidates for leading health posts included Jay Bhattacharya, a Stanford University scientist who opposed covid lockdowns; Florida Surgeon General Joseph Ladapo, who opposes mRNA covid vaccines and rejected well-established disease control practices during a measles outbreak; Johns Hopkins University surgeon Marty Makary; and Means’ sister, Stanford-trained surgeon and health guru Casey Means.

All are mavericks of a sort, though their ideas are not uniform. Yet the notion that they could elbow aside a century of science-based health policy is profoundly troubling to many health professionals. They see Kennedy’s presence at the heart of the Trump transition as a triumph of the “medical freedom” movement, which arose in opposition to the Progressive Era idea that experts should guide health care policy and practices.

It could represent a turning away from the expectation that mainstream doctors be respected for their specialized knowledge, said Howard Markel, an emeritus professor of pediatrics and history at the University of Michigan, who began his clinical career treating AIDS patients and ended it after suffering a yearlong bout of long covid.

“We’ve gone back to the idea of ‘every man his own doctor,’” he said, referring to a phrase that gained currency in the 19th century. It was a bad idea then and it’s even worse now, he said.

“What does that do to the morale of scientists?” Markel asked. The public health agencies, largely a post-WWII legacy, are “remarkable institutions, but you can screw up these systems, not just by defunding them but by deflating the true patriots who work in them.”

FDA Commissioner Robert Califf told a conference on Nov. 12 that he worried about mass firings at the FDA. “I’m biased, but I feel like the FDA is sort of at peak performance right now,” he said. At a conference the next day, CDC Director Mandy Cohen reminded listeners of the horrors of vaccine-preventable diseases like measles and polio. “I don’t want to have to see us go backward in order to remind ourselves that vaccines work,” she said.

Exodus From the Agencies?

With uncertainty over the direction of their agencies, many older scientists at the NIH, FDA, and Centers for Disease Control and Prevention are considering retirement, said a senior NIH scientist who spoke on the condition of anonymity for fear of losing his job.

“Everybody I talk to sort of takes a deep breath and says, ‘It doesn’t look good,’” the official said.

“I hear of many people getting CVs ready,” said Arthur Caplan, a professor of bioethics at New York University. They include two of his former students who now work at the FDA, Caplan said.

Others, such as Georges Benjamin, executive director of the American Public Health Association, have voiced wait-and-see attitudes. “We worked with the Trump administration last time. There were times things worked reasonably well,” he said, “and times when things were chaotic, particularly during covid.” Any wholesale deregulation efforts in public health would be politically risky for Trump, he said, because when administrations “screw things up, people get sick and die.”

At the FDA, at least, “it’s very hard to make seismic changes,” former FDA chief counsel Dan Troy said.

But the administration could score easy libertarian-tinged wins by, for example, telling its new FDA chief to reverse the agency’s refusal to approve the psychedelic drug MDMA from the company Lykos. Access to psychedelics to treat post-traumatic stress disorder has grabbed the interest of many veterans. Vitamins and supplements, already only lightly regulated, will probably get even more of a free pass from the next Trump FDA.

‘Medical Freedom’ or ‘Nanny State‘

Trump’s health influencers are not monolithic. Analysts see potential clashes among Kennedy, Musk, and more traditional GOP voices. Casey Means, a “holistic” MD at the center of Kennedy’s “Make America Healthy Again” team, calls for the government to cut ties with industry and remove sugar, processed food, and toxic substances from American diets. Republicans lampooned such policies as exemplifying a “nanny state” when Mike Bloomberg promoted them as mayor of New York City.

Both the libertarian and “medical freedom” wings oppose aspects of regulation, but Silicon Valley biotech supporters of Trump, like Samuel Hammond of the Foundation for American Innovation, have pressed the agency to speed drug and device approvals, while Kennedy’s team says the FDA and other agencies have been “captured” by industry, resulting in dangerous and unnecessary drugs, vaccines, and devices on the market.

Kennedy and Casey Means want to end industry user fees that pay for drug and device rules and support nearly half the FDA’s $7.2 billion budget. It’s unclear whether Congress would make up the shortfall at a time when Trump and Musk have vowed to slash government programs. User fees are set by laws Congress passes every five years, most recently in 2022.

The industry supports the user-fee system, which bolsters FDA staffing and speeds product approvals. Writing new rules “requires an enormous amount of time, effort, energy, and collaboration” by FDA staff, Troy said. Policy changes made through informal “guidance” alone are not binding, he added.

Kennedy and the Means siblings have suggested overhauling agricultural policies so that they incentivize the cultivation of organic vegetables instead of industrial corn and soy, but “I don’t think they’ll be very influential in that area,” Caplan said. “Big Ag is a powerful entrenched industry, and they aren’t interested in changing.”

“There’s a fine line between the libertarian impulse of the ‘medical freedom’ types and advocating a reformation of American bodies, which is definitely ‘nanny state’ territory,” said historian Robert Johnston of the University of Illinois-Chicago.

Specific federal agencies are likely to face major changes. Republicans want to trim the NIH’s 27 research institutes and centers to 15, slashing Anthony Fauci’s legacy by splitting the National Institute of Allergy and Infectious Diseases, which he led for 38 years, into two or three pieces.

Numerous past attempts to slim down the NIH have failed in the face of campaigns by patients, researchers, and doctors. GOP lawmakers have advocated substantial cuts to the CDC budget in recent years, including an end to funding gun violence, climate change, and health equity research. If carried out, Project 2025, a policy blueprint from the conservative Heritage Foundation, would divide the agency into data-collecting and health-promoting arms. The CDC has limited clout in Washington, although former CDC directors and public health officials are defending its value.

“It would be surprising if CDC wasn’t on the radar” for potential change, said Anne Schuchat, a former principal deputy director of the agency, who retired in 2021.

The CDC’s workforce is “very employable” and might start to look for other work if “their area of focus is going to be either cut or changed,” she said.

Kennedy’s attacks on HHS and its agencies as corrupted tools of the drug industry, and his demands that the FDA allow access to scientifically controversial drugs, are closely reminiscent of the 1970s campaign by conservative champions of Laetrile, a dangerous and ineffective apricot-pit derivative touted as a cancer treatment. Just as Kennedy championed off-patent drugs like ivermectin and hydroxychloroquine to treat covid, Laetrile’s defenders claimed that the FDA and a profit-seeking industry were conspiring to suppress a cheaper alternative.

The public and industry have often been skeptical of health regulatory agencies over the decades, Grossman said. The agencies succeed best when they are called in to fix things — particularly after bad medicine kills or damages children, he said.

The 1902 Biologics Control Act, which created the NIH’s forerunner, was enacted in response to smallpox vaccine contamination that killed at least nine children in Camden, New Jersey. Child poisonings linked to the antifreeze solvent for a sulfa drug prompted the modern FDA’s creation in 1938. The agency, in 1962, acquired the power to demand evidence of safety and efficacy before the marketing of drugs after the thalidomide disaster, in which children of pregnant women taking the anti-nausea drug were born with terribly malformed limbs.

If vaccination rates plummet and measles and whooping cough outbreaks proliferate, babies could die or suffer brain damage. “It won’t be harmless for the administration to broadly attack public health,” said Alfredo Morabia, a professor of epidemiology at Columbia University and the editor-in-chief of the American Journal of Public Health. “It would be like taking away your house insurance.”

Sam Whitehead, Stephanie Armour, and David Hilzenrath contributed to this report.

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Grocery stores, pharmacies, community organizations, and other institutions across the United States are uniting to raise awareness of the National Maternal Mental Health Hotline

Científicos de las agencias federales de salud esperan la segunda administración de Donald Trump con incertidumbre y temor, preguntándose cómo el presidente electo conciliará filosofías radicalmente diferentes entre los líderes de su equipo.

Trump anunció hace pocos días que nominará a Robert F. Kennedy Jr. (RFK) como secretario del Departamento de Salud y Servicios Humanos (HHS), después de decir durante la campaña presidencial que dejaría que el activista antivacunas implementase “sus locuras” en materia de medicamentos, alimentos y salud.

Si el Senado confirma a Kennedy, sus críticos dicen que un movimiento médico radical antisistema, con raíces en siglos pasados, tomaría el poder, amenazando los logros de un orden de salud pública basado en la ciencia y construido con esfuerzo desde la Segunda Guerra Mundial.

Trump dijo en un post en la red social X que “los estadounidenses han sido aplastados por el complejo industrial alimentario y las compañías farmacéuticas que se han dedicado al engaño, la información falsa y la desinformación cuando se trata de salud pública”, haciéndose eco de las quejas de Kennedy sobre el establishment médico.

RFK, ex candidato presidencial demócrata, “acabará con la epidemia de enfermedades crónicas” y “¡Hará que Estados Unidos vuelva a ser grande y saludable!”, escribió Trump.

Las acciones de los fabricantes de vacunas cayeron en medio de las noticias previas al anuncio de Trump sobre RFK.

Si Kennedy hace realidad su visión de transformar la salud pública, los mandatos de vacunación infantil podrían debilitarse. Las nuevas vacunas podrían no ser aprobadas nunca, incluso si la Administración de Alimentos y Medicamentos (FDA) permite la comercialización de terapias peligrosas o ineficaces.

Los sitios web de la agencia podrían diseminar ideas sobre la salud no probadas o desacreditadas. Y si el plan de Trump de socavar los derechos de los funcionarios sigue adelante, cualquiera que cuestione estas decisiones podría ser despedido de inmediato.

“Nunca nadie como RFK Jr. se había acercado a la posición en la que podría estar para dar forma real a estas políticas”, dijo Lewis Grossman, profesor de Leyes en la American University y autor de “Choose Your Medicine”, una historia de la salud pública estadounidense.

Kennedy y su asesor Calley Means, un empresario del sector de la salud, afirman que se necesitan cambios drásticos debido a los altos niveles de enfermedades crónicas en Estados Unidos. Según ellos, las agencias gubernamentales han tolerado o promovido, de forma corrupta, dietas poco saludables, y medicamentos y vacunas peligrosos.

Means y Kennedy no respondieron a las solicitudes de comentarios. Cuatro miembros conservadores que formaron parte de la primera burocracia de la salud de Trump hablaron bajo condición de anonimato.

Recibieron con entusiasmo el regreso del ex presidente, pero expresaron pocas opiniones sobre políticas específicas. Días después de las elecciones, RFK Jr. anunció que la administración Trump despediría y reemplazaría inmediatamente a 600 funcionarios de los Institutos Nacionales de Salud (NIH). Creó un sitio web en el que buscaba candidatos por crowdsourcing para nombramientos federales, con una gran cantidad de enemigos de las vacunas y quiroprácticos entre los primeros favoritos.

En reuniones celebradas recientemente en Mar-a-Lago, la residencia de Trump en Florida, en las que participaron Elon Musk, Tucker Carlson, Donald Trump Jr, Kennedy y Means, según Politico, entre los candidatos a los principales puestos en el área de salud estaba Jay Bhattacharya, un científico de la Universidad de Stanford que se opuso a los cierres durante covid. También el cirujano general de Florida, Joseph Ladapo, que se opone a las vacunas de ARNm contra covid-19 y rechazó prácticas de control de enfermedades bien establecidas durante un brote de sarampión; el cirujano de la Universidad Johns Hopkins Marty Makary; y la hermana de Means, la cirujana formada en Stanford y gurú de la salud Casey Means.

Todos ellos pueden ser calificados de inconformistas, aunque sus ideas no son uniformes. Sin embargo, la posibilidad de que puedan dejar de lado un siglo de políticas de salud basadas en la ciencia es profundamente preocupante para muchos profesionales. Ven la presencia de Kennedy en el corazón de la transición de Trump como un triunfo del movimiento de “libertad médica”, que surgió en oposición a la idea de la Era Progresista de que los expertos son los que deben guiar la política y las prácticas de atención de salud.

Podría representar un alejamiento de la expectativa de que los médicos convencionales sean respetados por sus conocimientos especializados, dijo Howard Markel, profesor emérito de pediatría e historia en la Universidad de Michigan, que comenzó su carrera clínica tratando a pacientes con sida y la terminó tras sufrir un año de covid de larga duración.

“Hemos vuelto a la idea de ‘cada uno es su médico’”, comentó, refiriéndose a una frase que se impuso en el siglo XIX. Era una mala idea entonces y es aún peor ahora, agregó.

“¿Cómo afectará eso a la moral de los científicos?”, se preguntó Markel. Las agencias de salud pública, en gran medida un legado posterior a la Segunda Guerra Mundial, son “instituciones notables, pero se pueden echar a perder estos sistemas, no sólo quitándoles financiación, sino desmoralizando a los verdaderos patriotas que trabajan en ellas”.

El Comisionado de la FDA, Robert Califf, declaró en una conferencia el 12 de noviembre que le preocupaban los despidos masivos en la agencia. “No soy imparcial, pero creo que la FDA está en una especie de pico de rendimiento en este momento”, expresó.

Al día siguiente, en una conferencia, la directora de los Centros para el Control y Prevención de Enfermedades (CDC), Mandy Cohen, recordó los horrores de las enfermedades prevenibles mediante vacunación, como el sarampión y la poliomielitis. “No quiero que tengamos que dar marcha atrás para recordarnos que las vacunas funcionan”, afirmó.

Las acciones de algunos de los principales fabricantes de vacunas cayeron después que los medios de comunicación, encabezados por Politico, informaran de que se esperaba la elección de RFK.

Moderna, creadora de una de las vacunas más populares contra covid-19, cerró con una baja del 5,6%. Pfizer, otro fabricante de vacunas contra covid, cayó un 2,6%. GSK, que produce la vacuna contra el virus respiratorio sincitial, la hepatitis A y B, el rotavirus y la gripe, cayó algo más del 2%. La farmacéutica francesa Sanofi, cuyo sitio web presume de que sus productos vacunan a más de 500 millones de personas al año, cayó casi un 3,5%.

¿Éxodo de las agencias?

Ante la incertidumbre sobre la dirección de sus agencias, muchos científicos de edad avanzada de los NIH, la FDA y los CDC consideran la posibilidad de jubilarse, contó un científico de alto nivel de los NIH que habló bajo condición de anonimato por temor a perder su trabajo.

“Todo el mundo con quien hablo respira hondo y dice: ‘Esto no pinta bien’”, explicó el funcionario.

“Sé de muchas personas que están preparando sus currículums”, dijo Arthur Caplan, profesor de bioética en la Universidad de Nueva York. Entre ellos se encuentran dos de sus antiguos alumnos que ahora trabajan en la FDA, dijo Caplan.

Otros, como Georges Benjamin, director ejecutivo de la American Public Health Association, han han dicho que esperarán y verán qué pasa. “Trabajamos con la administración Trump la última vez. Hubo momentos en que las cosas funcionaron razonablemente bien”, explicó, “y momentos en que las cosas fueron caóticas, particularmente durante covid”.

Cualquier esfuerzo de desregulación al por mayor en la salud pública sería políticamente arriesgado para Trump, señaló Benjamin, porque cuando las administraciones “arruinan las cosas, la gente se enferma y muere”.

En la FDA, al menos, “es muy difícil hacer cambios sísmicos”, dijo Dan Troy, ex consejero jefe de la FDA.

Pero la administración podría conseguir fáciles victorias de tinte libertario, por ejemplo, diciendo a su nuevo jefe de la FDA que revierta la negativa de la agencia a aprobar el fármaco psicodélico MDMA de la empresa Lykos. El acceso a los psicodélicos para tratar el trastorno de estrés postraumático ha despertado el interés de muchos veteranos.

Las vitaminas y los suplementos, que ya sólo están ligeramente regulados, probablemente recibirán aún más carta blanca de la próxima FDA de Trump.

Libertad médica o Estado niñera

Pero los “influencers” de la salud en la futura administración Trump no son monolíticos. Los analistas ven posibles enfrentamientos entre Kennedy, Musk y las voces más tradicionales del Partido Republicano.

Casey Means, un médico holístico en el centro del equipo “Make America Healthy Again” de Kennedy, pide que el gobierno corte los lazos con la industria y elimine el azúcar, los alimentos procesados y las sustancias tóxicas de las dietas estadounidenses. Los republicanos tacharon estas políticas de “Estado niñera” cuando Mike Bloomberg las promovió como alcalde de Nueva York.

Tanto el ala libertaria como el de la “libertad médica” se oponen a aspectos de la regulación. Pero los partidarios de la biotecnología de Silicon Valley que están con Trump, como Samuel Hammond de la Foundation for American Innovation, han presionado a la agencia para que acelere la aprobación de medicamentos y dispositivos. Mientras tanto, el equipo de Kennedy dice que la FDA y otras agencias han sido “capturadas” por la industria, lo que resulta en medicamentos, vacunas y dispositivos peligrosos e innecesarios en el mercado.

Es probable que algunos organismos federales sufran cambios importantes. Los republicanos quieren reducir los 27 institutos y centros de investigación de los NIH a 15, y recortar el legado de Anthony Fauci dividiendo el Instituto Nacional de Alergias y Enfermedades Infecciosas, que dirigió durante 38 años, en dos o tres partes.

Numerosos intentos anteriores de reducir los NIH han fracasado frente a las campañas de pacientes, investigadores y médicos.

Legisladores republicanos han defendido recortes sustanciales del presupuesto de los CDC en los últimos años, incluido el fin de la financiación de la investigación sobre la violencia con armas de fuego, el cambio climático y la equidad en salud. De llevarse a cabo el Proyecto 2025, un proyecto político de la conservadora Heritage Foundation, dividiría la agencia en dos ramas: la de recopilación de datos y la de promoción de la salud. Los CDC tiene una influencia limitada en Washington, aunque ex directores y funcionarios de salud pública defienden su valor.

“Me sorprendería que los CDC no estuvieran en el radar” de posibles cambios, dijo Anne Schuchat, ex subdirectora principal de la agencia, que se jubiló en 2021.

El personal de los CDC es “muy empleable” y podría empezar a buscar otro trabajo si “su área de interés va a ser recortada o modificada”, opinó Schuchat.

Los ataques de Kennedy contra el HHS y sus agencias como herramientas corruptas de la industria farmacéutica, y sus demandas de que la FDA permita el acceso a medicamentos científicamente controversiales, recuerdan mucho a la campaña de los años 70 por parte de los conservadores que defendían el Laetrile, un peligroso e ineficaz derivado de la semilla de albaricoque promocionado como tratamiento contra el cáncer.

Al igual que Kennedy defendió fármacos sin patente como la ivermectina y la hidroxicloroquina para tratar covid, los defensores del Laetrile afirmaron que la FDA y una industria con fines de lucro estaban conspirando para suprimir una alternativa más barata.

A lo largo de las décadas, el público y la industria se han mostrado escépticos ante las agencias reguladoras de la salud, afirmó Grossman. Los organismos tienen más éxito cuando se les pide que solucionen problemas, sobre todo cuando un medicamento defectuoso mata o lastima a un niño.

La Ley de Control Biológico de 1902, que creó el precursor de los NIH, se promulgó en respuesta a vacunas contra la viruela contaminadas que mataron al menos a nueve niños en Camden, Nueva Jersey. Las intoxicaciones infantiles relacionadas con el disolvente anticongelante de un medicamento con sulfamidas impulsaron la creación de la FDA moderna en 1938.

En 1962, la agencia adquirió la facultad de exigir pruebas de seguridad y eficacia antes de la comercialización de medicamentos tras el desastre de la talidomida, cuando los hijos de mujeres embarazadas que tomaban el medicamento contra las náuseas nacieron con extremidades terriblemente malformadas.

Si las tasas de vacunación caen en picada y proliferan los brotes de sarampión y tos ferina, los bebés podrían morir o sufrir daños cerebrales. “Sufriremos las consecuencias si la administración ataca abiertamente la salud pública”, afirmó Alfredo Morabia, catedrático de Epidemiología de la Universidad de Columbia y director del American Journal of Public Health. “Sería como quitarte el seguro de tu casa”.

Sam Whitehead, Stephanie Armour, David Hilzenrath y Darius Tahir colaboraron con este artículo.

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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SACRAMENTO – Funcionarios de salud pública de California están recurriendo a las reservas estatales y federales para equipar a cerca de 10.000 trabajadores agrícolas con máscaras, guantes, gafas y otros equipos de seguridad, luego que, a principios de noviembre, el estado confirmara por lo menos 21 casos de gripe aviar en humanos.

Es el ejemplo más reciente de los desafíos que enfrenta el estado para prepararse, a pesar de los déficits multimillonarios.

Las autoridades informaron que habían empezado a distribuir más de 2 millones de equipos de protección individual a finales de mayo, cuatro meses antes de que se confirmara el primer caso humano en el estado.

También indicaron que, desde abril, cuando se detectó por primera vez un caso de gripe aviar en el ganado vacuno del país, estaban intensificando la coordinación con las autoridades sanitarias.

Hasta el momento, se ha confirmado la presencia de gripe aviar en más de 270 granjas lecheras en el centro de California. También detectaron rastros del virus en un sitio de muestreo de aguas residuales en el condado de Los Ángeles. Recientemente, surgieron  casos en una parvada de una granja de pavos situada en el condado de Sacramento.

Mientras intenta limitar la propagación de la gripe aviar entre los humanos, California está poniendo en práctica una serie de lecciones extraídas de la pandemia de covid-19. Por ejemplo, la coordinación con las autoridades sanitarias locales para tener una adecuada respuesta de emergencia. O implementar el seguimiento de las enfermedades infecciosas mediante la vigilancia de las aguas residuales.

El estado también se está esforzando por mantener una reserva adecuada de suministros de emergencia que le permitan responder a una primera oleada de cualquier nueva catástrofe de salud pública sin que eso produzca un drenaje significativo del presupuesto estatal.

“Estamos mucho mejor preparados para responder a una pandemia que en 2020”, declaró Amy Palmer, vocera de la Oficina de Servicios de Emergencia del Gobernador de California (Cal OES).

Un caso concreto: antes de que el coronavirus golpeara en 2020, las reservas de suministros de emergencia del estado apenas alcanzaban para llenar dos canchas de baloncesto. Pero cuando California intensificó su respuesta a la pandemia logró acumular una cantidad de equipos de protección personal y otros suministros para desastres como para llenar 52 campos de fútbol americano.

California dispuso de $15.600 millones para dar respuesta directa a la pandemia durante los años de la crisis de covid. El gobierno federal fue quien proporcionó gran parte de esos recursos.

Hoy en día, la reserva de insumos cabe en unos 12 campos de fútbol, aunque el volumen cambia de un mes a otro.

Según el estado, hoy se cuenta con 101 millones de mascarillas, lo que representa 26 millones más que el suministro necesario para 90 días, según lo recomendado por las directrices estatales de preparación ante una pandemia.

Eso incluye 88 millones de mascarillas N95, un número que excede el que la agencia de servicios de emergencia consideró necesarias el año pasado. Las mascarillas de alta eficacia son un elemento crucial para protegerse de virus transmitidos por el aire como el que causa covid.

Aunque el estado está aumentando sus reservas, Palmer no pudo confirmar si el aumento de la reserva de mascarillas se relaciona con el temor a un aumento de la gripe aviar. Sólo dijo que los planificadores de salud pública trabajan siempre “para mantener  el ritmo ante el actual entorno de riesgo”.

El objetivo del estado, explicó Palmer, es garantizar la existencia de “un suministro inicial durante las emergencias que dé el tiempo suficiente para conseguir recursos”, ya sea a través del gobierno federal o comprándolos.

En los casos de gripe aviar detectados recientemente en California no se hallaron indicios de contagio entre humanos, y las autoridades sanitarias afirman que el riesgo para la población sigue siendo bajo.

La transmisión humana de la gripe aviar es uno de los peores escenarios posibles para una nueva pandemia, junto con la posibilidad de que resurja un coronavirus mutante; una mayor propagación internacional del mpox, el virus de Marburgo o el ébola. Otra opción es que aparezca un virus completamente nuevo para el que en principio no exista inmunidad ni vacuna.

Sin embargo, las autoridades sanitarias de todo el país han tenido dificultades para rastrear la transmisión de la gripe aviar. Y California tiene un historial de altibajos en su preparación ante emergencias.

En 2006, el gobernador republicano Arnold Schwarzenegger ordenó aumentar los planes de contingencia de California ante una pandemia, en respuesta a una amenaza anterior de gripe aviar. Esto incluyó tres hospitales móviles que podían desplegarse inmediatamente en caso de catástrofe.

Pero el gobernador demócrata Jerry Brown puso fin al programa en 2011, porque las finanzas del estado se desmoronaron. Cuando llegó el virus de la gripe aviar, el estado había distribuido 21 millones de mascarillas N95, algunas tan viejas que ya habían caducado.

Por una ley estatal aprobada en 2020, ahora los hospitales están obligados a mantener una reserva permanente para cubrir por un período de tres meses las necesidades de máscaras, batas y otros equipos de protección personal.

La normativa de California sobre enfermedades respiratorias que se transmiten por aire también exige que los hospitales y otros lugares de trabajo de alto riesgo tomen precauciones especiales, como el uso de salas de aislamiento con presión negativa y el nivel más avanzado posible de equipos de protección, hasta tanto se conozca mejor el nuevo patógeno.

Básicamente, estas medidas aseguran que ante el surgimiento de un virus desconocido, se tomen las máximas precauciones para evitar que se propague por el aire. Así se protege tanto a los trabajadores de la salud como a los pacientes.

“Es difícil exagerar sobre el nivel de falta de preparación demostrado por los hospitales, tanto dentro como fuera de California, para hacer frente al brote de covid-19 de 2020”, señala un análisis legislativo. “Imágenes desgarradoras de enfermeras caminando por los pasillos de los hospitales con máscaras improvisadas y bolsas de basura se convirtieron en algo habitual”.

Jan Emerson-Shea, portavoz de la Asociación de Hospitales de California, dijo que los hospitales “se preparan continuamente para responder a todo tipo de desastres, incluidos los brotes de virus transmisibles”.

Por otra parte, Palmer detalló que California tiene cinco hospitales móviles adquiridos al gobierno federal. Aunque tuvieron poco uso durante la pandemia, Palmer opinó que hay que mantenerlos. Y que es fundamental garantizar que estén equipados, en buenas condiciones. Por ejemplo, asegurándose de que los oxímetros de pulso tengan baterías que funcionen.

Pero, una vez más, el déficit actual hace que el estado intente encontrar un equilibrio en el uso de los recursos.

Aunque los legisladores rechazaron la mayor parte del recorte de $300 millones a la financiación de la salud pública propuesto por el gobernador demócrata Gavin Newsom, hace un año el estado redujo en un tercio el presupuesto para la reserva de equipos de protección personal. Esto se decidió después que el Departamento de Finanzas determinara que ya no era imprescindible hacer compras adicionales relacionadas con covid.

Además, California eliminó este año los fondos para la financiación de ocho remolques de 53 pies de largo que deberían haber transportado y distribuido los suministros entre los almacenes.

En los próximos 4 años también se recortarán $40 millones de los $175 millones del presupuesto que iban a ser destinados a la reserva para desastres.

La preparación decidida por el estado no convenció al grupo Californians Against Pandemics, que logró reunir más de un millón de firmas para presentar una propuesta a los votantes en noviembre. La idea era aumentar los impuestos a las personas con ingresos superiores a $5 millones y utilizar ese dinero para prevenir y combatir pandemias.

Pero esta iniciativa fracasó después que uno de sus principales impulsores, el ex ejecutivo de criptomonedas Sam Bankman-Fried, fuera condenado por estafar a clientes e inversores.

A cambio de que los partidarios de la iniciativa abandonaran la propuesta, las autoridades estatales acordaron ampliar el alcance de la Iniciativa de California para el Avance de la Medicina de Precisión, que se creó en 2015 para centrarse en el desarrollo de nuevos medicamentos y terapias, incluyendo tecnologías para prevenir otras pandemias.

“Al aprovechar el poder de la medicina de precisión, California se está colocando a la vanguardia en la preparación y prevención de pandemias”, dijo Newsom en ese momento.

Rodger Butler, vocero de la Agencia Estatal de Salud y Servicios Humanos, explicó que no está claro si esta iniciativa recibirá otros financiamientos adicionales.

Este artículo fue producido por KFF Health News, que publica California Healthline, un servicio editorialmente independiente de la California Health Care Foundation. 

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If you bring a baby into the Hurley Children’s Center clinic in downtown Flint, Michigan, Mona Hanna will find you. The pediatrician, who gained national prominence for helping uncover the city’s water crisis in 2015, strode across the waiting room in her white lab coat, eyes laser-focused on the chubby baby in the lap of an unsuspecting parent.

“Hi! I’m Dr. Mona!” she said warmly. “Any chance you guys live in Flint?” She learned the family is from neighboring Grand Blanc.

“That’s so sad!” Hanna said. “You should move to Flint! And have another baby! And you could be part of the Rx Kids program!” The parents chuckled politely. But the doctor was not kidding.

Billed as the first-ever citywide cash aid program for pregnant moms and babies, Rx Kids gives Flint residents $1,500 mid-pregnancy, and $500 each month for the baby’s first year. There are no strings attached. No income limits. And it’s universal; nearly every baby born since the program launched in January is enrolled.

Parents who bring their babies in for checkups at this clinic rattle off the ways the money has helped, from the cribs, diapers, clothes, and wipes they’ve bought to how it’s “kept them afloat” during maternity leave or provided crucial income when a spouse died.

But the true goal of Rx Kids goes far beyond Flint, as Hanna acknowledged, scooping up one of the Rx Kids babies in an exam room. “Do you think we should do this for babies everywhere? What do you think?” she asked, cooing. The baby gurgled happily, smiling. “That was an affirmative yes.”

Cash Payments as a Tool To Reduce Child Poverty

Many other countries, including Austria, Belgium, Canada, France, Germany, Ireland, Norway, Sweden, and the United Kingdom, already offer a child cash benefit. The U.S. essentially did, too, during the coronavirus pandemic: The 2021 expanded child tax credit gave low- and middle-income families (including those previously excluded because of insufficient income) hundreds of dollars per kid in direct, monthly payments for six months.

The child poverty rate fell to a historic low. But the expanded program expired at the end of 2021 and Congress did not renew it. The child poverty rate went back up.

For Luke Shaefer, director of the Poverty Solutions initiative at the University of Michigan’s Ford School of Public Policy and a longtime advocate of child cash benefits, it was “the most brutal day” of his career.

Soon after, he got an email from Hanna asking if he wanted to collaborate on the program that would become Rx Kids. The program’s goals go beyond cash aid for Michigan families: It is also aimed at getting donors, lawmakers, and voters excited about how child cash benefits could help their communities.

The list of the recently converted includes Republican state Sen. John Damoose, who has become an outspoken advocate for expanding Rx Kids. Referring to himself as “a pro-life person,” Damoose said, “I sure as heck better be concerned about making it easier for mothers to make the decision to have their children.” He said the Republican Party needs to get serious about supporting programs like Rx Kids. “We’ve been accused for years about being pro-birth, not pro-life. And I think that’s not without merit. We need to put our money where our mouth is and support these children and support their mothers.”

Already, what once seemed like a moon shot is gaining traction: Shaefer and Hanna say their communications with Vice President Kamala Harris’ presidential campaign helped shape Harris’ “baby bonus” proposal. President-elect Donald Trump’s campaign also supported expanding the child tax credit.

Meanwhile, Michigan has budgeted some $20 million in state Temporary Assistance for Needy Families cash to partially fund an expansion of Rx Kids to a short list of communities, if those areas can raise local matching funds. Those areas include rural communities like Michigan’s remote eastern Upper Peninsula, part of which is in Damoose’s district. “We want to make the tent as big as possible,” Hanna said.

But some Upper Peninsula health officials were initially wary. Each new Rx Kids community will need to raise millions of dollars in private donations to start and sustain the program in their community. “It could be a good thing,” Leann Espinoza, maternal-infant health program manager for the eastern Upper Peninsula, said in August. “But I’m not getting my hopes up. I know that sounds terrible.”

Upper Peninsula Families ‘Fall Through the Cracks’

In the wood-paneled rec room of the Clark Township Community Center, Espinoza broke the news to her team this summer: Rx Kids is not a program the eastern Upper Peninsula will be able to fund on its own.

It’s about “$3 million that we would need to raise,” she said, looking at three other LMAS District Health Department staff members.

Tonya Winberg, the public health nurse for Mackinac County, looked stunned. “It’s just, where does that $3 million come from?” Winberg asked. Other potential Rx Kids expansion sites, like Kalamazoo, have wealthy private foundations that can fund the program. The eastern Upper Peninsula does not.

“And how do we sustain it?” Espinoza added. “We hate to start programs, and then the funding is gone and we have to tell people, ‘It’s not here anymore; we can’t do it anymore.’”

The ruggedly beautiful and densely forested Upper Peninsula is used to feeling forgotten. There’s a running joke about how often it’s mislabeled as Canada or Wisconsin on maps. It has about a third of Michigan’s land mass, but just 3% of its residents. The sheer scale and sparse population mean options for food, housing, and child care are limited. Poverty rates are higher than the state average in much of Espinoza’s territory, and the region has some of the highest rates of newborns suffering from prebirth drug exposure in the state, according to the state health department.

At the community center, Espinoza and her colleagues start listing all the ways Rx Kids would be a lifesaver for families in the Upper Peninsula, many of whom have some income and some resources but “don’t make enough to make it,” Espinoza said. “The fall-through-the-cracks families. And those are the ones that I really, really, really think this program would benefit, especially up here.”

Espinoza’s next meeting was with one of those families. Jessica Kline and her 18-month-old daughter, Aurora, live in Munising, a tourist town on Lake Superior. “She’s got a big personality, and her hair is red, so she came with a warning label,” Kline said of her daughter, laughing.

Aurora is a tiny force, speeding around the family’s apartment, unfazed by the nasal tube that connects her to an oxygen machine. She was born early, at just 24 weeks gestation, weighing less than 2 pounds. No hospital in the Upper Peninsula was equipped to care for a preemie that young. So Aurora and her parents spent seven months at a hospital in Ann Arbor, five hours south of their home. “We didn’t have a reliable vehicle,” Kline said. “We didn’t have a source of income.” Hospital social services provided $19 a day for food, which Kline would save up to buy supplies for Aurora.

When they finally got Aurora home to the Upper Peninsula, their house had been vandalized, the copper pipes stripped out. Espinoza’s team helped them find housing, and drove them to get groceries. Every day is a series of small battles, from finding the medical supplies Aurora needs to figuring out how to get to a revolving door of specialists hundreds of miles away. Still, Aurora’s dad has a job in town. They’ve got family nearby. They’re making it work, Kline said.

But having a program like Rx Kids could have made a huge difference in her daughter’s first year. “Five hundred dollars a month would have been enough to actually be able to get ourselves on our feet,” she said.

After Espinoza left Kline’s apartment, she drove south to her office in Manistique. It was late. Everyone else had gone home. Espinoza sat at her desk, trying to be pragmatic. She knows Rx Kids would not magically solve the lack of child care and housing and all the other things you need to break the cycle of poverty. But it would fix Kline’s car. It would help.

There will undoubtedly be critics, Espinoza said — people who believe parents will just use this money to buy drugs. “‘What did they do to earn it?’” she imagined them saying. “‘You’re just giving them free money, and they didn’t do anything to get it?’ Because they don’t understand. They don’t understand the barriers. They don’t understand that sometimes the choice isn’t always yours. Like, I’ve talked to moms who desperately want to go to work, and they want to support their family, but there’s no child care. And so they have no other choice.”

Espinoza recently got an update from Rx Kids’ Hanna: Largely because of private foundations outside the Upper Peninsula, the program has raised enough money to fund a “perinatal” version of Rx Kids for five counties in the eastern Upper Peninsula. The perinatal program would provide the $1,500 payment mid-pregnancy, plus $500 a month for a baby’s first three months, rather than the full year. “But the goal really is the full program, so we are still raising money,” Hanna said via email.

“I think it’s fantastic if we even just get the perinatal version to start,” Espinoza said. “That’s more than we had before.”

This article is from a partnership that includes Michigan Public, NPR, and KFF Health News.

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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SACRAMENTO, Calif. — California public health officials are dipping into state and federal stockpiles to equip up to 10,000 farmworkers with masks, gloves, goggles, and other safety gear as the state confirms at least 21 human cases of bird flu as of early November. It’s the latest reminder of the state’s struggle to remain prepared amid multibillion-dollar deficits.

Officials said they began distributing more than 2 million pieces of personal protective equipment in late May, four months before the first human case was confirmed in the state. They said they began ramping up coordination with local health officials in April after bird flu was first detected in cattle in the U.S. Bird flu has now been confirmed at more than 270 dairies in central California, and traces were recently detected at a wastewater sampling site in Los Angeles County. Bird flu was also recently detected in a flock of commercial turkeys in Sacramento County.

California is putting a number of lessons from the covid-19 pandemic to use, such as coordinating emergency response with local health officials and tracking infectious diseases through wastewater surveillance, as the state tries to limit the spread of bird flu to humans. It’s striving to maintain an adequate emergency stockpile to withstand the first wave of any new public health disaster without hemorrhaging the state budget.

“We are far better prepared to respond to a pandemic than we were in 2020,” said Amy Palmer, a spokesperson for the Governor’s Office of Emergency Services.

For instance, before the coronavirus struck in 2020, the state’s emergency supplies stockpile was barely big enough to crowd two basketball courts.

By the time California ramped up its pandemic response, it had enough personal protective equipment and other disaster supplies to fill 52 football fields. California spent $15.6 billion on direct pandemic response during the covid crisis years, much of it provided by the federal government.

Today, the stockpile fits into about 12½ football fields, though it can seesaw from month to month.

According to the state, the current stockpile includes 101 million face masks, 26 million more than the 90-day supply recommended by the state’s pandemic preparedness guideline.

That includes 88 million N95 masks, more than the emergency services agency said was needed last year. The high-efficiency masks are considered crucial to protect against airborne viruses such as covid-19.

Although the state is building up its stockpile, Palmer could not say if the additional masks are related to fears of bird flu, only that planners are always working “to keep pace with the current risk environment.”

The state’s goal, Palmer said, is to have “an initial supply during emergencies to allow us the time to secure resources,” whether through the federal government or by buying more.

There is no indication of spread between humans in the recent California bird flu cases, and health officials say public risk remains low. Human transmission of bird flu is among several worst-case scenarios for a new pandemic, alongside the possibility of a resurgent mutant coronavirus; wider international spread of mpox, Marburg virus, or Ebola; or an entirely new virus for which there initially is no immunity or vaccine.

Yet, health officials nationwide have struggled to track bird flu transmission. And California has a history of swinging back and forth on preparedness.

Republican Gov. Arnold Schwarzenegger ordered an increase in California’s pandemic preparedness in 2006 in response to an earlier threat from bird flu. That included three mobile hospitals that could immediately be deployed during disasters.

Gov. Jerry Brown, a Democrat, ended the program in 2011 as state finances went bust. By the time covid struck, the state released 21 million N95 masks, some so old they were past their expiration date.

Now hospitals are required to maintain their own three-month supply of masks, gowns, and other personal protective equipment under a state law passed in 2020. California’s aerosol transmissible disease standard also uniquely requires hospitals and other high-risk workplaces to follow precautions such as using negative pressure isolation rooms and the highest level of protective equipment until more is known about a new pathogen.

“It is difficult to overstate the level of unpreparedness exhibited by hospitals both in and outside of California in dealing with the 2020 outbreak of COVID-19,” according to a legislative analysis. “Harrowing images of nurses walking the corridors of hospitals in makeshift masks and garbage bags became commonplace.”

California Hospital Association spokesperson Jan Emerson-Shea said hospitals “continuously prepare to respond to all types of disasters, including outbreaks of transmissible viruses.”

In addition, Palmer said California has five mobile hospitals acquired from the federal government, though they got little use during the pandemic. She said they have to be maintained, such as making sure pulse oximeters have working batteries.

But, once again, the current deficit has the state trying to strike a balance.

While lawmakers rejected most of Democratic Gov. Gavin Newsom’s $300 million proposed cut to public health funding, the state slashed funding for its stockpile of personal protective equipment by one-third a year ago after it determined that no additional covid-related purchases were necessary, according to the Department of Finance. California eliminated funding this year for eight 53-foot-long trailers that would have moved stockpiled items between warehouses. It’s also cutting nearly $40 million over the next four years from its $175 million disaster stockpile budget.

The state’s preparedness wasn’t good enough for Californians Against Pandemics, which gathered more than 1 million signatures to put a ballot measure before voters in November. The measure would have increased taxes on people with incomes over $5 million and used that money for pandemic prevention and response.

But that effort collapsed after one of its key financial supporters, former cryptocurrency executive Sam Bankman-Fried, was convicted of defrauding customers and investors. In exchange for initiative backers dropping the measure, state officials agreed to broaden the scope of the California Initiative to Advance Precision Medicine, which was created in 2015 to focus on developing new medicines and therapies, to include technologies for preventing another pandemic.

“By harnessing the power of precision medicine, California is moving to the forefront of pandemic preparedness and prevention,” Newsom said at the time.

Rodger Butler, a spokesperson for the state Health and Human Services Agency, said it’s unclear if the precision medicine initiative will receive additional funding.

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

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For Native American communities in the Great Plains, data paints a clear picture of the devastation caused by an ongoing syphilis outbreak.

According to the South Dakota Department of Health, 649 cases of syphilis have been documented this year. Of those, 546 were diagnosed among Native Americans, who make up only 9 percent of the state’s population.

“It’s completely preventable and curable, so something has gone horribly wrong that this has occurred,” said Meghan Curry O’Connell, the chief public health officer for the Great Plains Tribal Leaders’ Health Board and a citizen of the Cherokee Nation.

This year, the tribal leaders’ health board asked the U.S. Department of Health and Human Services to declare the outbreak a public health emergency, which could ease access to other resources that tribal leaders asked for, including public health workers, data, national stockpile supplies and funding.

According to the Great Plains Tribal Epidemiology Center, syphilis rates among Native Americans in its region, which covers Iowa, Nebraska, North Dakota and South Dakota, soared by 1,865 percent from 2020 to 2022 — more than 10 times the increase nationwide during the same period. The epidemiology center also found that 1 in 40 Native American babies born in the region in 2022 had a potentially life-threatening syphilis infection.

O’Connell said HHS officials’ response to the Great Plains Tribal Leaders’ Health Board fell short of fulfilling its requests. More recently, the National Indian Health Board also sent a letter to the agency urging it to declare a public health emergency for all tribes in the United States.

Months later, no public health emergency has been declared, and tribal and health leaders are still responding to the outbreak with limited resources.

HHS officials pointed to their work in forming a task force and hosting workshops to guide tribes’ response to the outbreak. But tribal leaders insist they need greater federal investment.

“We know how to address this, but we do need extra support and resources in order to do it,” O’Connell said.

Still, some health officials serving Native American communities say they’re seeing improvement. Natalie Holt, a physician and the chief medical officer for the Great Plains Area Indian Health Service, one of 12 regional divisions of the federal agency responsible for providing health care to Native Americans, said new cases have been declining.

Indian Health Service facilities in the region have averaged more than 1,300 syphilis tests monthly, she said, and cases are down from 93 in January to 31 in October.

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In the two counties around nurse practitioner Samantha Marsee’s clinic in rural northeastern Maryland, there’s not a single clinic that provides abortions. And until recently, Marsee herself wasn’t trained to treat patients who wanted to end a pregnancy.

“I didn’t really have a lot of knowledge about abortion care,” she said.

After Roe v. Wade was overturned, she watched state after state ban abortion, and Marsee decided to take part in the first class of a new training program offered by the University of Maryland School of Medicine and the University of Maryland-Baltimore.

Marsee learned how to administer medication abortion pills, procedural abortions, and highly effective birth control methods, including hormonal implants and intrauterine devices.

She cares for patients with all sorts of everyday ailments and health conditions, including pregnancy. “I do have patients who come in for confirmation of pregnancies and then disclose they don’t want to continue with the pregnancy for whatever reason,” Marsee said.

Now, with her new training, she can help.

Expanding the pool of health care providers with reproductive health care skills outside of the state’s urban centers is vital, said Mary Jo Bondy, associate dean of the School of Graduate Studies at the University of Maryland-Baltimore. She helped create the new training program.

In 2022, Maryland lawmakers passed the Abortion Care Access Act, expanding the type of medical care nurse practitioners, physician assistants, and certified nurse-midwives could offer, including abortion, and the training program “prioritized that group,” Bondy said.

Those types of professionals have long provided abortions to rural patients in other states, Bondy said, and “we have proof that receiving this care from an advanced practice clinician is safe.”

As many as 120 health care providers will be trained over the next two years. Some participants have said they are returning to communities that are hostile to abortion rights.

On Nov. 5, voters approved a ballot measure to protect reproductive rights in the Maryland Constitution, by an overwhelming margin, preliminary results show. The state is widely considered a safe haven for patients who live in states with abortion bans. The number of abortions in Maryland increased 29% from 2019 to 2023, driven largely by out-of-state residents. But one training participant, a family physician from the Eastern Shore, said providing abortions makes her concerned for her physical safety and asked not to be identified.

“The rural catchment and politics really drive it either out or at least into the quiet,” she said of abortion availability where she lives. She worries that her employer will question the prescriptions she writes for medication abortion pills and said pharmacists often refuse to give the medication to her patients.

Even in Maryland, pharmacists are allowed to refuse to dispense medication abortion pills.

As more health care providers are trained in abortion care, they need help from the state’s medical schools and health officials to overcome these barriers, the family physician said. She wants help with “access to medication and pushing in some ways the hand of our employers, or normalizing, ‘This is just health care.’”

For Marsee, the next step is to figure out how to let her patients know she can provide abortions. She plans to tell her current patients and hopes they’ll tell others.

“I’m working on a way to let people know that I’m here and can provide it,” Marsee said. “This is a conservative area, so it’s walking that line. I want people to know I’m here, but I don’t want to cause too much outrage and attention.”

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Este año, California ha dado el último paso para abrir el Medi-Cal, su programa de Medicaid, a todos los residentes que reúnan los requisitos, independientemente de su estatus migratorio.

Es una expansión significativa para un programa de protección social que ya de por sí es masivo.

El gasto anual de Medi-Cal asciende actualmente a  $157.000 millones, con los que atiende a unos 15 millones de residentes de bajos ingresos, más de un tercio de los californianos.

De ellos, aproximadamente 1.5 millones son inmigrantes que viven en Estados Unidos sin papeles, y su acceso a servicios de atención médica representa un costo estimado de $6.4 mil millones, según el Departamento de Servicios de Atención Médica.

Estos inmigrantes se han ido sumando al programa poco a poco, a medida que el estado fue eliminando el requisito de residencia legal. Primero, en 2016, se incluyó a los niños. En 2020, a los jóvenes de 19 a 25 años. En 2022, a las personas de 50 años o más. Finalmente, desde enero, a todos los adultos restantes.

Los defensores de los inmigrantes aplauden el aumento de personas inscriptas en el seguro público de California y elogian al estado por haber ampliado Medi-Cal y logrado que la tasa de personas sin cobertura médica bajara a un mínimo histórico de 6.4%.

Sin embargo, los proveedores de servicios de salud y los hospitales advierten que el estado no ha ampliado adecuadamente el número de profesionales ni ha aumentado lo suficiente los pagos de Medi-Cal. Por esta situación, algunos afiliados tienen problemas para encontrar prestadores de salud que los atiendan en plazos adecuados o directamente se quedan sin ninguna atención médica.

“La cobertura no significa necesariamente acceso”, afirmó Isabel Becerra, consejera delegada y presidenta de la Coalición de Centros de Salud Comunitarios del Condado de Orange, durante una cumbre sobre política sanitaria, el 2 de octubre en Los Ángeles. “Existe una escasez de profesionales de salud. Todos estamos luchando por recibir atención médica. Estamos compitiendo entre nosotros para conseguir que los médicos nos atiendan”.

Aunque el estado ha aumentado un 87,5% los pagos de Medi-Cal para la atención primaria, de maternidad y servicios de salud mental respecto de lo que paga Medicare, el seguro privado todavía tiende a pagar más, según la California Legislative Analyst’s Office.

Una iniciativa electoral presentada hace poco podría garantizar que los ingresos procedentes de un impuesto sobre los planes de salud gestionados se destinen a aumentar el pago a los proveedores de asistencia sanitaria que tratan a los pacientes de Medi-Cal.

Pero algunos creen que el próximo capítulo para dar cobertura a los inmigrantes requerirá algo más que Medi-Cal.

En 2022, Joaquín Arámbula, miembro de la Asamblea estatal por el Partido Demócrata, presentó un proyecto de ley en este sentido. Proponía que los aproximadamente 520.000 residentes indocumentados sin seguro que ganaran más del 138% del nivel federal de pobreza pudieran solicitar cobertura sanitaria subvencionada por el estado a través de Covered California, el mercado de seguros de salud estatal. Sin embargo, el proyecto de ley no avanzó en el comité este año.

La nueva entrega de la serie “Faces de Medi-Cal” muestra cómo Medi-Cal ha impactado en la vida de sus nuevos afiliados.

Entre ellos, Vanessa López Zamora, que por fin está recibiendo tratamiento para su hepatitis y cirrosis, pero tiene problemas para ver a un gastroenterólogo cerca de su casa; Douglas López, un trabajador de un parque de atracciones que atribuye la cobertura dental a la mejora de su bienestar; y Daniel García, que sufre de gota, pero ha renunciado a la búsqueda de un proveedor de atención primaria.

Todos ellos hablaron con KFF Health News luego de comenzar a ser beneficiarios de Medi-Cal.

“Empecé a sentirme mal hace mucho tiempo”

En marzo, el estómago de Vanessa López Zamora se había hinchado tanto que parecía que estaba embarazada. Había estado dolorida y vomitando durante días.

López Zamora contó que fue al servicio de urgencias de su localidad, el Kaweah Health Medical Center, pero no había ningún especialista disponible. Así que la mujer, de 31 años, fue trasladada en ambulancia a Adventist Health Bakersfield, a unas 80 millas de su casa en Visalia.

Contó que allí, los médicos le diagnosticaron hepatitis A y C y cirrosis, y le explicaron que eso le había causado lesiones internas en el hígado y el esófago.

Vanessa pasó cuatro días en el hospital y, para recibir tratamiento adicional, la remitieron a un gastroenterólogo, al que puede ir como nueva beneficiaria de Medi-Cal. Esta es una opción que no podía permitirse en el pasado, cuando tenía dolores de estómago y náuseas.

“Ha sido un proceso muy largo porque empecé a sentirme mal hace mucho tiempo”, dijo López Zamora, que trabaja como contable en una emisora de radio local de Visalia, en el valle de San Joaquín. “Mis hijas son muy pequeñas, y si no consigo el tratamiento necesario, no sabré cuánto tiempo me queda”, se lamentó.

López Zamora, que llegó a California desde Ciudad de México cuando tenía 8 años, está agradecida por la atención que recibió inicialmente.

Pero también está frustrada.

El gastroenterólogo al que la derivó el hospital está en Bakersfield y para Zamora es difícil ir: no conduce, y no puede viajar a otra ciudad.

El acceso limitado a especialistas —desde gastroenterólogos hasta cardiólogos— ha sido durante mucho tiempo un desafío para muchos pacientes de Medi-Cal, especialmente los que viven en zonas rurales o en regiones donde hay escasez de proveedores de salud.

El Valle de San Joaquín, donde vive López Zamora, tiene la menor oferta de especialistas del estado, según la California Health Care Foundation.

Michael Bowman, vocero Anthem Blue Cross, el plan de Medi-Cal de López Zamora, dijo en un correo electrónico que Anthem tiene una amplia red de especialistas que atienden a los beneficiarios de Medi-Cal, incluyendo más de 100 gastroenterólogos en un radio de 20 millas alrededor de Visalia.

López Zamora está tratando su cirrosis con medicamentos y dieta, pero en agosto su gastroenterólogo de Bakerfield descubrió signos de una condición precancerosa en el estómago.

Ella dijo que está buscando un especialista que atienda más cerca de su casa. Por ahora, su madre debe tomarse el día en el trabajo para llevarla a las citas médicas. Si no, toma el autobús.

López Zamora intentó utilizar el transporte proporcionado por Medi-Cal, pero se quedó varada en el hospital. Y ha tenido que cambiar dos veces de cita.

“Me llevaron, pero no me pudieron traer de vuelta porque no encontraban un Uber”, explicó.

Un proceso muy sencillo

Medi-Cal proporcionó a Douglas López el tratamiento dental que no podía costear.

En 2022, este hombre de 33 años ganaba el salario mínimo como trabajador de limpieza en un parque de atracciones. El plan de emergencia de Medi-Cal en el que se había anotado sólo cubría extracciones de urgencia.

Ese año, López experimentó un dolor agudo en las muelas de atrás cuando comía sus queridas bolitas de caramelo de coco y tamarindo de su Guatemala natal.

Un dentista le dijo que necesitaba varias obturaciones y tres endodoncias. Empezó el tratamiento, pero las facturas se fueron encareciendo: $150 la primera sesión, luego $200 y después $300.

“No podía permitírmelo”, recordó López, que vive en Fullerton. “Tenía que pagar el alquiler y la comida”.

Preocupado por perder los dientes, dejó de comer cualquier cosa que le causara dolor.

En enero, cuando el estado amplió la elegibilidad para el seguro a los residentes sin papeles de entre 26 y 49 años, el condado de Orange inscribió automáticamente a López en el plan Medi-Cal de Molina Healthcare. La cobertura transformó su atención, dijo.

Desde entonces, ya vio a un dentista seis veces. Le hicieron una limpieza, tres endodoncias, dos obturaciones y radiografías. Y Medi-Cal ha pagado la factura.

La experiencia de López contrasta con la de muchos otros beneficiarios, que luchan por obtener la atención que necesitan. El Centro de Investigación de Políticas de Salud de UCLA descubrió que el 21% de los dentistas de California vieron pacientes de Medi-Cal de todas las edades, según datos de 2019 a 2021.

Sin embargo, a menudo esos dentistas limitan el número de pacientes de Medi-Cal que reciben; entonces, solo el 15% de los adultos inscritos podrían recibir atención dental en un año determinado.

A López Medi-Cal lo ha ayudado. “Fue un proceso muy sencillo. Estaba muy emocionado porque podía buscar un dentista”, dijo. “Y mi miedo a perder los dientes por no recibir tratamiento desapareció”.

“Algo que ni siquiera puedes usar”

El año pasado, el dolor punzante en el brazo y en el pie que sufría Daniel García se agravó tanto que el hombre de 39 años fue una sala de emergencias.

García padece gota, un tipo de artritis inflamatoria que puede causarle un intenso dolor e hinchazón en las articulaciones. Cuando este año pudo tener la cobertura de Medi-Cal, pensó que por fin podría ir al médico para recibir tratamiento.

Pero el residente del condado de Los Ángeles dijo que no ha sido capaz de encontrar un proveedor de atención primaria que acepte tomar su seguro de Molina Healthcare.

“Es frustrante porque tienes algo que ni siquiera puedes usar”, dijo García, quien tampoco ha podido hacerse un examen físico anual. “He llamado y me dicen que no aceptan mi seguro”.

Molina declinó hacer comentarios sobre el caso de García y no respondió a preguntas sobre su red de atención primaria.

En California, casi 6 millones de personas viven en un total de 611 áreas donde escasea la atención primaria, según un análisis de KFF, que descubrió que el estado necesitaría sumar 881 profesionales para cerrar esta brecha.

García, trabajador de la construcción, dijo que leyó que podía controlar su artritis cambiando sus hábitos alimentarios. Ahora come más sano y ha reducido el consumo de azúcar y de Coca-Cola. En cuanto al dolor, lo alivia con ibuprofeno. Ha renunciado a buscar un proveedor de salud.

Mantener a los pacientes fuera de las salas de emergencias, que pueden ser hasta 12 veces más costosas que la atención primaria, es uno de los argumentos a favor de la expansión de Medi-Cal.

Estudios han demostrado que ampliar la cobertura de salud no solo reduce la cantidad de visitas a emergencias, sino que también aumenta el uso de atención preventiva por parte de los pacientes, según Drishti Pillai, directora de políticas de salud para inmigrantes en KFF.

 “Esto puede ayudar a ahorrar costos de salud, porque no se deja las enfermedades sin atención durante mucho tiempo, lo que podría hacer que su tratamiento se vuelva más complejo y costoso”, explicó Pillai.

Esta historia fue producida por Kaiser Health News, que publica California Healthline, un servicio editorialmente independiente de la California Health Care Foundation.

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

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ACF senior official departing HHS

KFF Health News has sued the U.S. Department of Health and Human Services Office of Inspector General to compel it to release a range of Medicare Advantage health plan audits and other financial records.

The suit, filed Nov. 12 in U.S. District Court in San Francisco under the Freedom of Information Act, or FOIA, seeks documents from the HHS inspector general’s office, which acts as a watchdog over federal health insurance programs run by the Centers for Medicare & Medicaid Services.

The suit asks for correspondence and other records of contact between HHS officials or their representatives and Medicare Advantage organizations concerning overpayment audit findings and potential financial penalties.

It also seeks records reflecting communication between HHS and CMS officials regarding the government’s policies for recovering overpayments discovered during Medicare Advantage audits, including a controversial decision in January 2023 to limit dollar recoveries for audits dating back a decade or more.

Additionally, the suit seeks copies of government contracts awarded to outside firms that have conducted Medicare Advantage audits, including budgets and performance evaluations, dating to 2020. In these audits, reviewers take a sample of 200 patients from a health plan and determine whether medical records support the diagnoses the government paid health plans to treat.

KFF Health News requested the records in August, but, more than two months later, “no documents, responsive or otherwise, have been produced,” the suit says.

Sam Cate-Gumpert, an attorney with Davis Wright Tremaine, which is representing KFF Health News pro bono in the case, said the information is “critically important to public oversight of government misspending.”

According to the suit, the inspector general’s office has audited the Medicare Advantage program more than three dozen times since 2019, revealing billions of dollars in overpayments.

But government officials have not recouped the overcharges, according to the suit.

The HHS Office of Inspector General “has left taxpayers footing the bill for billions of dollars in overpayments — even though HHS OIG’s primary purpose is to combat fraud and waste in Medicare and other federally funded health programs,” the suit alleges.

“In fact, taxpayers have been forced to pay for the Medicare Advantage program’s wasteful spending twice — first, because of the program itself, and second, because of the costs of the audits, which the government spends millions of dollars to conduct,” according to the suit.

Medicare Advantage, mostly run by private insurance companies, has enrolled more than 33 million seniors and people with disabilities, more than half of people on Medicare.

But the program has faced criticism that it costs billions of dollars more than it should with research showing that many health plans exaggerate how sick patients are to boost payments.

A FOIA lawsuit filed by KFF Health News in September 2019 prompted CMS to release summaries of 90 Medicare Advantage audits revealing millions of dollars in overpayments. As part of a settlement, CMS paid $63,000 in KFF Health News’ legal fees, though it did not admit to wrongfully withholding the records.

The HHS Office of Inspector General had no immediate comment on the suit.

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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Health researchers are noticing a growing problem in American pregnancies: more cases of blood pressure so high it can be deadly for the parent and baby.

U.S. rates of newly developed and chronic maternal high blood pressure skyrocketed from 2007 through 2019, and researchers say they haven’t slowed down. Hospitals are working to adjust their standards of care to match best practices.

Sara McGinnis died as a result of her pregnancy in 2018. Her Kalispell, Montana, medical team didn’t recognize her symptoms of rising high blood pressure: a severe headache, swollen body and fatigue beyond anything she’d experienced in her first pregnancy. She suffered a massive stroke and seizure late in pregnancy and never got to meet her son, who survived an emergency delivery.

McGinnis had eclampsia, a condition typically characterized by seizures late in pregnancy. The severe and sometimes deadly pregnancy complication generally develops from persistent high blood pressure. Rising blood pressure makes the heart work in overdrive, which damages organs along the way.

One reason for the big increase in cases is that more doctors are looking out for the condition. But that’s not enough to explain the increase in the nation’s overall maternal death rate.

Lifestyle and genetic factors play a role, but physician and health researcher Natalie Cameron, with Northwestern University’s Feinberg School of Medicine, said people who don’t have risk factors going into pregnancy are also getting sick more often. More research is needed to understand why.

“Pregnancy is a natural stress test. It’s unmasking this risk that was there all the time,” Cameron said. “And there’s a lot we don’t know.”

The federal government has worked for years to expand training in screening and treatment for severe high blood pressure in pregnancy. The nation’s best-practice guidelines go back to 2015.

Last year, the federal government boosted funding for training to expand implementation of best practices.

“So much of the disparity in this space is about women’s voices not being heard,” said Carole Johnson, head of the federal agency charged with improving access to health care.

But it takes time for hospitals to incorporate those kinds of changes, researchers said.

Take Montana, for example, which last year became one of 35 states to implement the federal patient safety guidelines. That year, more than two-thirds of hospitals in the state provided patients with timely care. Just over half of hospitals did so before the training.

Some hospitals had treatment plans for high blood pressure in pregnancy but found their doctors’ use was “hit or miss.” One health system found that even the way nurses checked pregnant patients’ blood pressure varied.

Wanda Nicholson, who chairs the independent U.S. Preventive Services Task Force, said blood pressure in pregnancy “can change in a matter of days, or in a 24-hour period.”

That’s why, she said, consistent monitoring for high blood pressure is key to keeping people safe.

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

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

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Jason Farned and his team at the San Gabriel Valley Mosquito and Vector Control District had spent years preparing for the likely arrival of dengue, a dangerous virus typically found in tropical climates outside the mainland United States.

They’d watched nervously as invasive Aedes mosquito species that can carry the virus appeared in Los Angeles about a decade ago and began to spread, likely introduced by international trade and enticed to stay by a warming climate that makes it easier for mosquitoes to thrive.

Then, in October 2023, an email came from the Pasadena Public Health Department: A person in the city had contracted California’s first-known case of dengue from a local mosquito.

“When it happens in real time, real life, you know, it is very different,” Farned said. “There’s no room for error here. We have to be quick and effective in identifying the most at-risk areas and responding.”

Across California, public health and pest control authorities are facing a new reality as the Aedes mosquitoes bring the threat of dengue and potentially other tropical diseases, such as chikungunya, Zika, and yellow fever, that were once of concern only to international travelers.

So far this year, authorities have identified at least 13 cases of locally acquired dengue, up from two in 2023, with 11 in Los Angeles County and two in the San Diego area. The Aedes mosquitoes spread the disease by biting an infected person and then biting a previously uninfected person.

Mosquito-borne viral illnesses, chiefly malaria, have long been a scourge in many tropical regions, and preventive measures focus mainly on controlling the mosquitoes. The Aedes mosquitoes, known for their aggressive, daytime biting, are now present in at least 24 California counties. They breed in water, in as little as a capful.

“When these locally acquired cases occur, … we want to act on them pretty quickly so that it does not become an endemic infection in our region,” said Aiman Halai, director of the Los Angeles County Department of Public Health’s Vector-Borne Disease Unit.

California officials are hoping to beat back dengue by expanding mosquito surveillance, developing detailed response plans for mosquito outbreaks and human infections, and improving data sharing across agencies. They’re also going door to door in neighborhoods to remove standing water sources and apply pesticides. Residents are advised to wear bug repellent and long-sleeved clothing and control mosquitoes around their homes to prevent biting and infection.

Some vector control districts — local agencies charged with managing disease-bearing insects and other animals — are even growing their own sterile mosquitoes to release into the wild to reduce local Aedes populations.

Outside of California, locally acquired dengue cases have occurred in Arizona, Florida, Hawaii, and Texas. In March, Puerto Rico declared a public health emergency after a spike in cases there, where dengue is endemic. Meanwhile, worldwide dengue cases are on track to more than double this year, with 12.3 million documented through August, up from 6.5 million in 2023, according to the World Health Organization.

Most people who get dengue have no symptoms, but about 1 in 4 become ill. A mild case can feel like the flu and usually dissipates within a week, but about 5% of those infected with dengue become very sick, with symptoms that can include internal bleeding, shock, and organ failure, and the most severe cases can be fatal. People infected a second time are at especially high risk.

There is no specific medication to treat dengue. Japanese pharmaceutical company Takeda developed a vaccine that has won approval in Europe and elsewhere, though it withdrew an application to the FDA last year, saying it could not provide data requested by the agency. A vaccine developed in Brazil could soon be approved for use in that country. But the only FDA-approved vaccine is authorized only for children in narrow circumstances and will soon go out of production.

At the San Gabriel Valley Mosquito and Vector Control District, one of five agencies tasked with mosquito control across Los Angeles County, public health workers have put together an Aedes and dengue response plan based on updated guidance from the state.

When they discover a case, they identify all the properties and public spaces within 150 meters — roughly the distance an Aedes mosquito can fly — and then go door to door, removing standing water, where mosquitoes can breed; applying pesticides from backpacks or trucks; and educating residents about the risk of dengue and how to protect themselves. District officials also set traps to catch mosquitoes so they can figure out their prevalence and test them for dengue.

Since local dengue cases began to appear, the district has gotten more efficient in implementing its response plan, district manager Farned said. All full-time and seasonal staff members — about 40 people — have been trained in a variety of tasks, such as door-to-door education and coming in during off-hours to answer phones, Farned said.

While vector control teams respond to cases, separate teams from the Los Angeles County Public Health Department go door to door in the affected neighborhood when they determine that a dengue case was locally acquired, surveying residents and offering free dengue testing to try to identify others who may be infected.

Additionally, the department has been sending alerts to local health providers, advising them to be on the lookout for possible dengue cases and test for it when suspected, even among patients who haven’t traveled to a place where dengue is endemic. This advice follows a national alert put out by the Centers for Disease Control and Prevention in June. Health authorities are also emphasizing that people who travel to locations with dengue should continue to wear mosquito repellent when they get home, to reduce the risk of spreading the disease to local mosquitoes.

As happened during the covid-19 pandemic, mistrust of public health authorities can make outreach challenging for health and pest control teams in some neighborhoods, officials said.

Pest control officers can seek a warrant to enter and treat a property for mosquitoes if a homeowner refuses to give access, said Jeremy Wittie, a former president and the legislative committee chair for the Mosquito and Vector Control Association of California, which represents the more than 70 mosquito and vector control agencies in California. This is easier in districts such as his, the Coachella Valley Mosquito and Vector Control District, that have warrants giving officials standing permission to enter a property after 24 hours without needing to ask a judge.

In counties such as Santa Clara, where Aedes mosquitoes first appeared in 2022 but have yet to establish themselves, officials hope to suppress the threat with stepped-up surveillance, speedy eradication efforts, and more public outreach. Santa Clara County Vector Control District Manager Nayer Zahiri said the aim was to eliminate Aedes but acknowledged the climate conditions that encourage the mosquitoes’ spread are “totally out of our control.”

In some counties with pervasive mosquito problems, including San Diego, San Joaquin, and Stanislaus, officials have sprayed pesticides from planes or helicopters to address spikes in local mosquito populations, Wittie said. These sprayings typically aim to control the larvae of a different type of mosquito, Culex, that can spread West Nile virus and which — unlike the Aedes species, which thrive in urban habitats — are found in harder-to-reach rural environments, Wittie said.

Aerial spraying hasn’t been deployed to address the recent dengue outbreaks, which are in more urban environments where spraying from trucks is a better option, Wittie said. Drones are another option that some vector control authorities are exploring.

Some districts are experimenting with the decades-old sterile insect technique, commonly used for other pests such as fruit and screwworm flies, in which males are sterilized with radiation and then released to mate, resulting in eggs that don’t hatch. (Female mosquitoes are separated from the males before sterilization and not released. Only the females bite).

Ultimately, the public will have to take the mosquito threat more seriously and contribute to prevention efforts, Wittie said. “This mosquito is going to be here to stay, unfortunately. I hope it kind of wakes people up and pushes them to be part of that solution.”

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

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

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Jason Farned y su equipo en el Distrito de Control de Mosquitos y Vectores del Valle de San Gabriel habían pasado años preparándose para la posible llegada del dengue, un virus peligroso que normalmente se encuentra en climas tropicales fuera de Estados Unidos continental.

Habían observado con nerviosismo cómo las especies de mosquitos Aedes invasores, que pueden transmitir el virus, aparecieron en Los Ángeles hace aproximadamente una década y comenzaron a propagarse, tal vez introducidos por el comercio internacional. Llegaron para quedarse, alentados por el calentamiento climático que facilita la supervivencia de estos insectos.

Entonces, en octubre de 2023, llegó un correo electrónico del Departamento de Salud Pública de Pasadena: una persona en la ciudad había contraído el primer caso conocido de dengue en California de un mosquito local.

“Cuando ocurre en tiempo real, en la vida real, sabes que es muy diferente”, dijo Farned. “Aquí no hay margen de error. Tenemos que ser rápidos y efectivos para identificar las áreas de mayor riesgo y responder”.

En toda California, las autoridades de salud pública y de control de plagas enfrentan una nueva realidad: los mosquitos Aedes traen la amenaza del dengue y potencialmente otras enfermedades tropicales, como el chikungunya, el Zika y la fiebre amarilla, que antes solo preocupaban a los viajeros internacionales.

En lo que va del año, las autoridades han identificado al menos 13 casos de dengue de transmisión local, frente a dos en 2023, con 11 en el condado de Los Ángeles y dos en el área de San Diego. Los mosquitos Aedes transmiten la enfermedad al picar a una persona infectada y luego picar a una persona que previamente no estaba infectada.

Las enfermedades virales transmitidas por mosquitos, principalmente la malaria, han sido una plaga en muchas regiones tropicales, y las medidas preventivas se centran principalmente en controlar a los mosquitos.

Los mosquitos Aedes, conocidos por sus picaduras agresivas durante el día, están ahora presentes en al menos 24 condados de California. Se reproducen en agua, en tan solo la tapa de botella.

“Cuando ocurren estos casos de transmisión local, … queremos actuar rápidamente para que no se convierta en una infección endémica en nuestra región”, dijo Aiman Halai, director de la Unidad de Enfermedades Transmitidas por Vectores del Departamento de Salud Pública del Condado de Los Ángeles.

Las autoridades de California esperan vencer al dengue expandiendo la vigilancia de los mosquitos, desarrollando planes de respuesta detallados para brotes de mosquitos e infecciones humanas y mejorando el intercambio de datos entre agencias.

También van de puerta en puerta en los vecindarios para eliminar fuentes de agua estancada y aplicar pesticidas. Se aconseja a los residentes que usen repelente de insectos y ropa de manga larga, y que controlen los mosquitos alrededor de sus hogares para evitar picaduras e infecciones.

Algunos distritos de control de vectores —agencias locales encargadas de manejar insectos y otros animales portadores de enfermedades— incluso están criando sus propios mosquitos estériles para liberarlos en la naturaleza y reducir las poblaciones locales de Aedes.

Fuera de California, se han reportado casos de dengue de transmisión local en Arizona, Florida, Hawaii y Texas. En marzo, Puerto Rico declaró una emergencia de salud pública tras un aumento de casos en la isla, en donde el dengue es endémico.

Mientras tanto, los casos de dengue a nivel mundial están en camino de más que duplicarse este año, con 12,3 millones documentados hasta agosto, frente a 6,5 millones en 2023, según la Organización Mundial de la Salud (OMS).

La mayoría de las personas que desarrollan dengue no presentan síntomas, pero alrededor de 1 de cada 4 enferma. Un caso leve puede sentirse como una gripe y generalmente desaparece en una semana, pero alrededor del 5% de los infectados se enferman gravemente, con síntomas que pueden incluir sangrado interno, shock y falla orgánica; los casos más graves pueden ser fatales. Las personas infectadas una segunda vez tienen un riesgo especialmente alto.

No existe un medicamento específico para tratar el dengue. La farmacéutica japonesa Takeda desarrolló una vacuna que ha sido aprobada en Europa y en otros lugares, aunque retiró una solicitud a la Administración de alimentos y Medicamentos de Estados Unidos (FDA) el año pasado, diciendo que no podía proporcionar los datos solicitados por la agencia.

Una vacuna desarrollada en Brasil podría ser aprobada pronto para su uso en ese país. Sin embargo, la única vacuna aprobada por la FDA está autorizada solo para niños en circunstancias específicas y pronto dejará de producirse.

En el Distrito de Control de Mosquitos y Vectores del Valle de San Gabriel, una de las cinco agencias encargadas del control de mosquitos en el condado de Los Ángeles, los trabajadores de salud pública han elaborado un plan de respuesta para el Aedes y dengue basado en la guía actualizada del estado.

Cuando descubren un caso, identifican todas las propiedades y espacios públicos dentro de los 150 metros —aproximadamente la distancia que puede volar un mosquito Aedes— y luego van de puerta en puerta, eliminando agua estancada donde los mosquitos pueden reproducirse; aplicando pesticidas desde mochilas o camiones; y educando a los residentes sobre el riesgo de dengue y cómo protegerse.

Los funcionarios del distrito también colocan trampas para capturar mosquitos y evaluar su prevalencia y analizarlos en busca de dengue.

Desde que comenzaron a aparecer casos locales de dengue, se han vuelto más eficientes en la implementación de su plan de respuesta, dijo Farned, gerente del distrito. Se ha capacitado a todo el personal a tiempo completo y temporal —unas 40 personas— en una variedad de tareas, como la educación puerta a puerta y responder llamadas fuera del horario laboral, explicó Farned.

Mientras los equipos de control de vectores responden a los casos, otros equipos del Departamento de Salud Pública del Condado de Los Ángeles van de puerta en puerta en el vecindario afectado cuando determinan que un caso de dengue fue adquirido localmente, encuestando a los residentes y ofreciendo pruebas gratuitas de dengue para tratar de identificar a otras personas que puedan estar infectados.

Además, el departamento ha estado enviando alertas a los proveedores de salud locales, aconsejándoles que estén atentos a posibles casos de dengue y lo examinen cuando se sospeche, incluso entre pacientes que no hayan viajado a un lugar donde el dengue es endémico.

Este consejo sigue una alerta nacional emitida por los Centros para el Control y Prevención de Enfermedades (CDC) en junio. Las autoridades sanitarias también están enfatizando que las personas que viajan a lugares con dengue deben continuar usando repelente de mosquitos cuando regresen a casa, para reducir el riesgo de propagar la enfermedad a los mosquitos locales.

Como sucedió durante la pandemia de covid-19, la desconfianza hacia las autoridades de salud pública puede dificultar el alcance comunitario para los equipos de salud y control de plagas en algunos vecindarios, dijeron las autoridades.

Los oficiales de control de plagas pueden solicitar una orden para entrar y tratar una propiedad en busca de mosquitos si un propietario se niega a dar acceso, dijo Jeremy Wittie, ex presidente y líder del comité legislativo de la Asociación de Control de Mosquitos y Vectores de California, que representa a las más de 70 agencias especializadas en el estado.

Esto es más fácil en distritos como el suyo, el Distrito de Control de Mosquitos y Vectores del Valle de Coachella, que tienen órdenes que otorgan permiso permanente para entrar en una propiedad después de 24 horas sin necesidad de pedirlo a un juez.

En condados como Santa Clara, donde los mosquitos Aedes aparecieron por primera vez en 2022 pero aún no se han establecido, las autoridades esperan reprimir la amenaza con una mayor vigilancia, esfuerzos de erradicación rápidos y más divulgación pública.

El gerente del Distrito de Control de Vectores del Condado de Santa Clara, Nayer Zahiri, dijo que el objetivo era eliminar los Aedes, pero reconoció que las condiciones climáticas que favorecen la propagación de los mosquitos están “totalmente fuera de nuestro control”.

En algunos condados con problemas generalizados de mosquitos, incluidos San Diego, San Joaquín y Stanislaus, las autoridades han rociado pesticidas desde aviones o helicópteros para atacar picos en las poblaciones locales de mosquitos, dijo Wittie. Tradicionalmente, estas fumigaciones buscan controlar las larvas de otro tipo de mosquito, Culex, que puede transmitir el Virus del Nilo Occidental y que, a diferencia de las especies de Aedes, que prosperan en hábitats urbanos, se encuentran en ambientes rurales de difícil acceso, dijo Wittie.

La fumigación aérea no se ha implementado para abordar los recientes brotes de dengue, que se encuentran en entornos más urbanos donde el rociado desde camiones es una mejor opción, explicó Wittie. Los drones son otra alternativa que algunas autoridades de control de vectores están explorando.

Algunos distritos están experimentando con la técnica de insectos estériles, una estrategia utilizada por décadas para otras plagas como las moscas de la fruta y los gusanos barrenadores, en la que los machos son esterilizados con radiación y luego liberados para aparearse, lo que resulta en huevos que no abren. (Las moscas hembras se separan de los machos antes de la esterilización y no se liberan. Solo las hembras pican).

En última instancia, el público tendrá que tomar la amenaza de los mosquitos más en serio y contribuir a los esfuerzos de prevención, dijo Wittie. “Desafortunadamente, este mosquito va a quedarse aquí. Espero que esto ponga en alerta a las personas y las impulse a ser parte de la solución”.

Esta historia fue producida por Kaiser Health News, que publica California Healthline, un servicio editorialmente independiente de la California Health Care Foundation.

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

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Donald Hammen, 80, and his longtime next-door neighbor in south Minneapolis, Julie McMahon, have an understanding. Every morning, she checks to see whether he’s raised the blinds in his dining room window. If not, she’ll call Hammen or let herself into his house to see what’s going on.

Should McMahon find Hammen in a bad way, she plans to contact his sister-in-law, who lives in a suburb of Des Moines. That’s his closest relative. Hammen never married or had children, and his younger brother died in 2022.

Although Hammen lives alone, a web of relationships binds him to his city and his community — neighbors, friends, former co-workers, fellow volunteers with an advocacy group for seniors, and fellow members of a group of solo agers. McMahon is an emergency contact, as is a former co-worker. When Hammen was hit by a car in February 2019, another neighbor did his laundry. A friend came over to keep him company. Other people went on walks with Hammen as he got back on his feet.

Those connections are certainly sustaining. Yet Hammen has no idea who might care for him should he become unable to care for himself.

“I’ll cross that bridge when I come to it,” he told me.

These are fundamental questions for older adults who live alone: Who will be there for them, for matters large and small? Who will help them navigate the ever more complex health care system and advocate on their behalf? Who will take out the garbage if it becomes too difficult to carry? Who will shovel the snow if a winter storm blows through?

American society rests on an assumption that families take care of their own. But 15 million Americans 50 and older didn’t have any close family — spouses, partners, or children — in 2015, the latest year for which reliable estimates are available. Most lived alone. By 2060, that number is expected to swell to 21 million.

Beyond that, millions of seniors living on their own aren’t geographically close to adult children or other family members. Or they have difficult, strained relationships that keep them from asking for support.

These older adults must seek assistance from other quarters when they need it. Often they turn to neighbors, friends, church members, or community groups — or paid help, if they can afford it.

And often, they simply go without, leaving them vulnerable to isolation, depression, and deteriorating health.

When seniors living alone have no close family, can nonfamily helpers be an adequate substitute? This hasn’t been well studied.

“We’re just beginning to do a better job of understanding that people have a multiplicity of connections outside their families that are essential to their well-being,” said Sarah Patterson, a demographer and sociologist at the Institute for Social Research at the University of Michigan.

The takeaway from a noteworthy study published by researchers at Emory University, Johns Hopkins University, and the Icahn School of Medicine at Mount Sinai was this: Many seniors adapt to living solo by weaving together local social networks of friends, neighbors, nieces and nephews, and siblings (if they’re available) to support their independence.

Still, finding reliable local connections isn’t always easy. And nonfamily helpers may not be willing or able to provide consistent, intense hands-on care if that becomes necessary.

When AARP surveyed people it calls “solo agers” in 2022, only 25% said they could count on someone to help them cook, clean, get groceries, or perform other household tasks if needed. Just 38% said they knew someone who could help manage ongoing care needs. (AARP defined solo agers as people 50 and older who aren’t married, don’t have living children, and live alone.)

Linda Camp, 73, a former administrator with the city of St. Paul, Minnesota, who never married or had children, has written several reports for the Citizens League in St. Paul about growing old alone. Yet she was still surprised by how much help she required this summer when she had cataract surgery on both eyes.

A former co-worker accompanied Camp to the surgery center twice and waited there until the procedures were finished. A relatively new friend took her to a follow-up appointment. An 81-year-old downstairs neighbor agreed to come up if Camp needed something. Other friends and neighbors also chipped in.

Camp was fortunate — she has a sizable network of former co-workers, neighbors, and friends. “What I tell people when I talk about solos is all kinds of connections have value,” she said.

Michelle Wallace, 75, a former technology project manager, lives alone in a single-family home in Broomfield, Colorado. She has worked hard to assemble a local network of support. Wallace has been divorced for nearly three decades and doesn’t have children. Though she has two sisters and a brother, they live far away.

Wallace describes herself as happily unpartnered. “Coupling isn’t for me,” she told me when we first talked. “I need my space and my privacy too much.”

Instead, she’s cultivated relationships with several people she met through local groups for solo agers. Many have become her close friends. Two of them, both in their 70s, are “like sisters,” Wallace said. Another, who lives just a few blocks away, has agreed to become a “we’ll help each other out when needed” partner.

“In our 70s, solo agers are looking for support systems. And the scariest thing is not having friends close by,” Wallace told me. “It’s the local network that’s really important.”

Gardner Stern, 96, who lives alone on the 24th floor of the Carl Sandburg Village condominium complex just north of downtown Chicago, has been far less deliberate. He never planned for his care needs in older age. He just figured things would work out.

They have, but not as Stern predicted.

The person who helps him the most is his third wife, Jobie Stern, 75. The couple went through an acrimonious divorce in 1985, but now she goes to all his doctor appointments, takes him grocery shopping, drives him to physical therapy twice a week and stops in every afternoon to chat for about an hour.

She’s also Gardner’s neighbor — she lives 10 floors above him in the same building.

Why does she do it? “I guess because I moved into the building and he’s very old and he’s a really good guy and we have a child together,” she told me. “I get happiness knowing he’s doing as well as possible.”

Over many years, she said, she and Gardner have put their differences aside.

“Never would I have expected this of Jobie,” Gardner told me. “I guess time heals all wounds.”

Gardner’s other main local connections are Joy Loverde, 72, an author of elder-care books, and her 79-year-old husband, who live on the 28th floor. Gardner calls Loverde his “tell it like it is” friend — the one who helped him decide it was time to stop driving, the one who persuaded him to have a walk-in shower with a bench installed in his bathroom, the one who plays Scrabble with him every week and offers practical advice whenever he has a problem.

“I think I would be in an assisted living facility without her,” Gardner said.

There’s also family: four children, all based in Los Angeles, eight grandchildren, mostly in L.A., and nine great-grandchildren. Gardner sees most of this extended clan about once a year and speaks to them often, but he can’t depend on them for his day-to-day needs.

For that, Loverde and Jobie are an elevator ride away. “I’ve got these wonderful people who are monitoring my existence, and a big-screen TV, and a freezer full of good frozen dinners,” Gardner said. “It’s all that I need.”

As I explore the lives of older adults living alone in the next several months, I’m eager to hear from people who are in this situation. If you’d like to share your stories, please send them to khn.navigatingaging@gmail.com.

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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Statement from Secretary Xavier Becerra on New Data Showing Continued Low Uninsurance Rate

Voters in three states — Arizona, Missouri, and Nevada — chose on Tuesday to advance protections for abortion rights in their state constitutions. Donald Trump, meanwhile, is likely to win all three states in his victorious bid for the White House.

It’s a conundrum for Democrats, who expected ballot initiatives on abortion rights in those states to boost the prospects of their candidates, including Vice President Kamala Harris. But data from VoteCast, a large survey of U.S. voters conducted by The Associated Press and partners including KFF, found that about 3 in 10 voters in Arizona, Missouri, and Nevada who supported the abortion rights measures also voted for Trump.

“We saw lots of people who voted in favor of abortion access and still voted for Donald Trump,” said Liz Hamel, director of Public Opinion and Survey Research for KFF, a health information nonprofit that includes KFF Health News.

VoteCast is a survey of more than 115,000 registered voters in all 50 states conducted between Oct. 28 and Nov. 5. It’s intended to be “the most accurate picture possible of who has voted, and why,” according to the AP.

About 1 in 4 of the polled voters said abortion was the “single most important” factor to their vote, though that number was higher among Democrats, young women, Black adults, and Hispanic adults.

Abortion rights referendums passed in seven states on Tuesday, including Missouri and Arizona, where state bans were overturned. Vice President Kamala Harris made reproductive rights a cornerstone of her campaign, but the VoteCast results reinforce earlier surveys that indicated economic concerns were the foremost issue in the election.

Tuesday’s was the first presidential election since the U.S. Supreme Court’s conservative majority overturned Roe v. Wade. During Trump’s first term as president, he nominated three Supreme Court justices who later joined the 2022 ruling that eliminated women’s constitutional right to abortion care.

Mike Islami, 20, voted for Trump in Madison, Wisconsin, where he’s a full-time student. He said abortion is “a woman’s right” that “was definitely in the back of my mind” when he cast his ballot.

“I don’t think much is going to change” about abortion access during Trump’s second term, he said. “I believe his policy is that he’s just going to give it back to the states and from there they could decide how important it was.”

The survey found that the percentage of voters who said abortion was the most important factor in their vote was similar in states that had abortion measures on the ballot and states without them.

When voters cast their ballots, they were more motivated by economic anxiety and the cost of filling up their gas tanks, housing, and food, according to the survey results. Trump won those voters as much in hotly contested states such as Pennsylvania and Wisconsin as in reliably red states.

Glen Bolger, a Republican campaign strategist, said the 2022 election results demonstrated that Republican candidates are better off talking about the economy and the cost of living than they are about abortion.

This year, Trump voters who supported abortion rights amendments may have decided to take Trump “at his word that he was not going to support a national ban,” Bolger said. In casting their vote for Trump, he said, those supporters may have thought, “Let’s elect him to deal with the cost of living and health care and gasoline and everything else.”

The VoteCast survey found stronger support for abortion ballot initiatives from female voters: 72% of women in Nevada, 69% in Arizona, 62% in Missouri.

Erica Wallace, 39, of Miami, voted for Harris and in favor of an abortion rights ballot measure in Florida, which fell just short of the 60% threshold needed to amend the state constitution.

“As a grown woman, you’re out and you’re working, living your life,” said Wallace, an executive secretary who lives in Miami. She said the state’s ban, which criminalizes abortion care before many women know they’re pregnant, amounts to unequal treatment for women.

“I pay my taxes. I live good,” she said. “I’m doing everything every other citizen does.”

Men were more likely to vote against protecting abortion rights. Men voted 67% in Nevada, 64% in Arizona, and 55% in Missouri for the abortion rights ballot initiatives.

The VoteCast survey found that, overall, voters believed Harris was better able to handle health care. That is consistent with the long-standing view that “Democrats traditionally have the advantage on health care,” Hamel said. Still, Trump outperformed Harris among more than half of voters who said they were very concerned about health care costs.

Family premiums for employer-sponsored health insurance rose 7% in 2024 to an average of $25,572 annually, according to KFF’s 2024 Employer Health Benefits Survey. On average, workers contribute $6,296 annually to the cost of family coverage.

“Everybody is impacted by high health-care costs, and nobody has a solution to it,” Bolger said. “That’s something voters are very frustrated about.”

Florence Robbins in Madison, Wisconsin, and Denise Hruby in Miami contributed to this report.

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

Health care might not have been the biggest issue in the campaign, but the return of Donald Trump to the presidency is likely to have a seismic impact on health policy over the next four years. 

Changes to the Affordable Care Act, Medicaid, and the nation’s public health infrastructure are likely on the agenda. But how far Trump goes will depend largely on who staffs key health policy roles and on whether Democrats take a majority in the U.S. House, where several races remain uncalled. 

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

Panelists Rachel Cohrs Zhang Stat News @rachelcohrs Read Rachel's stories. Alice Miranda Ollstein Politico @AliceOllstein Read Alice's stories.

Among the takeaways from this week’s episode:

• As of Friday morning, it remained unclear which party will control the House next year. A Democratic-controlled House would offer a check against Republican policy changes and some control of key government oversight committees. A Republican House would give the party full control of Congress and the presidency. Either way, the party in control will have a slim majority.
• Majorities of voters in eight states voted to protect abortion rights — though the ballot measures passed in only seven states. (More than half of voters in Florida voted for the abortion rights measure, but the state requires at least 60% support for ballot measures to pass.)
• Robert F. Kennedy Jr. — now a key voice in the Trump transition team — is telegraphing big plans for health policy. Who ends up in Trump’s Cabinet will make a difference, as the president-elect is seemingly outsourcing much of his health policy planning in favor of focusing on issues such as the economy, immigration, and trade.
• And conservative appointees throughout the judicial system are likely to remain friendly to Trump administration causes, which could open the door to more challenges to federal policies. Several important legal challenges are already winding through the courts.

Also this week, Rovner interviews KFF Health News’ Jackie Fortiér, who reported and wrote the latest KFF Health News-Washington Post “Bill of the Month” feature, about a 2-year old who had an expensive run-in with a rattlesnake. Do you have a medical bill that is exorbitant, baffling, infuriating, or all of the above? Tell us about it!

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

Julie Rovner: KFF Health News’ “Dentists Are Pulling ‘Healthy’ and Treatable Teeth to Profit From Implants, Experts Warn,” by Brett Kelman and Anna Werner of CBS News. 

Alice Miranda Ollstein: Politico’s “The Election’s Stakes for Global Health,” by Carmen Paun. 

Rachel Cohrs Zhang: KFF Health News’ “As Nuns Disappear, Many Catholic Hospitals Look More Like Megacorporations,” by Samantha Liss. 

Also mentioned in this week’s podcast:

• The New York Times’ “R.F.K. Jr. Lays Out Possible Public Health Changes Under Trump,” by Remy Tumin.
• KFF Health News’ “Toddler’s Backyard Snakebite Bills Totaled More Than a Quarter Million Dollars,” by Jackie Fortiér.

Credits Zach Dyer Audio producer Emmarie Huetteman Editor

To hear all our podcasts, click here.

And subscribe to KFF Health News’ “What the Health?” on Spotify, Apple Podcasts, Pocket Casts, or wherever you listen to podcasts.

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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