$42 million in grant awards to build economic stability and family well-being

Voters in Missouri and Nebraska approved ballot measures Tuesday that guarantee paid leave for sick workers. Alaska voters seem poised to pass a similar measure that has a wide lead.

These two Republican-led states join 15 others and D.C. — largely Democratic-controlled places — in requiring some employers to provide workers with paid sick leave.

Proponents cheered Tuesday’s results. “Thanks to the voters, we can ensure that hard working Nebraskans don’t have to choose between paying their bills or caring for their health,” Jodi Lepaopao, campaign manager for Paid Sick Leave for Nebraskans, wrote in a statement.

The coronavirus pandemic elevated the issue by highlighting gaps in such benefits. At the height of the health crisis, the federal government provided temporary relief for sick workers, but those federal protections ended in 2021.

Beginning next year, many workers in these two states will be able to accrue paid time off as they work, earning about a week of paid leave per year. In Missouri and Nebraska, workers for larger organizations could earn one hour of paid sick time for every 30 hours worked. In Alaska, eligible workers would accrue a maximum of 56 hours of paid time each year.

In Missouri and Alaska, the measures also called for boosting the minimum wage.

Opponents in Missouri said they were disappointed with Tuesday’s results and were exploring legal action.

“We stand by our belief that Missouri business owners are best equipped to run their businesses without additional government mandates and regulations,” according to a joint statement from the Missouri Chamber of Commerce and Industry, the National Federation of Independent Business and other business groups.

Opponents had argued that employers should be the ones deciding which benefits are best.

These paid sick leave ballot measures flew under the radar compared with more high-profile ballot initiatives such as those on abortion, which was on the ballot in 10 states, including in Missouri and Nebraska. Voters approved abortion protections in seven states.

Campaigns supporting the sick leave initiatives in Alaska, Missouri and Nebraska raked in less than $9 million combined in cash contributions, according to a KFF Health News analysis of state campaign filings as of Oct. 28. That’s significantly less than Missouri’s ballot measures on abortion and sports betting, which state records show had amassed more than $55 million combined in cash contributions.

Most of the money funneled to the paid sick leave campaigns came from backers outside those states, the filings show. The Sixteen Thirty Fund, a D.C.-based advocacy group, was a top contributor to the three campaigns.

“We will build on these victories and continue to support organizations fighting for paid leave policies nationwide,” the group said in a statement.

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.

USE OUR CONTENT

This story can be republished for free (details).

California this year took the final step in opening Medi-Cal, its Medicaid program, to every eligible resident regardless of immigration status. It’s a significant expansion for an already massive safety net program.

Medi-Cal’s annual spending now stands at $157 billion, serving about 15 million low-income residents, more than a third of Californians. Of those, about 1.5 million are immigrants living in the U.S. without authorization, costing an estimated $6.4 billion, according to the Department of Health Care Services. They have been gradually added to the program as the state lifted legal residency as an eligibility requirement for children in 2016, young adults ages 19-25 in 2020, people 50 and older in 2022, and all remaining adults in January.

As California’s public insurance roll swells, advocates for immigrants praise the Golden State for an expansion that has helped reduce the uninsured rate to a record low 6.4%. Providers and hospitals, however, caution that the state hasn’t expanded its workforce adequately or increased Medi-Cal payments sufficiently, leaving some enrollees unable to find providers to see them in a timely manner — if at all.

“Coverage does not necessarily mean access,” said Isabel Becerra, CEO and president of the Coalition of Orange County Community Health Centers, during an Oct. 2 health policy summit in Los Angeles. “There’s a workforce shortage. We’re all fighting for those doctors. We’re fighting with each other for those doctors.”

Though the state has raised Medi-Cal payments for primary care, maternity care, and mental health services to 87.5% of what Medicare pays, private insurance still tends to pay more, according to the California Legislative Analyst’s Office.

A ballot initiative approved this month guarantees that revenue from a tax on managed-care plans goes toward raising the pay of health care providers who serve Medi-Cal patients.

Some believe the next chapter for covering immigrants will require more than Medi-Cal.

Democratic state Assembly member Joaquin Arambula in 2022 proposed legislation to allow the approximately 520,000 uninsured unauthorized residents who earn more than 138% of the federal poverty level to apply for state-subsidized health coverage through Covered California, the state’s health exchange. The bill, however, died in committee this year.

The final installment of the “Faces of Medi-Cal” series looks at how Medi-Cal has affected its newest enrollees. They include Vanessa López Zamora, who is finally getting treated for hepatitis and cirrhosis but has trouble seeing a gastroenterologist close to home; Douglas Lopez, an entertainment park worker who credits dental coverage for boosting his well-being; and Daniel Garcia, who suffers from gout but has given up his search for a primary care provider. All spoke to KFF Health News in Spanish after recently becoming eligible for Medi-Cal.

‘Started Feeling Sick a Long Time Ago’

In March, Vanessa López Zamora’s stomach had swollen so much it looked like she was pregnant. She had been vomiting and in pain for days.

She went to her local emergency room, at Kaweah Health Medical Center, but it didn’t have a specialist available, she said. So, the 31-year-old was transferred by ambulance to Adventist Health Bakersfield, about 80 miles from her home in Visalia.

Doctors diagnosed her with hepatitis A and C and cirrhosis, which had caused internal injuries to her liver and esophagus, she said. She spent four days in the hospital and for further treatment got a referral to a gastroenterologist, whom she can see as a new Medi-Cal enrollee — an option she couldn’t afford in the past when she had stomach pains and nausea.

“It’s been a very long process because I started feeling sick a long time ago.” said López Zamora, an accountant at a local radio station in Visalia in the San Joaquin Valley. “My girls are very little, and if I can’t get the necessary treatment, I won’t know how much time I have left.”

López Zamora, who came to California from Mexico City when she was 8 years old, is grateful for the care she initially received.

But she’s also frustrated.

The gastroenterologist the hospital referred her to is in Bakersfield — a tough journey for López Zamora, who doesn’t drive and can’t afford to travel to another city.

Limited access to specialists — from gastroenterologists to cardiologists — has been a long-standing challenge for many Medi-Cal patients, especially those in rural areas or regions facing staff shortages. The San Joaquin Valley, where López Zamora lives, has the lowest supply of specialists in the state, according to the California Health Care Foundation.

Michael Bowman, a spokesperson for Anthem Blue Cross, her Medi-Cal plan, said in an email that Anthem has a broad network of specialists that serve Medi-Cal beneficiaries, including more than 100 gastroenterologists within 20 miles of Visalia.

She is treating her cirrhosis with medication and diet, but in August her gastroenterologist in Bakerfield discovered signs of a precancerous condition in the stomach.

López Zamora said she is searching for a specialist closer to home. For now, she relies on her mother, who must take the day off work, to get to appointments or she takes the bus. She tried using transportation provided by Medi-Cal but was left stranded at the hospital. And she has rescheduled her appointments twice.

“They drove me up but didn’t take me back because they couldn’t find an Uber,” she said.

‘A Very Simple Process’

Medi-Cal gave Douglas Lopez the dental treatment he couldn’t afford.

The 33-year-old earned minimum wage as a cleaner in an entertainment park in 2022, and the emergency Medi-Cal plan he signed up for covered only emergency extractions.

That year, Lopez experienced a sharp pain in his back teeth when he ate his beloved coconut-and-tamarind candy balls from his native Guatemala.

A dentist told him that he needed several filings and three root canals. He began treatment, but the bills became more expensive: $150 the first session, then $200, then $300.

“I couldn’t afford it,” recalled Lopez, who lives in Fullerton. “I had to pay rent and food.”

Worried he would lose teeth, he stopped eating anything that would cause him pain.

In January, Orange County automatically enrolled Lopez in Molina Healthcare’s Medi-Cal plan when the state expanded insurance eligibility for unauthorized residents ages 26-49. The coverage has transformed his care, he said.

So far, Lopez has seen a dentist six times, for a cleaning, three root canals, two filings, and X-rays. And Medi-Cal has footed the bill.

Lopez’s experience contrasts with that of many other Medi-Cal enrollees, who struggle to get the care they need. The UCLA Center for Health Policy Research found that 21% of California dentists saw Medi-Cal patients of all ages, according to data from 2019 to 2021. Often those dentists limit the number of Medi-Cal patients they will see; only 15% of adult enrollees might get dental care in a given year.

Lopez said Medi-Cal has come through for him.

“It was a very simple process. I was so excited to search for a dentist,” Lopez said. “The fear of losing my teeth because I wasn’t getting treatment disappeared.”

‘Something That You Can’t Even Use’

Last year, the stabbing pain in Daniel Garcia’s arm and foot got so bad that the 39-year-old went to the ER.

Garcia has gout, a type of inflammatory arthritis that can cause intense pain and swelling in his joints. When he became eligible for Medi-Cal coverage this year, he thought he could finally see a doctor for treatment.

But the Los Angeles County resident said he hasn’t been able to find a primary care provider willing to take his Molina Healthcare insurance.

“It’s frustrating because you have something that you can’t even use,” said Garcia, who has been unable to get an annual physical. “I’ve called, and they say they don’t take my insurance.”

Molina declined to comment on Garcia’s case and didn’t respond to questions about its primary care network.

Nearly 6 million people in California live in a total of 611 primary care shortage areas, according to a KFF analysis, which found the state would need to add 881 practitioners to close this gap.

Garcia, a construction worker, said he read that he could manage his arthritis by changing his eating habits. He now eats healthier and has cut back on sugar and Coke. As for the pain, he eases it with ibuprofen. He has given up looking for a provider.

Keeping patients out of the ER, which can be 12 times as expensive as primary care, is one of the arguments for expanding Medi-Cal. Studies have shown that not only does expanding health coverage lead to lower rates of ER visits, but expanding coverage also leads to patients using preventive care more, said Drishti Pillai, immigrant health policy director at KFF, a health information nonprofit that includes KFF Health News.

“It can help save health care costs because conditions are no longer going untreated for a long time, in which case they may become more complex and expensive to treat,” Pillai said.

This article is part of “Faces of Medi-Cal,” a series exploring the impact of the state’s safety-net health program on enrollees.

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.

USE OUR CONTENT

This story can be republished for free (details).

A new federal watchdog audit is ratcheting up pressure on government officials to crack down on billions of dollars in overcharges linked to Medicare Advantage home visits.

But so far, the Centers for Medicare & Medicaid Services has rejected a recommendation from the Health and Human Services Inspector General to limit payments stemming from house visits that don’t result in any medical treatment — a potential red flag that may signal overcharges.

In late October, the HHS watchdog found that the health plans pocketed $7.5 billion in 2023 from diagnosing health conditions that prompted no medical services — about $4.2 billion of it through health assessments done in patients’ homes. And court records show that for a decade or more, CMS officials have failed to act on their concerns that the home visits waste tax dollars and should be limited.

UnitedHealthcare, the largest Medicare Advantage contractor, accounted for about two-thirds of the payments tied to home visits and chart reviews, in which health plans mine patient medical files to add new diagnoses that can bring in additional revenue, according to the audit.

Assistant Inspector General Erin Bliss said the health plans are making billions without offering any treatment for medical conditions they flag during the visits, such as diabetes and major depression.

“Frankly, it needs to stop,” Bliss said.

CMS, which runs the Medicare program, disagrees.

In a statement to KFF Health News by spokesperson Alexx Pons, the agency said it “appreciates the OIG’s review in this area” and will continue to study the issue.

However, CMS disagreed with the OIG’s call to restrict use of home health assessments in computing how much to pay health plans. People on Medicare “should have access to care that is appropriately provided in the home setting,” CMS wrote in a written response included in the audit report.

“One would think that CMS would kick its regulatory oversight up a notch or two,” said Richard Lieberman, a Colorado health data analytics expert.

“In contrast, CMS appears to be unconcerned and is telling OIG to stay out of their lane,” he said.

UnitedHealthcare spokesperson Heather Soule said in a statement that the OIG had drawn “inaccurate conclusions” in the audit.

The home visits are “among the most comprehensive and thorough assessments of a patient’s health and physical environment available in the healthcare system, helping to identify and drive needed follow-on care for the vast majority of the patients with whom we engage,” according to the company.

No Care Provided

Government spending on Medicare Advantage, which is dominated by UnitedHealthcare and a handful of other health insurance companies, is expected to hit $462 billion this year.

The industry, whose more than 33 million members make up over half of people eligible for Medicare, argues that most enrollees are satisfied with the care they receive and typically pay less out-of-pocket than those on original Medicare.

Whether Medicare Advantage is a good deal for taxpayers is another matter, largely because many health plans exaggerate how sick patients are to boost their payments, multiple federal audits and other investigations have shown. Medicare pays the health plans higher rates for sicker patients.

For fiscal year 2023, CMS identified $12.7 billion in overpayments linked to diagnoses not supported by patients’ medical records.

The OIG audit tied $7.5 billion in payments to health conditions that prompted no treatment, including serious diseases such as diabetes, congestive heart failure, and major depression. That suggests that the medical condition either didn’t exist or that the health plan failed to treat it adequately, auditors said.

“These are serious conditions. You would think you would see additional care during that year,” said Jacqualine Reid, who led the OIG audit team. “We are asking CMS to step up its oversight.”

Homegrown

The in-home visits have sparked controversy for more than a decade. A June 2014 media investigation found that a sharp rise in home visits had inflated Medicare’s costs by billions of dollars. The visits, which typically last less than an hour, are often conducted by nurse practitioners, who do not treat the patient, but go over a checklist of possible health conditions.

Sabrina Skeldon, a Texas lawyer who advises physicians on billing issues, said problems arise when health plans fail to order necessary medical tests to confirm a diagnosis made during a home visit — and treat it.

Skeldon noted that The Cigna Group in 2023 paid $172 million to settle a whistleblower lawsuit that alleged its Medicare Advantage plan illegally collected payments for medical diagnoses that were based solely on in-home assessments.

The OIG audit comes as the Justice Department presses a civil fraud case that accuses UnitedHealth Group of cheating Medicare out of more than $2 billion by mining patient records to churn up diagnoses that boosted revenue, while ignoring evidence of overpayments. The company denies the allegations.

Court filings from the case show CMS officials were concerned years ago that home visits and chart reviews could needlessly drive up costs.

In April 2014, CMS backed off a proposal to restrict their use amid complaints from the industry that it would lose billions of dollars as a result. Similarly, CMS officials scrapped a proposal to tighten scrutiny on the chart reviews after what one official called an “uproar” from the industry.

CMS officials also had concerns that unchecked home visits might affect efforts to recover overpayments through billing reviews known as “RADV” audits.

Former CMS official Thomas Hutchinson, who ran the agency’s Medicare Plan Payment Group from September 2006 through June 2010, testified in a deposition that officials had “heard about various folks that figured out how they could RADV-proof things by doing in-home visits.”

In a confidential April 2015 slide presentation, CMS officials observed that health plans were “now conducting health risk assessments in beneficiaries’ homes. One purpose of the assessments is to identify conditions and create medical records documentation that substantiates diagnoses.”

And an October 2015 CMS memo circulated among senior agency staff cites “limitations around home visits” among the possible ways to “strengthen” the RADV audits.

In its statement to KFF Health News, CMS said it was “committed” to ensuring that diagnoses health plans submitted for payment were accurate. But the agency declined to answer written questions about the impact of home visits on its audit program, which has yet to complete reviews of payments dating back as far as 2011.

UnitedHealthcare had the lowest rates of unconfirmed diagnoses among five large Medicare Advantage organizations audited in 2011, according to court records.

Overall, the company ended up with underpayments of more than $261 million for 15 of its plans audited for 2011-2013, court records show. The audit findings for other Medicare Advantage firms are blacked out in court filings.

CMS audits payments to just 30 out of more than 700 contracts a year. That’s not enough to protect tax dollars, said Matthew Fiedler, a health policy researcher at The Brookings Institution.

“They should be auditing 10 times as many contracts,” he said. “Where we are now you are not likely to get caught.”

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

USE OUR CONTENT

This story can be republished for free (details).

This highlights the Department’s Commitment to reduce the burden of STIs in the United States

Voters backed abortion rights in seven of the 10 states where the issue appeared on ballots Tuesday, including in Missouri, among the first states to ban abortion after the U.S. Supreme Court overturned federal abortion protections with its 2022 decision in Dobbs v. Jackson Women’s Health Organization. At first glance, the nation’s patchwork of abortion rules was seemingly reshaped.

But when Alison Dreith, director of strategic partnerships at the Midwest Access Coalition abortion fund, which has helped people from Missouri and 27 other states get abortions, was asked before the results came in how her organization was preparing for logistic changes, she simply said: “We’re not.”

That’s because actual access to abortion in the country remains largely unchanged despite Tuesday’s results. The web of preexisting state laws on abortions could remain in place while they are contested in court, a process that could take months or longer.

States that passed abortion rights amendments in 2022 and 2023 offer a view into the lengthy legal road ahead for abortion policies to take effect. It took nine months after Ohio voters added abortion protections to their state’s constitution for a judge to strike down the state’s 24-hour waiting period for abortions. And some of Michigan’s abortion restrictions, including its 24-hour waiting period, were suspended only in June, 19 months after Michigan voters approved their state’s abortion rights amendment.

Missouri has an extensive set of such rules. Legal abortions had almost ceased even before the state’s ban was triggered by the Dobbs decision. Over three decades, state lawmakers passed restrictions on abortion providers that made it increasingly difficult to operate there. By 2018, only one clinic was providing abortions in the state, a Planned Parenthood affiliate in St. Louis. Anticipating further tightened restrictions, it opened a large facility 20 miles away in Illinois in 2019.

The laws that reduced the number of recorded abortions in the state from 5,772 in 2011 to 150 in 2021 remain on the books, despite the newly passed amendment protecting abortion rights. The state’s two Planned Parenthood affiliates filed a lawsuit Wednesday challenging those laws and requesting a preliminary injunction blocking their enforcement so the groups may resume abortion services in the state when the amendment goes into effect Dec. 5.

The state’s Republican-dominated legislature has attempted to ignore previous voter-passed amendments. After Missouri voters added Medicaid expansion to the state’s constitution in 2020, the state legislature refused to fund the program until a judge ordered the state to start accepting applications, prompting significant delays in enrollment. The state’s presumptive House speaker, Republican Jon Patterson, has said the legislature must respect the outcome of the Nov. 5 ballot measure vote, while others have pledged to bring the issue to voters again.

Abortion services often get talked about like a light switch, according to Kimya Forouzan, principal state policy adviser at the Guttmacher Institute, a nonprofit that supports abortion rights. But the infrastructure needed to provide abortions is not so easy to turn on and off.

North Dakota’s abortion ban was repealed by the courts in September, for example, but the lone provider of abortions in the state before the ban took effect has no plans to return, having moved operations a five-minute drive away to Minnesota.

Check out my full article here.

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.

USE OUR CONTENT

This story can be republished for free (details).

To discover how millions in opioid settlement funds are being spent in Idaho, you can visit the state attorney general’s website, which hosts 91 documents from state and local entities getting the money.

What you’ll find is a lot of bureaucratese.

Nearly three years ago, these jurisdictions signed an agreement promising annual reports “specifying the activities and amounts” they have funded.

But many of those reports remain difficult, if not impossible, for the average person to decipher.

It’s a scenario playing out in a host of states. As state and local governments begin spending billions in opioid settlement funds, one of the loudest and most frequent questions from the public has been: Where are the dollars going? Victims of the crisis, along with their advocates and public policy experts, have repeatedly called on governments to transparently report how they’re using these funds, which many consider “blood money.”

Last year, KFF Health News published an analysis by Christine Minhee, founder of OpioidSettlementTracker.com, that found 12 states — including Idaho — had made written commitments to publicly report expenditures on 100% of their funds in a way an average person could find and understand. (The other 38 states promised less.)

But there’s a gap between those promises and the follow-through.

This year, KFF Health News and Minhee revisited those 12 states: Arizona, Colorado, Delaware, Idaho, Massachusetts, Minnesota, Missouri, New Hampshire, New Jersey, Oregon, South Carolina, and Utah. From their reports, it became clear that some did not fulfill their promises. And several just squeaked by, meeting the letter of the law but falling far short of communicating to the public in a clear and meaningful manner.

Take Idaho, for instance. Jurisdictions there completed a standard form showing how much money they spent and how it fell under approved uses of the settlement. Sounds great. But in reality, it reads like this: In fiscal year 2023, the city of Chubbuck spent about $39,000 on Section G, Subsection 9. Public Health District No. 6 spent more than $26,000 on Section B, Subsection 2.

Cracking that code requires a separate document. And even that provides only broad outlines.

G-9 refers to “school-based or youth-focused programs or strategies that have demonstrated effectiveness in preventing drug misuse.” B-2 refers to “the full continuum of care of treatment and recovery services for OUD and any co-occurring SUD/MH conditions,” referring to opioid use disorder and substance use disorder or mental health conditions.

“What does that mean? How exactly are you doing that?” asked Corey Davis, a project director at the Network for Public Health Law, when he first saw the Idaho reports.

Does a school-based program involve hiring mental health counselors or holding a one-time assembly? Does treatment and recovery services mean paying for someone’s rehab or building a new recovery house?

Without details on the organizations receiving the money or descriptions of the projects they’re enacting, it’s impossible to know where the funds are going. It would be similar to saying 20% of your monthly salary goes to food. But does that mean grocery bills, eating out at restaurants, or hiring a cook?

The Idaho attorney general’s office, which oversees the state’s opioid settlement reports, did not respond to requests for comment.

Although Idaho and the other states in this analysis do better than most in having any reports publicly available, Davis said that doesn’t mean they get an automatic gold star.

“I don’t think we should grade them on a curve,” he said. It’s not “a high bar to let the public see at some reasonable level of granularity where their money is going.”

To be sure, many state and local governments are making concerted efforts to be transparent. In fact, seven of the states in this analysis reported 100% of their expenditures in a way that is easy for the public to find and understand. Minnesota’s dashboard and downloadable spreadsheet clearly list projects, such as Renville County’s use of $100,000 to install “a body scanner in our jail to help staff identify and address hidden drugs inside of inmates.” New Jersey’s annual reports include details on how counties awarded funds and how they’re tracking success.

There are also states such as Indiana that didn’t originally promise 100% transparency but are now publishing detailed accounts of their expenditures.

However, there are no national requirements for jurisdictions to report money spent on opioid remediation. In states that have not enacted stricter requirements on their own, the public is left in the dark or forced to rely on ad hoc efforts by advocates and journalists to fill the gap.

Wading Through Reports

When jurisdictions don’t publicly report their spending — or publish reports without meaningful details — the public is robbed of an opportunity to hold elected officials accountable, said Robert Pack, a co-director of East Tennessee State University’s Addiction Science Center and a national expert on addiction issues.

He added: People need to see the names of organizations receiving the money and descriptions of their work to ensure projects are not duplicating efforts or replacing existing funding streams to save money.

“We don’t want to burden the whole thing with too much reporting,” Pack said, acknowledging that small governments run on lean budgets and staff. But organizations typically submit a proposal or project description before governments give them money. “If the information is all in hand, why wouldn’t they share it?”

Norman Litchfield, a psychiatrist and the director of addiction medicine at St. Luke’s Health System in Idaho, said sharing the information could also foster hope.

“A lot of people simply are just not aware that these funds exist and that these funds are currently being utilized in ways that are helping,” he said. Greater transparency could “help get the message out that treatment works and treatment is available.”

Other states that lacked detail in some of their expenditure reports said further descriptions are available to the public and can be found in other state documents.

In South Carolina, for instance, more information can be found in the meeting minutes of the Opioid Recovery Fund Board, said board chair Eric Bedingfield. He also wrote that, following KFF Health News’ inquiry, staff will create an additional report showing more granular information about the board’s “discretionary subfund” awards.

In Missouri, Department of Mental Health spokesperson Debra Walker said, further project descriptions are available through the state budget process. Anyone with questions is welcome to email the department, she said.

Bottom line: The details are technically publicly available, but finding them could require hours of research and wading through budgetary jargon — not exactly a system friendly to the average person.

Click Ctrl+F

New Hampshire’s efforts to report its expenditures follow a similar pattern.

Local governments control 15% of the state’s funds and report their expenditures in yearly letters posted online. The rest of the state’s settlement funds are controlled by the Department of Health and Human Services, along with an opioid abatement advisory commission and the governor and executive council.

Grant recipients from the larger share explain their projects and the populations they serve on the state’s opioid abatement website. But the reports lack a key detail: how much money each organization received.

To find those dollar figures, people must search through the opioid abatement advisory commission’s meeting minutes, which date back several years, or search the governor and executive council’s meeting agendas for the proposed contracts. Typing in the search term “opioid settlement” brings up no results, so one must try “opioid” instead, surfacing results about opioid settlements as well as federal opioid grants. The only way to tell which results are relevant is by opening the links one by one.

Davis, from the Network for Public Health Law, called the situation an example of “technical compliance.” He said people in recovery, parents who lost their kids to overdose, and others interested in the money “shouldn’t have to go click through the meeting notes and then control-F and look for opioids.”

James Boffetti, New Hampshire’s deputy attorney general, who helps oversee the opioid settlement funds, agreed that “there’s probably better ways” to share the various documents in one place.

“That doesn’t mean they aren’t publicly available and we’re somehow not being transparent,” he said. “We’ve certainly been more than transparent.”

The New Hampshire Department of Health and Human Services said it will be compiling its first comprehensive report on the opioid settlement funds by the end of the year, as laid out in statute.

Where’s the Incentive?

With opioid settlement funds set to flow for another decade-plus, some jurisdictions are still hoping to improve their public reporting.

In Michigan, the state is using some of its opioid settlement money to incentivize local governments to report on their shares. Counties were offered $1,000 to complete a survey about their settlement spending this year, said Laina Stebbins, a spokesperson for the Michigan Department of Health and Human Services. Sixty-four counties participated — more than double the number from last year, when there was no financial incentive.

In Maryland, lawmakers took a different approach. They introduced a bill that required each county to post an annual report detailing the use of its settlement funds and imposed specific timelines for the health department to publish decisions on the state’s share of funds.

But after counties raised concerns about undue administrative burden, the provisions were struck out, said Samuel Rosenberg, a Democrat representing Baltimore who sponsored the House bill.

Lawmakers have now asked the health department to devise a new plan by Dec. 1 to make local governments’ expenditures public.

Toni Torsch, a Maryland resident whose son Dan died of an overdose at age 24, said she’ll be watching to ensure the public gets a clear picture of settlement spending.

“This is money we got because people’s lives have been destroyed,” she said. “I don’t want to see that money be misused or fill a budget hole.”

Methodology

In March 2023, KFF Health News published an analysis by Christine Minhee, founder of OpioidSettlementTracker.com, assessing states’ written commitments to report how they use opioid settlement dollars. That analysis determined that 12 states had promised to publicly report expenditures on 100% of their funds in a way an average person could track.More than a year later, KFF Health News senior correspondent Aneri Pattani and Minhee revisited those 12 states’ reporting practices to determine if they had fulfilled their promises and to assess how useful the resulting expenditure reports were to the public.Expenditure reports were gathered via state and local government websites, Google searches, and Minhee’s Expenditure Report Tracker. If Minhee and Pattani were unable to find public reports, they contacted state governments directly.For expenditures to be considered “publicly reported,” they had to meet the following criteria:1. Expenditures had to be expressed as specific dollar amounts. Descriptions of how the money was used without a dollar figure would not qualify.2. The report passes the “Googleability test”: Could a typical member of the public reasonably be expected to find expenditure information by keyword-searching online? If people had to file a public records request, navigate lengthy budget or appropriations documents, or rifle through meeting minutes for the information, it would not qualify.For an expenditure report to be considered “publicly reported with clarity,” it had to meet one additional criterion:3. Reports had to contain some combination of vendor name (e.g., an individual or organization) that received the money and a description of the money’s use such that a typical member of the public could understand the specific service, product, or effort the money supported.Each state divides opioid settlement funds into shares controlled by different entities. The majority of expenditures in each share were required to meet the above-listed criteria in order for that share to be classified as “publicly reported” or “publicly reported with clarity.”For example, in Utah, 50% of opioid settlement funds are controlled by county governments. As of Oct. 9, less than half of all counties had reported expenditures in a manner that was easily accessible to the public. As such, that 50% share was not counted as “publicly reported.”This analysis was conducted by Pattani and Minhee from July to October. Classifications were made based on states’ expenditure reports as of Oct. 9.

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

USE OUR CONTENT

This story can be republished for free (details).

Natalie Holt sees reminders nearly everywhere of the serious toll a years-long syphilis outbreak has taken in South Dakota. Scrambling to tamp down the spread of the devastating disease, public health officials are blasting messages to South Dakotans on billboards and television, urging people to get tested.

Holt works in Aberdeen, a city of about 28,000 surrounded by a sea of prairie, as 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 and Alaska Natives in the U.S.

The response to this public health issue, she said, is not so different from the approach with the coronavirus pandemic — federal, state, local, and tribal groups need to “divide and conquer” as they work to test and treat residents. But they are responding to this crisis with fewer resources because federal officials haven’t declared it a public health emergency.

The public pleas for testing are part of health officials’ efforts to halt the outbreak that has disproportionately hurt Native Americans in the Great Plains and Southwest. According to the Great Plains Tribal Epidemiology Center, syphilis rates among Native Americans in its region soared by 1,865% from 2020 to 2022 — over 10 times the 154% increase seen nationally during the same period. The epidemiology center’s region spans Iowa, Nebraska, North Dakota, and South Dakota. The center also found that 1 in 40 Native American and Alaska Native babies born in the region in 2022 had a syphilis infection.

The rise in infections accelerated in 2021, pinching public health leaders still reeling from the coronavirus pandemic.

Three years later, the outbreak continues — the number of new infections so far this year is 10 times the full 12-month totals recorded in some years before the upsurge. And tribal health leaders say their calls for federal officials to declare a public health emergency have gone unheeded.

Pleas for help from local and regional tribal health leaders like Meghan Curry O’Connell, the chief public health officer for the Great Plains Tribal Leaders’ Health Board and a citizen of the Cherokee Nation, preceded a September letter from the National Indian Health Board, a Washington, D.C.-based nonprofit that advocates for health care for U.S. tribes, to publicly urge the Department of Health and Human Services to declare a public health emergency. Tribal leaders said they need federal resources including public health workers, access to data and national stockpile supplies, and funding.

According to data from the South Dakota Department of Health, 577 cases of syphilis have been documented this year in the state. Of those, 430 were among Native American people — making up 75% of the state’s syphilis cases, whereas the group accounts for just 9% of the population.

The numbers can be hard to process, O’Connell said.

“It’s completely preventable and curable, so something has gone horribly wrong that this has occurred,” she said.

The Great Plains Tribal Leaders’ Health Board first called on HHS to declare a public health emergency in February. O’Connell said the federal agency sent a letter in response outlining some resources and training it has steered toward the outbreak, but it stopped short of declaring an emergency or providing the substantial resources the board requested. The board’s now months-old plea for resources was like the recent one from the National Indian Health Board.

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

Syphilis is a sexually transmitted infection that can result in life-threatening damage to the heart, brain, and other organs if left untreated. Women infected while pregnant can pass the disease to their babies. Those infections in newborns, called congenital syphilis, kill dozens of babies each year and can lead to devastating health effects in others.

Holt said the Indian Health Service facilities she oversees have averaged more than 1,300 tests for syphilis monthly. She said a recent decline in new cases detected each month — down from 92 in January to 29 in September — may be a sign that things are improving. But a lot of damage has been done during the past few years.

Cases of congenital syphilis across the country have more than tripled in recent years, according to the Centers for Disease Control and Prevention. In 2022, 3,700 cases were reported — the most in a single year since 1994.

The highest rate of reported primary and secondary syphilis cases in 2022 was among non-Hispanic American Indian or Alaska Native people, with 67 cases per 100,000, according to CDC data.

O’Connell and other tribal leaders said they don’t have the resources needed to keep pace with the outbreak.

Chief William Smith, vice president of Alaska’s Valdez Native Tribe and chairperson of the National Indian Health Board, told HHS in the organization’s letter that tribal health systems need greater federal investment so the system can better respond to public health threats.

Rafael Benavides, HHS’ deputy assistant secretary for public affairs, said the agency has received the letter sent in early September and will respond directly to the authors.

“HHS is committed to addressing the urgent syphilis crisis in American Indian and Alaska Native communities and supporting tribal leaders’ efforts to mobilize and raise awareness to address this important public health crisis,” he said.

Federal officials from the health department and the CDC have formed task forces and hosted workshops for tribes on how to address the outbreak. But tribal leaders insist a public health emergency declaration is needed more than anything else.

Holt said that while new cases seem to be declining, officials continue to fight further spread with what resources they have. But obstacles remain, such as convincing people without symptoms to get tested for syphilis. To make this easier, appointments are not required. When people pick up medications at a pharmacy, they receive flyers about syphilis and information about where and when to get tested.

Despite this “full court press” approach, Holt said, officials know there are people who do not seek health care often and may fall through the cracks.

O’Connell said the ongoing outbreak is a perfect example of why staffing, funding, data access, and other resources need to be in place before an emergency develops, allowing public health agencies to respond immediately.

“Our requests have been specific to this outbreak, but really, they’re needed as a foundation for whatever comes next,” she said. “Because something will come next.”

Healthbeat is a nonprofit newsroom covering public health published by Civic News Company and KFF Health News. Sign up for its newsletters here.

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

USE OUR CONTENT

This story can be republished for free (details).

If President-elect Donald Trump and a Republican Senate try to roll back reproductive health rights or pursue a widely prophesied national abortion ban, California Attorney General Rob Bonta is poised to challenge him.

Two years ago, Bonta, a Democrat who heads the state justice department, directed his staff to draft legal analyses against a possible national abortion ban after the U.S. Supreme Court overturned 50 years of abortion protections under Roe v. Wade. Bonta said they thought through arguments, even going so far as to decide in which court they would file suit.

Bonta said his team had a strategy in place starting from Election Day.

After the Dobbs decision, Trump boasted that he “was able to kill” Roe v. Wade. He said he would veto any federal abortion ban after declining to say whether he’d veto one. And Project 2025’s Mandate for Leadership, a road map for the next conservative president that was crafted by many former Trump advisers, described the overturning of Roe as “just the beginning.” It also calls for ending a requirement that Obamacare plans cover emergency contraceptives; the mailing of medication abortion pills; and federal funding of Planned Parenthood and other clinics that provide abortion.

By comparison, Californians have enshrined rights to abortion and contraception into the state constitution. The state in 2022 also enacted 15 bills and approved $200 million in new spending to expand abortion protections in the Golden State and make it easier for low-income and out-of-state patients to get care.

Bonta, who was appointed attorney general in 2021 by Gov. Gavin Newsom, has sued a national anti-abortion group and a chain of anti-abortion crisis pregnancy centers for marketing unproven and potentially harmful “abortion pill reversal” procedures. In September, he sued Providence St. Joseph Hospital, a Catholic hospital that had allegedly denied a patient an emergency abortion, instead discharging her with an offer of a bucket and towels. Last week, Bonta reached a settlement with the city of Beverly Hills over its alleged blocking of an abortion clinic from opening.

He has joined other states in lawsuits over medication abortion, emergency abortions, and travel between states for care. For Bonta, the issue of abortion is personal. His wife, Assembly member Mia Bonta, shared in 2022 that she had an abortion when she was 21. As her boyfriend, Bonta held her hand when she made the decision.

Bonta spoke to KFF Health News correspondent Molly Castle Work about his passion to protect women’s reproductive health rights and how his upbringing influences his legal decisions. This interview, which took place Oct. 31, has been edited for length and clarity.

Q: How do you think your upbringing prepared you for this job?

A: It starts with inspiration from my parents. They learned that you can’t just hope and wait for the things that you want; you have to fight. They joined the United Farm Workers of America. My dad worked in the front office with Cesar Chavez, my mom with Dolores Huerta. They were fighting for the people that feed our state and our nation but weren’t being treated right.

I remember growing up, I would go with my mom … to protests and rallies and demonstrations. I was at her side, slogans in my throat and fist in the air, or placards in my hand, calling out the human rights abuses. There was that belief that everyday people cannot accept the unacceptable, and if something’s not right, we’ll fight, and can and do create the change that they seek.

I want to be the person that comes in with my positional power, my authority, the reach and the strength of this office behind me and on my side working together to protect those people who are being mistreated and wronged.

Q: You’ve been a longtime champion of reproductive rights. Why are you so passionate?

A: Some things you just feel in your gut. And you have your own personal story. My wife has told the story, and it’s her story to tell. She had an abortion, and I accompanied her and held her hand. It was her choice and her right and her decision and her bodily autonomy and self-determination. And every woman deserves that.

And I don’t like bullies. I don’t like people who attack others and try to take things away from them. It’s wrong and it’s my role to protect those rights. And these are not imagined rights — before Dobbs, they existed for 50 years for every woman in the United States of America.

We’re in a fight for freedom right now, certainly including reproductive freedom, and it’s something that I think the entire nation has some connection to, and it’s wrong for elected officials, presidential candidates, to make political decisions, to get in the way of a decision that should be made between a woman, her doctor, her faith.

Q: Tell me more about your wife’s decision to share her own abortion story after the U.S. Supreme Court issued the Dobbs decision. Why was it important for you both to share that story?

A: We talked about it, of course, but it was her decision. And it’s not something that’s easy to talk about, but I think it was important to talk about, especially given that moment.

It was painful to see that people lost faith and trust in the Supreme Court and it was important for people to know that their leaders are side by side with them, have experiences and passions and cares just like them, have worries and fears just like them.

And I think it was important to Mia to emphasize the impact of these decisions on women of color and vulnerable women, poor women. It was important for her to lift up her voice and, through her pain, own her power and show her strength and communicate with others about her own experience.

Q: You have joined and led multistate efforts to defend abortion in states such as Idaho and Texas. Why is it California’s place to push for access outside its borders?

A: We fight the fight wherever it is. We get involved in all sorts of different types of issues, supporting transgender and gender-nonconforming youth, supporting commonsense constitutionally lawful gun safety laws. And certainly when it comes to reproductive health care, we do the same. There are strategic, intentional, deliberate attacks, by design, in certain courts outside of California. And so it’s very important for us to bring our knowledge, our expertise, our legal insight into those fights.

Q: What happens if Trump wins the election? How does that change your job? And what type of preparations are you making?

A: We’ve been preparing since the Dobbs decision dropped. Shortly after that, I asked my team to start writing the brief for a national abortion ban: Just think it through, you know. Think through the arguments. Do we have a pathway to challenge it in court?

Hopefully we’ll never have to challenge it in court. There’s no national abortion ban, and maybe there never will be, but we want to be ready if there is. We want to have thought through it when we had time and been able to do the in-depth and the nuanced review.

I think the people of our state and the people of our country want us to have been doing that.

Q: So, I’m sure you know I have to ask: Are you considering a run for governor?

A: There will be a time to make that decision after the election. That time is not now. I am honored and grateful that I’ve gotten lots of encouragement from people. That gives me inspiration about the work that my team is doing.

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.

USE OUR CONTENT

This story can be republished for free (details).

Voters backed abortion rights in seven of the 10 states where the issue appeared on ballots Tuesday — at first glance, seemingly reshaping the nation’s patchwork of abortion rules.

Colorado, Maryland, Montana, and New York — states where abortions are already permitted at least until fetal viability — all will add abortion protections to their state constitutions. Nevada voters also favored protections and can enshrine them by passing the measure again in the next general election.

Florida and South Dakota voters, meanwhile, did not pass abortion rights amendments, and Nebraska voters essentially affirmed the state’s existing ban on abortions after the first trimester, while rejecting a measure that would have protected abortions later into pregnancy.

The biggest changes came in Arizona, where, in 2022, abortion was banned after 15 weeks, and in Missouri, which has had a near-total ban. Voters in those states approved constitutional amendments to protect abortion rights through fetal viability, opening the door to overturning those states’ restrictions and increasing access to abortion services.

But when Alison Dreith, director of strategic partnerships at the Midwest Access Coalition abortion fund, which has helped people from Missouri and 27 other states get abortions, was asked before the results came in how her organization was preparing for logistical changes, she said simply: “We’re not.”

That’s because actual access to abortion in the country remains largely unchanged, despite the Nov. 5 results. The web of preexisting state laws on abortions will likely remain in place while they are contested in court, a process that could take months or even years.

Dreith said she doesn’t think many voters understood all that before heading to the polls. “It might not get them the results that they want, especially immediately,” Dreith said.

Further complicating these state results: The election wins of Donald Trump as president-elect and Republicans in the U.S. Senate, giving their party control, have raised the question of whether a national abortion ban will be on the table. Republicans had demurred on the campaign trail. Such a law would take time to enact, too.

The abortion landscape changed dramatically when the U.S. Supreme Court overturned federal abortion protections with its 2022 decision in Dobbs v. Jackson Women’s Health Organization. That left abortion rules up to the states, prompting 14 to enact bans with few exceptions and several others to limit access.

The ruling also led to a raft of ballot measures: Voters in 16 states have now weighed in on abortion-related ballot measures. Thirteen have favored access to abortions in some way. And while the Florida amendment to protect abortion access failed to meet the necessary 60% threshold to pass, it did receive a majority of the vote.

Abortion opponents such as Susan B. Anthony Pro-Life America praised the votes rejecting amendments in Florida and South Dakota and lamented the amendments that passed in states, such as Missouri, with restrictive abortion rules and bans.

“We mourn the lives that will be lost,” Sue Liebel, its director of state affairs, wrote in a statement. “The disappointing results are a reminder that human rights battles are not won overnight.”

States that passed abortion rights amendments in 2022 and 2023 offer a view into the lengthy legal road ahead for abortion policies to take effect. It took nine months after Ohio voters added abortion protections to their state’s constitution for a judge to strike down the state’s 24-hour waiting period for abortions. And some of Michigan’s abortion restrictions, including its own 24-hour waiting period, were suspended only in June, 19 months after Michigan voters approved their state’s abortion rights amendment.

Missouri has an extensive set of such rules. Legal abortions had almost ceased even before the state’s ban was triggered by the Dobbs decision. Over three decades, state lawmakers passed a series of restrictions on abortion providers that made it increasingly difficult to operate there. By 2018, only one clinic was providing abortions in the state, a Planned Parenthood affiliate in St. Louis. Anticipating further tightened restrictions, it opened a large facility 20 miles away in Illinois in 2019.

Those laws that reduced the number of recorded abortions in the state from 5,772 in 2011 down to 150 in 2021 remain on the books, despite the newly passed amendment protecting abortion rights.

Abortion services often get talked about like a light switch, according to Kimya Forouzan, principal state policy adviser at the Guttmacher Institute, a nonprofit that supports abortion rights. But the infrastructure needed to provide abortions is not so easy to turn on and off.

North Dakota’s abortion ban was repealed by the courts in September, for example, but the lone provider of abortions in the state before the ban took effect has no plans to return, having moved operations a five-minute drive away to Minnesota.

And even when clinics quickly ramp up services, the legal wrangling over abortion rules can lead to policy whiplash, with patients caught in the middle.

Georgia’s law banning most abortions after about six weeks spent years in the courts after it passed in 2019. During two brief stretches after the Dobbs decision, once in 2022 and again in 2024, court rulings meant that clinics in the state could provide abortions up to 22 weeks of pregnancy.

Demand for abortion surged during those times, and clinics were able to resume offering services quickly. But when state courts later said the ban should be enforced, those windows slammed shut. During the 2022 period, some patients scheduled for abortions were left sitting in waiting rooms, according to Megan Cohen, medical director of Planned Parenthood Southeast.

The various abortion rights amendments that passed Nov. 5 could also face challenges.

In Missouri, the state’s Republican-dominated legislature has attempted to ignore voter-passed amendments before. After Missouri voters added Medicaid expansion to the state’s constitution in 2020, the state legislature refused to fund the program until a judge ordered the state to start accepting applications, prompting significant delays in enrollment.

The state’s presumptive House speaker, Republican Jon Patterson, has said the legislature must respect the outcome of the Nov. 5 ballot measure vote, while others have pledged to bring the issue to voters again.

In the meantime, Dreith of the Midwest Access Coalition said people seeking abortions in the Midwest will do what they often do in the region for everything from groceries to health care: drive.

“We expect that the resources we need are not in our communities,” Dreith said, “and I think that’s been helpful to us in this crisis.”

KFF Health News’ Renuka Rayasam and Sam Whitehead in Georgia and Arielle Zionts in South Dakota 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.

USE OUR CONTENT

This story can be republished for free (details).

El triunfo electoral del ex presidente Donald Trump y su regreso a la Casa Blanca probablemente traerán cambios que reducirían los programas nacionales de salud públicos, aumentando la tasa de personas sin seguro e imponiendo nuevas barreras al aborto y otros servicios de salud reproductiva.

Las repercusiones se sentirán mucho más allá de Washington, DC, e incluso podrían erosionar las protecciones al consumidor de la Ley de Cuidado de Salud a Bajo Precio (ACA), imponer requisitos de trabajo para Medicaid, recortar fondos para la red de seguridad, y desafiar a las agencias federales que protegen la salud pública.

Las restricciones al aborto podrían endurecerse a nivel nacional, con un posible esfuerzo para restringir el envío por correo de medicamentos abortivos.

Con la inclusión de Robert F. Kennedy Jr., líder del movimiento anti vacunas, en el círculo de asesores de Trump, intervenciones de salud pública con respaldo científico riguroso —como la fluoración del agua potable o la vacunación infantil— podrían también estar en la mira.

Trump derrotó a la vicepresidenta Kamala Harris con 277 votos del Colegio Electoral, según declaró la agencia de noticias Associated Press (AP) a las 5:34 am ET del miércoles 6. Obtuvo el 51% del voto a nivel nacional, en comparación con el 47.5 % de Harris, según las proyecciones de AP.

La victoria de Trump dará una plataforma mucho más amplia a los escépticos y críticos de los programas y acciones de salud federales. En el peor de los casos, las autoridades de salud pública temen que el país podría ver aumentos en enfermedades prevenibles, un debilitamiento de la confianza pública en la ciencia, y la adopción de políticas basadas en ideas desacreditadas, como el supuesto vínculo entre vacunas y autismo.

Trump declaró en una entrevista con NBC News el 3 de noviembre que “tomaría una decisión” sobre la prohibición de algunas vacunas, diciendo que consultaría con Kennedy, calificándolo como “un tipo muy talentoso”.

Aunque Trump ha dicho que no intentará nuevamente derogar ACA, su administración enfrentará una decisión inmediata el próximo año sobre si respaldar una extensión de los subsidios para las primas mejorados para los planes de seguro del Obamacare. Sin estos subsidios, se proyectan aumentos pronunciados de las primas que reducirían la inscripción. La tasa actual de personas sin seguro, de aproximadamente un 8%, casi con seguridad aumentaría.

Los detalles de sus políticas aún no han avanzado mucho más allá de los “conceptos de un plan” que Trump mencionó durante su debate con Harris, aunque el vicepresidente electo JD Vance dijo que la administración buscaría inyectar más competencia en los mercados de ACA.

Se proyecta que los republicanos obtendrán una mayoría en el Senado, además de la Casa Blanca, mientras que el control de la Cámara de Representantes aún no se había resuelto al miércoles temprano.

Las encuestas muestran que ACA ha ganado apoyo entre el público, incluidas disposiciones como las protecciones para condiciones preexistentes y la posibilidad de que los jóvenes permanezcan en los planes de salud familiars hasta los 26 años.

Los seguidores de Trump y otros que han trabajado en su administración dicen que el ex presidente quiere mejorar la ley de manera que reduzca los costos. Señalan que ya ha demostrado ser firme en cuanto a reducir los altos precios de la atención médica, aludiendo a esfuerzos durante su presidencia para promover la transparencia de precios en los costos médicos.

“En cuanto a asequibilidad, lo veo construyendo sobre el primer mandato”, dijo Brian Blase, quien se desempeñó como asesor de salud de Trump de 2017 a 2019. En comparación con una administración demócrata, dijo, habrá “mucho más enfoque” en “minimizar el fraude y el despilfarro”.

Los esfuerzos para debilitar ACA podrían incluir recortes de fondos para la promoción de inscripciones, permitir a los consumidores comprar más planes de salud que no cumplan con las protecciones al consumidor, y permitir a las aseguradoras cobrar primas más altas a las personas con enfermedades.

Los demócratas dicen que esperan lo peor.

“Sabemos cuál es su agenda”, dijo Leslie Dach, presidente ejecutivo de Protect Our Care, una organización de políticas y defensa de la atención médica en Washington, DC. Dach trabajó en la administración Obama ayudando a implementar ACA. “Van a aumentar los costos para millones de estadounidenses y les quitarán cobertura a millones, y, mientras tanto, darán exenciones fiscales a los ricos”.

Theo Merkel, director de la Private Health Reform Initiative en el Instituto Paragon de Salud, de orientación conservadora y dirigido por Blase, dijo que los subsidios mejorados de ACA, que se extendieron bajo la Ley de Reducción de la Inflación (IRA) en 2022 no mejoran los planes ni reducen las primas. Dijo que solo ocultan el bajo valor de los planes con mayores subsidios gubernamentales.

Otros partidarios de Trump dicen que el presidente electo podría apoyar la preservación de la autoridad de Medicare para negociar precios de medicamentos, otra disposición de la IRA.

Trump ha defendido la reducción de los precios de los medicamentos y, en 2020, promovió un modelo de prueba que habría vinculado los precios de algunos medicamentos en Medicare a costos más bajos en el extranjero, dijo Merkel, quien trabajó en la primera Casa Blanca de Trump. La industria farmacéutica demandó con éxito para bloquear el programa.

Dentro del círculo de Trump, algunos nombres ya han sido mencionados como posibles líderes para el Departamento de Salud y Servicios Humanos (HHS). Estos incluyen al ex gobernador de Louisiana, Bobby Jindal, y Seema Verma, quien dirigió los Centros de Servicios de Medicare y Medicaid (CMS) durante su administración.

Kennedy, quien suspendió su campaña presidencial independiente y respaldó a Trump, ha dicho a sus seguidores que Trump le prometió el control del HHS. Trump dijo públicamente antes del día de las elecciones que le daría a Kennedy un papel importante en su administración, aunque podría tener dificultades para obtener la confirmación del Senado para un puesto en el gabinete.

Mientras que Trump ha prometido proteger a Medicare y ha dicho que apoya la financiación de beneficios para el cuidado en el hogar, ha sido menos específico sobre sus intenciones para Medicaid, que brinda cobertura a personas de bajos ingresos y con discapacidades. Algunos analistas de salud esperan que el programa sea especialmente vulnerable a recortes de gastos, lo que podría ayudar a financiar la extensión de exenciones fiscales que expiran a fines del próximo año.

Los posibles cambios incluyen la imposición de requisitos de trabajo a los beneficiarios en algunos estados. La administración y los republicanos en el Congreso también podrían intentar cambiar la forma en que se financia Medicaid. Actualmente, el gobierno federal paga a los estados un porcentaje variable de los costos del programa. Los conservadores han buscado durante mucho tiempo poner un límite a las asignaciones federales a los estados, lo que según los críticos llevaría a recortes drásticos.

“Medicaid será un gran objetivo en una administración Trump”, dijo Larry Levitt, vicepresidente ejecutivo de políticas de salud en KFF, una organización sin fines de lucro de información sobre salud que incluye a KFF Health News.

Es menos claro el futuro potencial de los derechos de salud reproductiva.

Trump ha dicho que las decisiones sobre las restricciones al aborto deben dejarse a los estados. Trece estados prohíben el aborto con pocas excepciones, mientras que otros 28 restringen el procedimiento según la duración gestacional, según el Instituto Guttmacher, una organización de investigación y políticas centrada en el avance de los derechos reproductivos. Antes de las elecciones, Trump dijo que no firmaría una prohibición nacional del aborto.

Medidas estatales para proteger los derechos al aborto fueron adoptadas en cuatro estados, incluido Missouri, donde Trump ganó por aproximadamente 18 puntos, según informes preliminares de AP. Los votantes en Florida y Dakota del Sur rechazaron medidas a favor del derecho al aborto.

Trump podría actuar para restringir el acceso a medicamentos abortivos, utilizados en más de la mitad de los abortos, ya sea retirando la autorización de la Administración de Drogas y Alimentos (FDA) para los medicamentos o aplicando una ley del siglo XIX, la Ley Comstock, que los opositores al aborto dicen que prohíbe su envío. Trump ha dicho que, en general, no usaría la ley para prohibir el envío de medicamentos por correo.

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

USE OUR CONTENT

This story can be republished for free (details).

Former President Donald Trump’s election victory and looming return to the White House will likely bring changes that scale back the nation’s public health insurance programs — increasing the uninsured rate, while imposing new barriers to abortion and other reproductive care.

The reverberations will be felt far beyond Washington, D.C., and could include an erosion of the Affordable Care Act’s consumer protections, the imposition of work requirements in Medicaid and funding cuts to the safety net insurance, and challenges to federal agencies that safeguard public health. Abortion restrictions may tighten nationwide with a possible effort to restrict the mailing of abortion medications.

And with the elevation of vaccine skeptic Robert F. Kennedy Jr. to Trump’s inner circle of advisers, public health interventions with rigorous scientific backing — whether fluoridating public water supplies or inoculating children — could come under fire.

Trump defeated Vice President Kamala Harris with 277 Electoral College votes, The Associated Press declared at 5:34 a.m. ET on Wednesday. He won 51% of the vote nationally to Harris’ 47.5%, the AP projected.

Trump’s victory will give a far broader platform to skeptics and critics of federal health programs and actions. Worst case, public health authorities worry, the U.S. could see increases in preventable illnesses; a weakening of public confidence in established science; and debunked notions — such as a link between vaccines and autism — adopted as policy. Trump said in an NBC News interview on Nov. 3 that he would “make a decision” about banning some vaccines, saying he would consult with Kennedy and calling him “a very talented guy.”

While Trump has said he will not try again to repeal the Affordable Care Act, his administration will face an immediate decision next year on whether to back an extension of enhanced premium subsidies for Obamacare insurance plans. Without the enhanced subsidies, steep premium increases causing lower enrollment are projected. The current uninsured rate, about 8%, would almost certainly rise.

Policy specifics have not moved far beyond the “concepts of a plan” Trump said he had during his debate with Harris, though Vice President-elect JD Vance later said the administration would seek to inject more competition into ACA marketplaces.

Republicans were projected to claim a Senate majority, in addition to the White House, while control of the House was not yet resolved early Wednesday.

Polls show the ACA has gained support among the public, including provisions such as preexisting condition protections and allowing young people to stay on family health plans until they are 26.

Trump supporters and others who have worked in his administration say the former president wants to improve the law in ways that will lower costs. They say he has already shown he will be forceful when it comes to lowering high health care prices, pointing to efforts during his presidency to pioneer price transparency in medical costs.

“On affordability, I’d see him building on the first term,” said Brian Blase, who served as a Trump health adviser from 2017 to 2019. Relative to a Democratic administration, he said, there will be “much more focus” on “minimizing fraud and waste.”

Efforts to weaken the ACA could include slashing funds for enrollment outreach, enabling consumers to purchase more health plans that don’t comply with ACA consumer protections, and allowing insurers to charge sicker people higher premiums.

Democrats say they expect the worst.

“We know what their agenda is,” said Leslie Dach, executive chair of Protect Our Care, a health care policy and advocacy organization in Washington, D.C. He worked in the Obama administration helping to implement the ACA. “They’re going to raise costs for millions of Americans and rip coverage away from millions and, meanwhile, they will give tax breaks to rich people.”

Theo Merkel, director of the Private Health Reform Initiative at the right-leaning Paragon Health Institute, which Blase leads, said the enhanced ACA subsidies extended by the Inflation Reduction Act in 2022 do nothing to improve plans or lower premiums. He said they paper over the plans’ low value with larger government subsidies.

Other Trump supporters say the president-elect may support preserving Medicare’s authority to negotiate drug prices, another provision of the IRA. Trump has championed reducing drug prices, and in 2020 advanced a test model that would have tied the prices of some drugs in Medicare to lower costs overseas, said Merkel, who worked in Trump’s first White House. The drug industry successfully sued to block the program.

Within Trump’s circles, some names have already been floated as possible leaders for the Department of Health and Human Services. They include former Louisiana Gov. Bobby Jindal and Seema Verma, who ran the Centers for Medicare & Medicaid Services during the Trump administration.

Kennedy, who suspended his independent presidential run and endorsed Trump, has told his supporters that Trump promised him control of HHS. Trump said publicly before Election Day that he would give Kennedy a big role in his administration, but he may have difficulty winning Senate confirmation for a Cabinet position.

While Trump has vowed to protect Medicare and said he supports funding home care benefits, he’s been less specific about his intentions for Medicaid, which provides coverage to lower-income and disabled people. Some health analysts expect the program will be especially vulnerable to spending cuts, which could help finance the extension of tax breaks that expire at the end of next year.

Possible changes include the imposition of work requirements on beneficiaries in some states. The administration and Republicans in Congress could also try to revamp the way Medicaid is funded. Now, the federal government pays states a variable percentage of program costs. Conservatives have long sought to cap the federal allotments to states, which critics say would lead to draconian cuts.

“Medicaid will be a big target in a Trump administration,” said Larry Levitt, executive vice president for health policy at KFF, a health information nonprofit that includes KFF Health News.

Less clear is the potential future of reproductive health rights.

Trump has said decisions about abortion restrictions should be left to the states. Thirteen states ban abortion with few exceptions, while 28 others restrict the procedure based on gestational duration, according to the Guttmacher Institute, a research and policy organization focused on advancing reproductive rights. Trump said before the election that he would not sign a national abortion ban.

State ballot measures to protect abortion rights were adopted in seven states, including Missouri, which Trump won by about 18 points, according to preliminary AP reports. Abortion rights measures were rejected by voters in Florida, South Dakota, and Nebraska.

Trump could move to restrict access to abortion medications, used in more than half of abortions, either by withdrawing the FDA’s authorization for the drugs or by enforcing a 19th-century law, the Comstock Act, that abortion opponents say bans their shipment. Trump has said he generally would not use the law to ban mail delivery of the drugs.

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

USE OUR CONTENT

This story can be republished for free (details).

HURON, S.D. — Kelly Engebretson was excited to get fitted for a prosthetic after having part of his leg amputated. But he wasn’t sure how he’d get to the appointment.

Nah Thu Thu Win’s twin sons needed vaccinations before starting kindergarten. But she speaks little English, and the boys lacked health insurance.

William Arce and Wanda Serrano were recovering from recent surgeries. But the couple needed help sorting out their insurance and understanding their bills.

Engebretson, Win, Arce, and Serrano were fortunate to have someone to help.

They’re all paired with community health workers in Huron, a city of 14,000 people known for being home to the state fair and what’s billed as the world’s largest pheasant sculpture.

Three workers, employed by the Huron Regional Medical Center, help patients navigate the health system and address barriers, like poverty or unstable housing, that could keep them from getting care. Community health workers can also provide basic education on managing chronic health problems, such as diabetes or high cholesterol.

Community health worker programs are spreading across the U.S., including in rural areas and small cities as health providers and state and federal governments increasingly invest in them. These initiatives gained attention during the coronavirus pandemic and have been found to improve people’s health and access to preventive care while reducing expensive hospital visits.

Community health worker programs can address common barriers in rural areas, where people face higher rates of poverty and certain health problems, said Gabriela Boscán Fauquier, who oversees community health worker initiatives at the National Rural Health Association.

The workers are “an extension of the health care system” and serve as a link “between the formality of this health care system and the community,” she said.

The programs are often based at hospital systems or community health centers. The workers have a median pay of $23 an hour, according to the federal Bureau of Labor Statistics. Patients are typically referred to programs by clinicians who notice personal struggles or frequent visits to hospital emergency departments.

South Dakota is among the states that have recently funded community health worker programs, developed training requirements for the workers, and approved Medicaid reimbursement for their services. The state’s certification program requires 200 hours of coursework and 40 hours of job shadowing.

Huron Regional Medical Center launched its initiative in fall 2022, after receiving a $228,000 federal grant. The program is now funded by the nonprofit hospital and Medicaid reimbursements.

Huron, a small city surrounded by rural areas, is mostly populated by white people. But thousands of Karen people — an ethnic minority from the Southeast Asian country of Myanmar — began arriving in 2006. Many are refugees. The city also has a significant Hispanic population from the Caribbean, Mexico, and Central and South America.

Mickie Scheibe, one of Huron’s community health workers, recently stopped by the house of client Kelly Engebretson. The 61-year-old hadn’t been able to work since he had part of his leg amputated, due to diabetes complications.

Scheibe helps with “the hoops you’ve got to jump through,” such as applying for Medicaid, Engebretson said.

He told Scheibe that he didn’t know how he was going to get to his prosthetic fitting in Sioux Falls — a two-hour drive from home. Scheibe, 54, said she would help find him a safe ride.

She also invited Engebretson to a diabetes education program.

“Put me down as a definitely absolutely,” he replied, adding that he’d invite his mother to tag along.

The same day, Scheibe’s co-worker Sau-Mei Ramos visited the apartment where William Arce and Wanda Serrano live. Arce was recovering from heart surgery, while Serrano was healing from knee and shoulder operations.

The couple, both 61, moved three years ago from Puerto Rico to be near their children in Huron. Ramos, who’s also from Puerto Rico, coordinated their appointments, answered their billing questions, and helped Arce find a walker and supplemental insurance.

Ramos, 29, handed Arce a pamphlet about heart health and asked him to read the section on angina, the pain that results when not enough blood flows to the heart.

“Qué entiende?” she said, asking Arce what he understood about his condition. Arce, speaking in Spanish, responded that he knew what angina was and what symptoms to watch for.

Later that day, Paw Wah Sa, the third community health worker in town, met with client Nah Thu Thu Win, who moved to Huron in February from Myanmar with her husband and twin 6-year-olds. The Win family, like Sa, are part of the local Karen community, whose people have been persecuted under the military rulers of Myanmar, the country formerly known as Burma.

Win, 29, had assumed the kids would qualify for Medicaid. But unlike most other states, South Dakota does not immediately offer coverage to children who legally immigrated into the U.S. The boys’ father hopes to eventually add them to his work-sponsored insurance.

Sa didn’t want the kids to have to wait for health care. The 24-year-old previously took the twins to a free mobile dental clinic in Huron. It turned out they needed more advanced dental work, which they could get free only in Sioux Falls. Sa helped make the arrangements.

Many Karen residents and people from rural parts of Latin America had little access to health care before moving to the U.S., Sa and Ramos said. They said a major part of their job is explaining what kind of care is available, and when it’s important to seek help.

The three community health workers sometimes take clients grocery shopping, to teach them how to understand labels and identify healthful food.

Boscán Fauquier, with the National Rural Health Association, said that because community health workers are familiar with the cultures they serve, they can suggest affordable food that clients are familiar with.

Rural America’s overall population is shrinking, but the 2020 census showed it has become more diverse as people representing ethnic minorities are drawn to jobs in industries such as farming, meatpacking, and mining. Others are attracted by rural areas’ lower crime rates and cheaper housing.

Boscán Fauquier said many rural community health worker programs serve people from minority groups, who are more likely than white people to face barriers to health care.

She pointed to programs serving Native American reservations, the Black Belt region of the South, and Spanish-speaking communities, where the workers are called promotoras. But community health workers also serve rural white communities, such as those in Appalachia impacted by the opioid crisis.

Medicare, the federal health program for adults 65 or older, has been reimbursing community health worker services since January. Boscán Fauquier said advocates hope more state Medicaid programs and private insurers will allow reimbursement too.

Engebretson said he’s happy to see community health workers across South Dakota, not just in big cities.

The more they “can branch out to the people, the better it would be,” he said.

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

USE OUR CONTENT

This story can be republished for free (details).

RICHMOND, Vt. — On a warm autumn morning, Roger Brown walked through a grove of towering trees whose sap fuels his maple syrup business. He was checking for damage after recent flooding. But these days, his workers’ health worries him more than his trees’.

The cost of Slopeside Syrup’s employee health insurance premiums spiked 24% this year. Next year it will rise 14%.

The jumps mean less money to pay workers, and expensive insurance coverage that doesn’t ensure employees can get care, Brown said. “Vermont is seen as the most progressive state, so how is health care here so screwed up?”

Vermont consistently ranks among the healthiest states, and its unemployment and uninsured rates are among the lowest. Yet Vermonters pay the highest prices nationwide for individual health coverage, and state reports show its providers and insurers are in financial trouble. Nine of the state’s 14 hospitals are losing money, and the state’s largest insurer is struggling to remain solvent. Long waits for care have become increasingly common, according to state reports and interviews with residents and industry officials.

Rising health costs are a problem across the country, but Vermont’s situation surprises health experts because virtually all its residents have insurance and the state regulates care and coverage prices.

For more than 15 years, federal and state policymakers have focused on increasing the number of people insured, which they expected would shore up hospital finances and make care more available and affordable.

“Vermont’s struggles are a wake-up call that insurance is only one piece of the puzzle to ensuring access to care,” said Keith Mueller, a rural health expert at the University of Iowa.

Regulators and consultants say the state’s small, aging population of about 650,000 makes spreading insurance risk difficult. That demographic challenge is compounded by geography, as many Vermonters live in rural areas, where it’s difficult to attract more health workers to address shortages.

At least part of the cost spike can be attributed to patients crossing state lines for quicker care in New York and Massachusetts. Those visits can be more expensive for both insurers and patients because of long ambulance rides and charges from out-of-network providers.

Patients who stay, like Lynne Drevik, face long waits. Drevik said her doctor told her in April that she needed knee replacement surgeries — but the earliest appointment would be in January for one knee and the following April for the other.

Drevik, 59, said it hurts to climb the stairs in the 19th-century farmhouse in Montgomery Center she and her husband operate as an inn and a spa. “My life is on hold here, and it’s hard to make any plans,” she said. “It’s terrible.”

Health experts say some of the state’s health system troubles are self-inflicted.

Unlike most states, Vermont regulates hospital and insurance prices through an independent agency, the Green Mountain Care Board. Until recently, the board typically approved whatever price changes companies wanted, said Julie Wasserman, a health consultant in Vermont.

The board allowed one health system — the University of Vermont Health Network — to control about two-thirds of the state’s hospital market and allowed its main facility, the University of Vermont Medical Center in Burlington, to raise its prices until it ranked among the nation’s most expensive, she said, citing data the board presented in September.

Hospital officials contend their prices are no higher than industry averages.

But for 2025, the board required the University of Vermont Medical Center to cut the prices it bills private insurers by 1%.

The nonprofit system says it is navigating its own challenges. Top officials say a severe lack of housing makes it hard to recruit workers, while too few mental health providers, nursing homes, and long-term care services often create delays in discharging patients, adding to costs.

Two-thirds of the system’s patients are covered by Medicare or Medicaid, said CEO Sunny Eappen. Both government programs pay providers lower rates than private insurance, which Eappen said makes it difficult to afford rising prices for drugs, medical devices, and labor.

Officials at the University of Vermont Medical Center point to several ways they are trying to adapt. They cited, for example, $9 million the hospital system has contributed to the construction of two large apartment buildings to house new workers, at a subsidized price for lower-income employees.

The hospital also has worked with community partners to open a mental health urgent care center, providing an alternative to the emergency room.

In the ER, curtains separate areas in the hallway where patients can lie on beds or gurneys for hours waiting for a room. The hospital also uses what was a storage closet as an overflow room to provide care.

“It’s good to get patients into a hallway, as it’s better than a chair,” said Mariah McNamara, an ER doctor and associate chief medical officer with the hospital.

For the about 250 days a year when the hospital is full, doctors face pressure to discharge patients without the ideal home or community care setup, she said. “We have to go in the direction of letting you go home without patient services and giving that a try, because otherwise the hospital is going to be full of people, and that includes people that don’t need to be here,” McNamara said.

Searching for solutions, the Green Mountain Care Board hired a consultant who recommended a number of changes, including converting four rural hospitals into outpatient facilities, in a worst-case scenario, and consolidating specialty services at several others.

The consultant, Bruce Hamory, said in a call with reporters that his report provides a road map for Vermont, where “the health care system is no match for demographic, workforce, and housing challenges.”

But he cautioned that any fix would require sacrifice from everyone, including patients, employers, and health providers. “There is no simple single policy solution,” he said.

One place Hamory recommended converting to an outpatient center only was North Country Hospital in Newport, a village in Vermont’s least populated region, known as the Northeast Kingdom.

The 25-bed hospital has lost money for years, partly because of an electronic health record system that has made it difficult to bill patients. But the hospital also has struggled to attract providers and make enough money to pay them.

Officials said they would fight any plans to close the hospital, which recently dropped several specialty services, including pulmonology, neurology, urology, and orthopedics. It doesn’t have the cash to upgrade patient rooms to include bathroom doors wide enough for wheelchairs.

On a recent morning, CEO Tom Frank walked the halls of his hospital. The facility was quiet, with just 14 admitted patients and only a couple of people in the ER. “This place used to be bustling,” he said of the former pulmonology clinic.

Frank said the hospital breaks even treating Medicare patients, loses money treating Medicaid patients, and makes money from a dwindling number of privately insured patients.

The state’s strict regulations have earned it an antihousing, antibusiness reputation, he said. “The cost of health care is a symptom of a larger problem.”

About 30 miles south of Newport, Andy Kehler often worries about the cost of providing health insurance to the 85 workers at Jasper Hill Farm, the cheesemaking business he co-owns.

“It’s an issue every year for us, and it looks like there is no end in sight,” he said.

Jasper Hill pays half the cost of its workers’ health insurance premiums because that’s all it can afford, Kehler said. Employees pay $1,700 a month for a family, with a $5,000 deductible.

“The coverage we provide is inadequate for what you pay,” he said.

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

USE OUR CONTENT

This story can be republished for free (details).

HHS Celebrates One-Year Anniversary of the Task Force on Maternal Mental Health, Details Next Steps

Durante la práctica de porristas en abril, Karter, la hija de Jana Duey que cursa el sexto grado, sufrió una conmoción cerebral cuando cayó de cabeza desde varios pies de altura sobre una colchoneta en el gimnasio. Días después, la joven aún tenía dolor de cabeza, mareos y sensibilidad a la luz y al ruido.

Karter descansó una semana y media en su casa en Centennial, Colorado, y luego regresó a la escuela cuando sus síntomas de conmoción fueron tolerables; al principio, solo iba medio día y con un calendario adaptado que le permitía hacer tareas en papel en lugar de en la computadora, y tomarse más tiempo para ir de una clase a otra.

Según Duey, Karter iba a la enfermería cuando tenía dolor de cabeza. También comenzó fisioterapia para rehabilitar su cuello y recuperar el equilibrio después del accidente, ya que sentía inestabilidad al caminar.

Después que los niños sufren conmociones cerebrales, una de las mayores preocupaciones para ellos y sus padres o cuidadores es cuándo pueden volver a hacer deportes, dijo Julie Wilson, doctora de Karter y codirectora del Programa de Conmociones en el Children’s Hospital Colorado, en Aurora.

Volver a la escuela lo antes posible, con el apoyo adecuado, y hacer ejercicio ligero que no implique riesgo de golpearse la cabeza son pasos importantes para la recuperación luego de una conmoción, según las investigaciones más recientes.

“Es muy importante que los niños y adolescentes vuelvan a sus actividades diarias habituales tan pronto como sea posible y tan pronto como puedan tolerarlas”, afirmó Wilson.

En agosto, el Departamento de Educación de Colorado actualizó sus directrices para desmentir mitos comunes sobre las conmociones, como la necesidad de pérdida de consciencia para diagnosticar una conmoción.

Las nuevas directrices reflejan las mejores prácticas basadas en evidencia sobre cómo el regreso a la escuela y al ejercicio puede mejorar la recuperación. Según expertos médicos, educar a las familias y escuelas sobre estas nuevas pautas es esencial, especialmente durante el aumento de conmociones en otoño debido a deportes como el fútbol americano y el fútbol.

Más de 2 millones de niños a nivel nacional han sido diagnosticados alguna vez con una conmoción o lesión cerebral, según la Encuesta Nacional de Entrevistas de Salud de 2022.

Numerosos estudios de la última década han demostrado que los adolescentes se recuperan más rápido de las conmociones y disminuyen el riesgo de síntomas prolongados al hacer ejercicio ligero, como en una bicicleta estática o con una caminata rápida, dos días después de la conmoción. Ese mismo período también puede ser el momento ideal para regresar al aula, siempre que los niños puedan tolerar los síntomas restantes de la conmoción.

“Aunque el cerebro no es un músculo, actúa como uno y tiene un fenómeno de úsalo o piérdelo”, comentó Christina Master, pediatra y especialista en medicina deportiva y lesiones cerebrales del Children’s Hospital of Philadelphia.

En lugar de esperar en casa a recuperarse por completo, Master sugiere que los estudiantes regresen a la escuela con apoyo adicional de los maestros y descansos para aliviar síntomas como dolores de cabeza o fatiga, e ir aumentando la actividad de manera gradual.

Todos los estados tienen normas para los estudiantes atletas lesionados, que incluyen removerlos de los deportes, autorización médica para regresar y educación sobre las conmociones. Aunque algunos, como Virginia e Illinois, tienen políticas de “regreso al aprendizaje”, Colorado no está entre ellos. Este y otros 15 estados tienen protocolos de gestión de conmociones basados en la comunidad.

Eso es lo que Colorado actualizó este verano. REAP —que significa Remover/Reducir; Educar; Ajustar/Acomodar; y Progresar— es un protocolo para que las familias, proveedores de salud y escuelas ayuden a los estudiantes a recuperarse durante las primeras cuatro semanas después de una conmoción.

La escuela puede enviar un mensaje para alertar a los maestros de que un estudiante sufrió una conmoción, y luego enviar actualizaciones semanales con detalles sobre cómo manejar síntomas, por ejemplo, la dificultad para concentrarse.

“Tenemos nuevos protocolos para apoyar a estos niños”, afirmó Toni Grishman, consultora principal en lesiones cerebrales del Departamento de Educación de Colorado. “Pueden seguir teniendo síntomas de conmoción, pero podemos apoyarlos”.

Los síntomas de conmoción se resuelven en la mayoría de los pacientes durante el primer mes. Sin embargo, aquellos con síntomas persistentes, llamados síntomas post-conmocionales persistentes, pueden beneficiarse de un equipo de atención multidisciplinario: médicos, fisioterapeutas, psicólogos y apoyo adicional en la escuela, comentó Wilson.

David Howell, director del Laboratorio de Investigación de Conmociones de Colorado en el Centro Médico de la Universidad de Colorado Anschutz, está estudiando cómo los niños y sus familias enfrentan los impactos físicos, cognitivos, sociales y emocionales de las conmociones.

En algunos estudios, los adolescentes usan sensores para medir la intensidad y el volumen del ejercicio, así como los síntomas comunes de las conmociones, como problemas de sueño y equilibrio. En otros, los niños y sus padres responden preguntas sobre sus percepciones y expectativas sobre el proceso de recuperación.

“Lo que uno aporta a una lesión a menudo se exacerba con la lesión”, dijo Howell, mencionando la ansiedad, la depresión o el simple hecho de atravesar un momento social difícil. La recuperación puede verse influenciada por las relaciones con los amigos y la familia.

Duey dijo que la parte más difícil de la recuperación de Karter fue que no pudo estar con las porristas durante nueve semanas, incluyendo la competencia final de su equipo en Florida. Karter, ahora de 12 años, observaba la práctica y apoyaba a sus compañeras en primavera, pero perderse la competencia le dolió profundamente, dijo Duey.

“Hubo muchas lágrimas”, comentó Duey.

Si bien reconocer una conmoción y actuar rápidamente puede ayudar a cualquiera, en la práctica, más de la mitad de los casos de estudiantes en Colorado pueden pasar desapercibidos con conmociones no diagnosticadas, según las estimaciones de Grishman.

Las razones para los diagnósticos omitidos son muchas, señaló Grishman, como la falta de educación, barreras al acceso médico, la reticencia de los padres a informar a las escuelas sobre una conmoción por temor a que se excluya a su hijo de las actividades, o no tomar en serio los síntomas en un estudiante con antecedentes de problemas de comportamiento.

Hacer que las escuelas sigan las pautas de conmoción, en general, es un desafío, comentó Grishman, y agregó que algunos distritos aún no lo hacen.

Dijo que es difícil rastrear el número de escuelas que siguieron las pautas del Departamento de Educación de Colorado el año pasado, pero espera que una mejora en la recopilación de datos brinde más detalles este año. Durante el año escolar pasado, Grishman y sus colegas capacitaron a 280 miembros del personal escolar en gestión de conmociones en 50 distritos escolares de Colorado.

Siempre que sea posible, los entrenadores deben estar en las líneas laterales para apoyar a los estudiantes atletas, señaló Master, y los atletas deben ser conscientes de los síntomas de conmoción en ellos mismos y en sus compañeros, y buscar atención de inmediato.

Sin embargo, las conmociones no se limitan al campo atlético escolar o a deportes como el fútbol americano o el fútbol. Deportes de aventura como el parkour, slackline, motocross, rodeo, esquí y snowboard también presentan riesgos de conmoción, dijeron Wilson y Grishman. “Las porristas, de hecho, es uno de los deportes con muchas conmociones asociadas”, añadió Howell.

Duey comentó que Karter ocasionalmente tiene dolores de cabeza, pero que recuperó su equilibrio con la ayuda de la fisioterapia y ya no presenta síntomas de conmoción. Está de vuelta en el equipo de porristas y preparándose para competir.

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

USE OUR CONTENT

This story can be republished for free (details).

Dentro de los más de 600 hospitales católicos en todo el país, no se puede encontrar ni una sola monja ocupando una oficina ejecutiva, según la Catholic Health Association.

Las monjas fundaron y dirigieron esos hospitales con la misión de atender a personas enfermas y pobres, aunque algunas también eran líderes empresariales astutas. La hermana Irene Kraus, ex directora ejecutiva del Sistema Nacional de Salud de las Hijas de la Caridad, fue famosa por acuñar la frase “sin margen, no hay misión”. Esto significa que los hospitales deben tener éxito —generando suficientes ingresos para superar los gastos— para cumplir con su misión original.

La Iglesia Católica aún regula la atención que se brinda a millones de personas en estos hospitales cada año, usando directrices religiosas para prohibir abortos y limitar anticonceptivos, fertilización in vitro y asistencia médica para morir.

Pero con el tiempo, ese enfoque en los márgenes llevó a los hospitales a transformarse en gigantes que operan subsidiarias con fines de lucro y pagan millones a sus ejecutivos, según informes fiscales de los propios hospitales. Estas instituciones, algunas de las cuales son empresas lucrativas, ahora se parecen más a otras megacorporaciones que a las organizaciones benéficas que supieron ser.

La ausencia de monjas en los cargos principales plantea la pregunta, dijo M. Therese Lysaught, teóloga moral católica y profesora de la Universidad Loyola en Chicago: “¿Qué significa ser un hospital católico cuando la empresa se ha comercializado tan profundamente?”.

El área de St. Louis sirve como la capital de facto de los sistemas de hospitales católicos. Es hogar de tres de los más grandes, junto con el brazo de cabildeo de hospitales católicos. El catolicismo está profundamente arraigado en la cultura de la región. Durante la única visita del Papa Juan Pablo II a Estados Unidos en 1999, celebró una misa en el centro de la ciudad en un estadio lleno con más de 100,000 personas.

Durante un cuarto de siglo, la hermana Mary Jean Ryan dirigió SSM Health, uno de esos sistemas gigantes con sede en St. Louis. Ahora retirada, a sus 86 años, dijo que fue una de las últimas monjas en el país en liderar un sistema de hospitales católicos.

Ryan creció en una familia católica en Wisconsin y se unió a un convento mientras estudiaba enfermería en los años 60, sorprendiendo a su familia. Admiraba a las monjas con las que trabajaba y sentía que estaban viviendo un propósito superior.

“Eran muy impresionantes”, dijo. “No es que necesariamente me gustaran todas”.

De hecho, las monjas que dirigían hospitales desafiaban la imagen simplificada que a menudo se les atribuye, escribió John Fialka en su libro “Sisters: Catholic Nuns and the Making of America”.

“Sus contribuciones a la cultura estadounidense no son pequeñas”, escribió. “Mujeres ambiciosas que tenían las habilidades y la resistencia para construir y dirigir grandes instituciones encontraron en el convento la primera y, durante mucho tiempo, la única vía para desarrollar sus talentos”.

Esto fue muy cierto para Ryan, quien ascendió de enfermera a directora ejecutiva de SSM Health, que hoy tiene hospitales en Illinois, Missouri, Oklahoma y Wisconsin.

El sistema se fundó hace más de un siglo cuando cinco monjas alemanas llegaron a St. Louis con $5. La viruela azotaba la ciudad y las Hermanas de Santa María caminaban por las calles ofreciendo atención gratuita a los enfermos.

Sus esfuerzos iniciales crecieron hasta convertirse en uno de los sistemas de salud católicos más grandes del país, con ingresos anuales que superan los $10 mil millones, según una auditoría de 2023. SSM Health atiende a pacientes en 23 hospitales y es co-propietaria de una gerenciadora de beneficios farmacéuticos con fines de lucro, Navitus, que coordina recetas para 14 millones de personas.

Pero Ryan, como muchas monjas en roles de liderazgo en décadas recientes, se enfrentó a una crisis existencial. A medida que menos mujeres se convertían en monjas, tuvo que asegurar el futuro del sistema sin ellas.

Cuando Ron Levy, quien es judío, comenzó como administrador en SSM, se negó a dirigir una oración en una reunión, recordó Ryan en su libro “On Becoming Exceptional”.

“Ron, no te estoy pidiendo que seas católico”, recordó diciéndole. “Y sé que solo llevas dos semanas aquí. Así que, si te gustaría que fueran tres, te sugiero que estés preparado para orar la próxima vez que te lo pidan”.

Levy trabajó en SSM por más de 30 años, rezando desde entonces, escribió Ryan.

En los hospitales católicos, las reuniones aún suelen comenzar con una oración. Los crucifijos adornan los edificios y las habitaciones de los pacientes. Las declaraciones sobre su misión en las paredes de las instalaciones de SSM recuerdan a los pacientes: “Revelamos la presencia sanadora de Dios”.

Por encima de todo, la fe católica llama a sus hospitales a tratar a todos, independientemente de su raza, religión o capacidad de pago, dijo Diarmuid Rooney, vicepresidente de la Catholic Health Association. Ninguna monja dirige los hospitales  miembros del grupo de cabildeo, según el grupo. Pero la misión que motivó a las monjas es “lo que nos motiva ahora”, dijo Rooney. “No son solo palabras en una pared”.

La Catholic Health Association insta a sus hospitales a autoevaluarse cada tres años sobre si están cumpliendo con las enseñanzas católicas. Creó una herramienta que evalúa siete criterios, incluyendo cómo un hospital actúa como extensión de la iglesia y atiende a pacientes pobres y marginados.

“No nos basamos en rumores sobre si la identidad católica está viva y bien en nuestras instalaciones y hospitales”, dijo Rooney. “Realmente podemos ver en una escala dónde se encuentran”.

La asociación no comparte los resultados con el público.

En SSM Health, “nuestra identidad católica está profunda y estructuralmente arraigada” incluso sin una monja a la cabeza, dijo el vocero Patrick Kampert. El sistema reporta a dos juntas. Una funciona como una típica junta directiva empresarial, mientras que la otra asegura que el sistema cumpla con las reglas de la Iglesia Católica. La iglesia requiere que la mayoría de esa junta de nueve miembros sea católica. Tres monjas sirven actualmente en ella; una es la presidenta.

Kampert explicó que, por separado, SSM también debe presentar un informe anual al Vaticano detallando la forma en que “profundizamos nuestra identidad católica y avanzamos el ministerio de sanación de Jesús”. SSM declinó proporcionar copias de esos informes.

Desde una perspectiva empresarial, sin embargo, es difícil distinguir un sistema de hospitales católicos como SSM de uno secular, dijo Ruth Hollenbeck, ex ejecutiva de Anthem que se retiró en 2018 tras negociar contratos de hospitales en Missouri. En los contratos, dijo, la diferencia se reducía a un solo párrafo que decía que los hospitales católicos no harían nada contrario a las directrices de la iglesia.

Para retener el estatus de exención de impuestos bajo las reglas del IRS, todos los hospitales sin fines de lucro deben proporcionar un “beneficio” a sus comunidades, como atención gratuita o a precio reducido para pacientes con bajos ingresos. Pero el IRS ofrece una definición amplia de lo que constituye un beneficio comunitario, lo que permite a los hospitales justificar su exención de impuestos.

En promedio, los hospitales sin fines de lucro del país reportaron que el 15,5% de sus gastos anuales en 2020 se destinaron a beneficios comunitarios, según la Asociación Americana de Hospitales.

SSM Health, incluyendo todas sus subsidiarias, destinó proporcionalmente mucho menos que el promedio de la asociación para hospitales individuales, asignando aproximadamente la misma proporción de sus gastos anuales a esfuerzos comunitarios durante tres años: 5.1% en 2020, 4.5% en 2021 y 4.9% en 2022, según un análisis de KFF Health News de sus declaraciones de impuestos e informes financieros auditados más recientes.

Un análisis separado del grupo de expertos Lown Institute colocó a cinco sistemas católicos —incluido Ascension en la región de St. Louis— en su lista de los 10 sistemas de salud con los mayores déficits de “cuota justa”, lo que significa que reciben más exenciones fiscales de lo que gastan en la comunidad.

Y Lown dijo que tres sistemas de salud católicos de la zona de St. Louis —Ascension, SSM Health y Mercy— tuvieron déficits de cuota justa de $614 millones, $235 millones y $92 millones, respectivamente, en el año fiscal 2021.

Ascension, Mercy y SSM cuestionaron la metodología de Lown, argumentando que no toma en cuenta la diferencia entre los pagos que reciben por los pacientes de Medicaid y el costo de atenderlos. Las declaraciones de impuestos del IRS sí lo hacen.

Sin embargo, Kampert dijo que muchos de los beneficios que SSM brinda no están reflejados en sus declaraciones de impuestos del IRS. Los formularios reflejan “cálculos muy simplistas” y no representan con precisión el verdadero impacto del sistema de salud en la comunidad, observó.

Hoy en día, SSM Health es dirigido por la veterana ejecutiva Laura Kaiser. Su compensación en 2022 fue de $8.4 millones, incluyendo pagos diferidos, según su declaración de impuestos del IRS. Kampert defendió la cantidad como necesaria “para retener y atraer al candidato más calificado”.

En contraste, SSM nunca le pagó un salario a Ryan, otorgando en su lugar una contribución anual a su convento de menos de $2 millones al año, según algunas declaraciones fiscales de su largo mandato. “No ingresé al convento para ganar dinero”, aclaró Ryan.

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

USE OUR CONTENT

This story can be republished for free (details).

ST. LOUIS — Inside the more than 600 Catholic hospitals across the country, not a single nun can be found occupying a chief executive suite, according to the Catholic Health Association.

Nuns founded and led those hospitals in a mission to treat sick and poor people, but some were also shrewd business leaders. Sister Irene Kraus, a former chief executive of Daughters of Charity National Health System, was famous for coining the phrase “no margin, no mission.” It means hospitals must succeed — generating enough revenue to exceed expenses — to fulfill their original mission.

The Catholic Church still governs the care that can be delivered to millions in those hospitals each year, using religious directives to ban abortions and limit contraceptives, in vitro fertilization, and medical aid in dying.

But over time, that focus on margins led the hospitals to transform into behemoths that operate for-profit subsidiaries and pay their executives millions, according to hospital tax filings. These institutions, some of which are for-profit companies, now look more like other megacorporations than like the charities for the destitute of yesteryear.

The absence of nuns in the top roles raises the question, said M. Therese Lysaught, a Catholic moral theologist and professor at Loyola University Chicago: “What does it mean to be a Catholic hospital when the enterprise has been so deeply commodified?”

The St. Louis area serves as the de facto capital of Catholic hospital systems. Three of the largest are headquartered here, along with the Catholic hospital lobbying arm. Catholicism is deeply rooted in the region’s culture. During Pope John Paul II’s only U.S. stop in 1999, he led Mass downtown in a packed stadium of more than 100,000 people.

For a quarter century, Sister Mary Jean Ryan led SSM Health, one of those giant systems centered on St. Louis. Now retired, the 86-year-old said she was one of the last nuns in the nation to lead a Catholic hospital system.

Ryan grew up Catholic in Wisconsin and joined a convent while in nursing school in the 1960s, surprising her family. She admired the nuns she worked alongside and felt they were living out a higher purpose.

“They were very impressive,” she said. “Not that I necessarily liked all of them.”

Indeed, the nuns running hospitals defied the simplistic image often ascribed to them, wrote John Fialka in his book “Sisters: Catholic Nuns and the Making of America.”

“Their contributions to American culture are not small,” he wrote. “Ambitious women who had the skills and the stamina to build and run large institutions found the convent to be the first and, for a long time, the only outlet for their talents.”

This was certainly true for Ryan, who climbed the ranks, working her way from nurse to chief executive of SSM Health, which today has hospitals in Illinois, Missouri, Oklahoma, and Wisconsin.

The system was founded more than a century ago when five German nuns arrived in St. Louis with $5. Smallpox swept through the city and the Sisters of St. Mary walked the streets offering free care to the sick.

Their early foray grew into one of the largest Catholic health systems in the country, with annual revenue exceeding $10 billion, according to its 2023 audited financial report. SSM Health treats patients in 23 hospitals and co-owns a for-profit pharmacy benefit manager, Navitus, that coordinates prescriptions for 14 million people.

But Ryan, like many nuns in leadership roles in recent decades, found herself confronted with an existential crisis. As fewer women became nuns, she had to ensure the system’s future without them.

When Ron Levy, who is Jewish, started at SSM as an administrator, he declined to lead a prayer in a meeting, Ryan recounted in her book, “On Becoming Exceptional.”

“Ron, I’m not asking you to be Catholic,” she recalled telling him. “And I know you’ve only been here two weeks. So, if you’d like to make it three, I suggest you be prepared to pray the next time you’re asked.”

Levy went on to serve SSM for more than 30 years — praying from then on, Ryan wrote.

In Catholic hospitals, meetings are still likely to start with a prayer. Crucifixes often adorn buildings and patient rooms. Mission statements on the walls of SSM facilities remind patients: “We reveal the healing presence of God.”

Above all else, the Catholic faith calls on its hospitals to treat everyone regardless of race, religion, or ability to pay, said Diarmuid Rooney, a vice president of the Catholic Health Association. No nuns run the trade group’s member hospitals, according to the lobbying group. But the mission that compelled the nuns is “what compels us now,” Rooney said. “It’s not just words on a wall.”

The Catholic Health Association urges its hospitals to evaluate themselves every three years on whether they’re living up to Catholic teachings. It created a tool that weighs seven criteria, including how a hospital acts as an extension of the church and cares for poor and marginalized patients.

“We’re not relying on hearsay that the Catholic identity is alive and well in our facilities and hospitals,” Rooney said. “We can actually see on a scale where they are at.”

The association does not share the results with the public.

At SSM Health, “our Catholic identity is deeply and structurally ingrained” even with no nun at the helm, spokesperson Patrick Kampert said. The system reports to two boards. One functions as a typical business board of directors while the other ensures the system abides by the rules of the Catholic Church. The church requires the majority of that nine-member board to be Catholic. Three nuns currently serve on it; one is the chair.

Separately, SSM also is required to file an annual report with the Vatican detailing the ways, Kampert said, “we deepen our Catholic identity and further the healing ministry of Jesus.” SSM declined to provide copies of those reports.

From a business perspective, though, it’s hard to distinguish a Catholic hospital system like SSM from a secular one, said Ruth Hollenbeck, a former Anthem insurance executive who retired in 2018 after negotiating Missouri hospital contracts. In the contracts, she said, the difference amounted to a single paragraph stating that Catholic hospitals wouldn’t do anything contrary to the church’s directives.

To retain tax-exempt status under Internal Revenue Service rules, all nonprofit hospitals must provide a “benefit” to their communities such as free or reduced-price care for patients with low incomes. But the IRS provides a broad definition of what constitutes a community benefit, which gives hospitals wide latitude to justify not needing to pay taxes.

On average, the nation’s nonprofit hospitals reported that 15.5% of their total annual expenses were for community benefits in 2020, the latest figure available from the American Hospital Association.

SSM Health, including all of its subsidiaries, spent proportionately far less than the association’s average for individual hospitals, allocating roughly the same share of its annual expenses to community efforts over three years: 5.1% in 2020, 4.5% in 2021, and 4.9% in 2022, according to a KFF Health News analysis of its most recent publicly available IRS filings and audited financial statements.

A separate analysis from the Lown Institute think tank placed five Catholic systems — including the St. Louis region’s Ascension — on its list of the 10 health systems with the largest “fair share” deficits, which means receiving more in tax breaks than what they spent on the community. And Lown said three St. Louis-area Catholic health systems — Ascension, SSM Health, and Mercy — had fair share deficits of $614 million, $235 million, and $92 million, respectively, in the 2021 fiscal year.

Ascension, Mercy, and SSM disputed Lown’s methodology, arguing it doesn’t take into account the gap between the payments they receive for Medicaid patients and the cost of delivering their care. The IRS filings do.

But, Kampert said, many of the benefits SSM provides aren’t reflected in its IRS filings either. The forms reflect “very simplistic calculations” and do not accurately represent the health system’s true impact on the community, he said.

Today, SSM Health is led by longtime business executive Laura Kaiser. Her compensation in 2022 totaled $8.4 million, including deferred payments, according to its IRS filing. Kampert defended the amount as necessary “to retain and attract the most qualified” candidate.

By contrast, SSM never paid Ryan a salary, giving instead an annual contribution to her convent of less than $2 million a year, according to some tax filings from her long tenure. “I didn’t join the convent to earn money,” Ryan said.

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

USE OUR CONTENT

This story can be republished for free (details).

During cheerleading practice in April, Jana Duey’s sixth grade daughter, Karter, sustained a concussion when she fell several feet headfirst onto a gym floor mat. Days after, Karter still had a headache, dizziness, and sensitivity to light and noise.

Karter rested for a week and a half at home in Centennial, Colorado, then returned to school when her concussion symptoms were tolerable — initially for just half-days and with accommodations allowing her to do schoolwork on paper instead of a screen and take extra time to get to and from classes. Karter went to the nurse’s office when she had a headache, Duey said. She began physical therapy to rehab her neck and regain her balance after the accident left her unsteady on her feet.

After children get concussions, a top concern for them and their parents or caregivers is when they can go back to sports, said Julie Wilson, Karter’s doctor and a co-director of the Concussion Program at Children’s Hospital Colorado in Aurora. Returning to school as quickly as possible, with appropriate support, and getting light exercise that doesn’t pose a head injury risk are important first steps in concussion recovery, and in line with the latest research.

“It’s really important to get children and teens back to their usual daily activities as soon as possible, and as soon as they can tolerate them,” Wilson said.

In August, the Colorado Department of Education updated guidelines dispelling common myths about concussions, such as a loss of consciousness being necessary for a concussion diagnosis. The revised guidelines reflect evidence-based best practices on how returning to school and exercise can improve recovery. Educating families and schools about the new guidelines is critical, according to medical experts, particularly during autumn’s uptick in concussions from sports such as football and soccer.

More than 2 million children nationwide had been diagnosed at some point with a concussion or brain injury, according to the 2022 National Health Interview Survey. A flurry of studies in the past decade have shown that adolescents recover more quickly from concussions and decrease the risk for prolonged symptoms by exercising lightly, for example on a stationary bike or with a brisk walk, two days after a concussion. That time frame may also be the sweet spot for getting back to the classroom, as long as the kids can tolerate any remaining concussion symptoms.

“Even though the brain is not a muscle, it acts like one and has a use-it-or-lose-it phenomenon,” said Christina Master, a pediatrician and sports medicine and brain injury specialist at Children’s Hospital of Philadelphia.

Instead of waiting at home to fully recover, Master said, students should return to school with extra support from teachers and breaks in their schedule to relieve symptoms such as headaches or fatigue, with a goal of gradually doing more.

Every state has return-to-play laws for student-athletes that include policies such as removal from sports, medical clearance to return, and education about concussions. While some states, such as Virginia and Illinois, have “return-to-learn” policies, Colorado is not among them. It and 15 other states have community-based concussion management protocols.

That is what Colorado updated this summer. REAP — which stands for Remove/Reduce; Educate; Adjust/Accommodate; and Pace — is a protocol for families, health care providers, and schools to help students recover during the first four weeks after a concussion. For example, school personnel can use an email-based system to alert teachers that a student sustained a concussion, then send weekly updates with details about how to manage symptoms, like difficulty concentrating.

“We have new protocols to support these kiddos,” said Toni Grishman, senior brain injury consultant at the Colorado Department of Education. “They might still have symptoms of concussion, but we can support them.”

Symptoms of concussion resolve in most patients in the first month. However, patients with ongoing symptoms, called persistent post-concussive symptoms, can benefit from a multidisciplinary care team that may include physicians, physical therapists, psychologists, and additional school support, Wilson said.

David Howell, director of the Colorado Concussion Research Laboratory at the University of Colorado Anschutz Medical Campus, is studying how children and their families cope with the physical, cognitive, social, and emotional impacts of concussions. In some studies, adolescents wear sensors to measure exercise intensity and volume, as well as common symptoms of concussion, like sleep and balance problems. In others, children and their parents answer questions about their perceptions and expectations of the recovery process.

“What you bring to an injury is oftentimes exacerbated by the injury,” Howell said, citing anxiety, depression, or just going through a difficult time socially. Recovery can be influenced by peer and family relationships.

Duey said the most difficult part of Karter’s recovery was her not being able to participate in cheer for nine weeks, including her team’s final competition in Florida. Karter, now 12, watched practice and supported her teammates in the spring, but missing out tore her up inside, Duey said.

“There were a lot of tears,” Duey said.

While recognizing a concussion and acting quickly can help anyone, in practice, more than half of students in Colorado may slip through the cracks with undiagnosed concussions, according to Grishman’s estimates.

The reasons for missed diagnoses are many, Grishman said, including lack of education, barriers to medical care, parental reluctance to inform schools about a concussion for fear their child will be excluded from activities, or not taking symptoms seriously in a student with a history of behavioral issues.

Getting schools to follow concussion guidelines, in general, is a challenge, Grishman said, adding that some districts still do not. She said it was hard to track the number of schools that followed Colorado education department guidelines last year but hopes improved data collection will provide more specifics this year. During the past school year, Grishman and her colleagues trained 280 school personnel in concussion management across 50 school districts in Colorado.

Whenever possible, athletic trainers should be on the sidelines to support student-athletes, Master said, and athletes should be aware of concussion symptoms in themselves and their teammates and seek care right away.

But concussions are not limited to the school athletic field or sports like football or soccer. Adventure sports like parkour, slacklining, motocross, rodeo, skiing, and snowboarding also pose concussion risks, Wilson and Grishman said. “Cheerleading is actually one that has a lot of concussions associated with it,” Howell added.

Duey said Karter occasionally has headaches, but her balance returned with help from physical therapy and she no longer experiences symptoms of her concussion. She is back to flying with her cheerleading squad and preparing to compete.

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

USE OUR CONTENT

This story can be republished for free (details).

“Right To Try” experimental drug program saved “thousands and thousands of lives”

Former President Donald Trump on Aug. 30

Former President Donald Trump has boasted in recent months about “Right To Try,” a law he signed in 2018. It’s aimed at boosting terminally ill patients’ access to potentially lifesaving medications not yet approved by the Food and Drug Administration.

“We have things to fight off diseases that will not be approved for another five or six years that people that are very sick, terminally ill, should be able to use. But there was no mechanism for doing it,” Trump said Aug. 30, speaking in Washington, D.C., to supporters of the conservative parental rights advocacy group Moms for Liberty.

He also said that because of Right To Try, “we have saved thousands and thousands of lives.”

Trump similarly praised the program during an Aug. 17 rally in Pennsylvania, in a podcast interview with a conservative commentator, and during his Republican National Convention acceptance speech: “Right To Try is a big deal,” Trump said then.

Medical experts who’ve studied the experimental treatment program, however, say there’s no evidence to support Trump’s claims. These experts say Right To Try weakened regulations intended to protect patients.

What Is Right To Try?

The Trickett Wendler, Frank Mongiello, Jordan McLinn, and Matthew Bellina Right To Try Act, aka Right To Try, passed Congress on a bipartisan basis and was signed into law in 2018. It sought to streamline the process for getting potentially lifesaving drugs that weren’t yet FDA-approved to terminally ill patients. The speed matters; industry groups say it takes 10 to 15 years on average for a new medicine to reach pharmacy shelves.

However, a similar FDA program, the expanded access pipeline, sometimes called “compassionate use,” has existed since the 1970s, and became law in 1987.

And that is the root of many criticisms of Right To Try.

“Right To Try is basically ‘expanded access light,’” said Alison Bateman-House, a medical ethicist who researches access to investigational medical products at New York University’s Grossman School of Medicine.

Right To Try caters to fewer patients than expanded access and offers them fewer treatments, Bateman-House said.

Easing Access or Erasing Safeguards?

Patients must meet specific, but different, criteria to qualify for either experimental medication program.

To qualify for expanded use, patients must have a “serious or immediately life-threatening disease or condition” for which there is no “comparable or satisfactory alternative therapy available to diagnose, monitor, or treat the disease or condition,” according to government regulations. Clinical trials must be infeasible for the patients, and the use of these drugs must not interfere with any in-progress studies. Also, the potential benefits must justify the risks, according to the prescribing physicians.

Then, after identifying a treatment, the patient’s doctor must receive approval from its manufacturer, the FDA, and the institutional review board overseeing the medication’s clinical trials.

The FDA said these steps exist so the agency can “fairly weigh the risks and benefits” of the medication and protect the patient’s safety. The agency also collects data about the drugs’ clinical impact on the patient and any adverse effects to inform the wider approval process for the drug.

Right To Try sought to hasten this approval process. Under the new program, for instance, a doctor must merely identify an experimental medication and receive authorization to use it from the manufacturer. In most cases, the FDA has no authority to approve or deny the application, and there’s no review board process to navigate.

But, because of the Right To Try program’s definitions, fewer patients and fewer medicines qualify.

Under Right To Try, patients must have a “life-threatening” disease or condition, not just “serious,” as with expanded access. Experimental medications are available only after they’ve completed Phase 1 clinical trials; treatments accessed through the expanded access program can be administered during a Phase 1 study.

Right To Try, which includes liability protections for manufacturers and prescribing physicians, also weakens requirements that govern how doctors disclose experimental medications’ risks to patients, leaving informed consent undefined. And it prevents the FDA from using information about how patients tolerate the drugs to “delay or adversely affect the review or approval of such drug(s),” unless top officials justify the benefit to public health in writing.

Supporters say Right To Try is an example of successful deregulation and claim that its more efficient approval process saved lives. But critics see this as a key reason for concern, because it “opens up the opportunity of exploiting desperate patients,” said Holly Fernandez Lynch, a bioethicist who studies pharmaceutical policy at the University of Pennsylvania’s Perelman School of Medicine.

Government data shows regulatory agencies weren’t the main hurdle patients faced when seeking experimental drugs. The FDA almost always approved expanded access applications, and quickly by government standards.

According to a 2018 FDA report on the expanded access program, the FDA authorized 99% of the roughly 9,000 requests it received in the previous five years, approving emergency requests for experimental medications in less than one day on average. More recent data shows that approval trend has continued, even as the number of applications has grown each year.

In rare cases in which the FDA didn’t automatically approve requests, regulators often didn’t deny them, but recommended tweaks to the requested dosage to address safety and effectiveness concerns.

Right To Try by the Numbers

The FDA does not share detailed information about the number of doses provided or patients treated under Right To Try. Instead, it posts only an annual summary showing how many drugs have been approved under the program. The agency says that since Right To Try began in 2018 it has approved 16 treatments: 12 from 2018 to 2022 and four last year.

The FDA declined to provide additional information about the number of Right To Try requests or approvals.

Although the 16 medications approved through Right To Try were possibly provided to more than one patient each, experts said it’s extremely unlikely thousands of patients were involved, as Trump said.

Trump’s claim represents an “egregious overestimate of the number of people who are using Right To Try,” said Fernandez Lynch, noting she believes the real numbers are “very, very low.”

The Trump campaign did not respond to multiple inquiries about the source of the former president’s statistics. Karoline Leavitt, the campaign’s national press secretary, told KFF Health News that in a second term “President Trump will of course remain open to other pathways to expand ‘Right to Try’ to save more American lives.”

It remains unclear how Trump might expand the program, though the conservative Goldwater Institute is advocating for “Right To Try 2.0,” which it claims will let patients receive individualized therapeutics.

Experts noted such drugs are already accessible through the expanded access program.

Meanwhile, evidence shows that the high price of experimental treatments, which are sometimes available through certain drug company programs but not typically covered by insurance, is a greater hurdle to patients than regulatory guardrails are.

“I don’t think that people are having a problem with the FDA blocking access to individualized therapeutics,” Bateman-House said. “I think the problem is that individualized therapeutics are incredibly expensive, and there’s only a very small number of researchers in the country who know how to make them.”

Our Ruling

Trump has claimed throughout the campaign that his Right To Try program is novel and has saved thousands of lives. But a similar program has existed for decades, and there is no evidence Right To Try has had anywhere close to the impact Trump said it has had.

Neither the Trump campaign nor Right To Try advocates provided evidence to back claims of widespread benefit. And government data shows only 16 medications have been approved under the program in its first six years, with no accounting of how many patients used those medications or their clinical outcomes.

Moreover, public health experts have said Right To Try weakens patient protections and fails to address the true barriers to experimental medications.

We rate Trump’s claim False.

our sources:

21 CFR §50.20

21 USC §360bbb-0a

Congressional Research Service, “Expanded Access and Right To Try: Access to Investigational Drugs,” March 16, 2021

Food and Drug Administration, “Expanded Access,” Feb. 28, 2024

Food and Drug Administration, “Expanded Access (Compassionate Use) Submission Data,” May 2, 2024

Food and Drug Administration, “Expanded Access Program Report,” May 2018

Food and Drug Administration, “Expanded Access to Investigational Drugs for Treatment Use: Questions and Answers, Guidance for Industry,” November 2022

Food and Drug Administration, “FDA Fact Sheet: Right To Try,” accessed Sept. 29, 2024

Food and Drug Administration, “Right To Try,” Jan. 23, 2023

Food and Drug Administration, “Right To Try Annual Reporting Summary,” June 6, 2024

Goldwater Institute, “Right To Try for Individualized Treatments (Right To Try 2.0),” accessed Sept. 29, 2024

Goldwater Institute, “Right To Try Is Working,” accessed Sept. 29, 2024

Goldwater Institute, “The Right To Try,” Oct. 5, 2014

Goldwater Institute, “What Is Right To Try?” accessed Sept. 29, 2024

Los Angeles Times, Marc Hayutin obituary, June 14, 2019

Phone interview with Alison Bateman-House, assistant professor at New York University’s Grossman School of Medicine, Sept. 24, 2024

Phone interview with Holly Fernandez Lynch, associate professor of medical ethics and law at the University of Pennsylvania Perelman School of Medicine, Sept. 17, 2024

PhRMA, “Research & Development Policy Framework,” accessed Sept. 29, 2024

Roll Call, “Speech: Donald Trump Holds a Political Rally in Wilkes-Barre, Pennsylvania,” Aug. 17, 2024

The Singju Post, “Full Transcript: Trump Addresses Moms for Liberty 2024 Summit,” Aug. 31, 2024

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

USE OUR CONTENT

This story can be republished for free (details).