More Mobile Clinics Are Bringing Long-Acting Birth Control to Rural Areas
Twice a month, a 40-foot-long truck transformed into a mobile clinic travels the Rio Grande Valley to provide rural Texans with women’s health care, including birth control.
The clinic, called the UniMóvil, is part of the Healthy Mujeres program at the University of Texas Rio Grande Valley School of Medicine.
The U.S. has about 3,000 mobile health programs. But Saul Rivas, an OB-GYN, said he wasn’t aware of any that shared the specific mission of Healthy Mujeres when he helped launch the initiative in 2017. “Mujeres” means “women” in Spanish.
It’s now part of a small but growing number of mobile programs aimed at increasing rural access to women’s health services, including long-acting reversible contraception.
There are two kinds of these highly effective methods: intrauterine devices, known as IUDs, and hormonal implants inserted into the upper arm. These birth control options can be especially difficult to obtain — or have removed — in rural areas.
“Women who want to prevent an unintended pregnancy should have whatever works best for them,” said Kelly Conroy, senior director of mobile and maternal health programs at the University of Arkansas for Medical Sciences.
The school is launching a mobile women’s health and contraception program in rural parts of the state this month.
Rural areas have disproportionately fewer doctors, including OB-GYNs, than urban areas. And rural providers may not be able to afford to stock long-acting birth control devices or may not be trained in administering them, program leaders say.
Mobile clinics help shrink that gap in rural care, but they can be challenging to operate, said Elizabeth Jones, a senior director at the National Family Planning & Reproductive Health Association.
Money is the greatest obstacle, Jones said. The Texas program costs up to $400,000 a year. A 2020 study of 173 mobile clinics found they cost an average of more than $630,000 a year. Mobile dental programs were the most expensive, averaging more than $1 million.
While many programs launch with the help of grants, they can be difficult to sustain, especially with over a decade of decreased or stagnant funding to Title X, a federal money stream that helps low-income people receive family planning services.
For example, a mobile contraception program serving rural Pennsylvania lasted less than three years before closing in 2023. It shut down after losing federal funding, said a spokesperson for the clinic that ran it.
Rural mobile programs aren’t as efficient or profitable as brick-and-mortar clinics. That’s because staff members may have to make hours-long trips to reach towns where they’ll probably see fewer patients than they would at a traditional site, Jones said.
She said organizations that can’t afford mobile programs can consider setting up “pop-up clinics” at existing health and community sites in rural areas.
Maria Briones is a patient who has benefited from the Healthy Mujeres program in southern Texas. The 41-year-old day care worker was concerned because she wasn’t getting her menstrual period with her IUD.
She considered going to Mexico to have the device removed because few doctors take her insurance on the U.S. side of the Rio Grande Valley.
But Briones learned that the UniMóvil was visiting a small Texas city about 20 minutes from her home. She told the staff there that she doesn’t want more kids but was worried about the IUD.
Briones decided to keep the device after learning it’s safe and normal not to have periods while using an IUD. She won’t get billed for her appointment with the mobile clinic, even though the university health system doesn’t take her insurance.
“They have a lot of patience, and they answered all the questions that I had,” Briones said.
IUDs and hormonal implants are highly effective and can last up to 10 years. But they’re also expensive — devices can cost more than $1,000 without insurance — and inserting an IUD can be painful.
Patient-rights advocates are also concerned that some providers pressure people to use these devices.
They say ethical birth control programs aim to empower patients to choose the contraceptive method — if any — that is best for them, instead of promoting long-acting methods in an attempt to lower birth and poverty rates. They point to the history of eugenics-inspired sterilization and even more recent incidents.
For example, an investigation by Time magazine found doctors are more likely to push Black, Latina, young, and low-income women than other patients to use long-acting birth control — and to refuse to remove the devices.
Rivas said Healthy Mujeres staffers are trained on this issue.
“Our goal isn’t necessarily to place IUDs and implants,” he said. It’s to “provide education and help patients make the best decisions for themselves.”
David Wise, a spokesperson for the University of Arkansas for Medical Sciences, said staff members with the university’s mobile program will ask patients if they want to get pregnant in the next year, and will support their choice. The Arkansas and Texas programs also remove IUDs and hormonal arm implants if patients aren’t happy with them.
The Arkansas initiative will visit 14 rural counties with four vehicles the size of food trucks that were used in previous mobile health efforts. Staffing and equipment will be covered by a two-year, $431,000 grant from an anonymous donor, Wise said.
In addition to contraception, faculty and medical residents staffing the vehicles will offer women’s health screenings, vaccinations, prenatal care, and testing and treatment for sexually transmitted infections.
Rivas said the Texas program was inspired by a study that found that, six months after giving birth, 34% of surveyed Texas mothers said long-acting contraception is their preferred birth control option — but only 13% were using that method.
“We started thinking about ways to address that gap,” Rivas said.
Healthy Mujeres, which is funded through multiple grants, started with a focus on contraception. It later expanded to services such as pregnancy ultrasounds, cervical cancer screenings, and testing for sexually transmitted infections.
While the Texas and Arkansas programs can bill insurance, they also have funding to help uninsured and underinsured patients afford their services. Both use community health workers — called promotoras in largely Spanish-speaking communities like the Rio Grande Valley — to connect patients with food, transportation, additional medical services, and other needs.
They partner with organizations that locals trust, such as food pantries and community colleges, which let the mobile units set up in their parking lots. And to further increase the availability of long-acting contraception in rural areas, the universities are training their students and local providers on how to insert, remove, and get reimbursed for the devices.
One difference between the programs is dictated by state laws. The Arkansas program can provide birth control to minors without a parent or guardian’s consent. But in Texas, most minors need consent before receiving health care, including contraception.
Advocates say these initiatives might help lower the rates of unintended and teen pregnancies in both states, which are higher than the national average.
Rivas and Conroy said their programs haven’t received much pushback. But Rivas said some churches that had asked the UniMóvil to visit their congregations changed their minds after learning the services included birth control.
Catherine Phillips, director of the Respect Life Office at Arkansas’ Catholic diocese, said the diocese supports efforts to achieve health care equity and she’s personally interested in mobile programs that visit rural areas such as where she lives.
But Phillips said the Arkansas program’s focus on birth control, especially long-acting methods, violates the teachings of the Catholic Church. Offering these services to minors without parental consent “makes it more egregious,” she said.
Jones said that, while these programs have hefty costs and other challenges, they also have benefits that can’t be measured in numbers.
“Building community trust and making an impact in the communities most impacted by health inequities — that’s invaluable,” she said.
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Harris Backs Slashing Medical Debt. Trump’s ‘Concepts’ Worry Advocates.
Patient and consumer advocates are looking to Kamala Harris to accelerate federal efforts to help people struggling with medical debt if she prevails in next month’s presidential election.
And they see the vice president and Democratic nominee as the best hope for preserving Americans’ access to health insurance. Comprehensive coverage that limits patients’ out-of-pocket costs offers the best defense against going into debt, experts say.
The Biden administration has expanded financial protections for patients, including a landmark proposal by the Consumer Financial Protection Bureau to remove medical debt from consumer credit reports.
In 2022, President Joe Biden also signed the Inflation Reduction Act, which limits how much Medicare enrollees must pay out-of-pocket for prescription drugs, including a $35-a-month cap on insulin. And in statehouses across the country, Democrats and Republicans have been quietly working together to enact laws to rein in debt collectors.
But advocates say the federal government could do more to address a problem that burdens 100 million Americans, forcing many to take on extra work, give up their homes, and cut spending on food and other essentials.
“Biden and Harris have done more to tackle the medical debt crisis in this country than any other administration,” said Mona Shah, senior director of policy and strategy at Community Catalyst, a nonprofit that has led national efforts to strengthen protections against medical debt. “But there is more that needs to be done and should be a top priority for the next Congress and administration.”
At the same time, patient advocates fear that if former President Donald Trump wins a second term, he will weaken insurance protections by allowing states to cut their Medicaid programs or by scaling back federal aid to help Americans buy health insurance. That would put millions of people at greater risk of sinking into debt if they get sick.
In his first term, Trump and congressional Republicans in 2017 tried to repeal the Affordable Care Act, a move that independent analysts concluded would have stripped health coverage from millions of Americans and driven up costs for people with preexisting medical conditions, such as diabetes and cancer.
Trump and his GOP allies continue to attack the ACA, and the former president has said he wants to roll back the Inflation Reduction Act, which also includes aid to help low- and middle-income Americans buy health insurance.
“People will face a wave of medical debt from paying premiums and prescription drug prices,” said Anthony Wright, executive director of Families USA, a consumer group that has backed federal health protections. “Patients and the public should be concerned.”
The Trump campaign did not respond to inquiries about its health care agenda. And the former president doesn’t typically discuss health care or medical debt on the campaign trail, though he said at last month’s debate he had “concepts of a plan” to improve the ACA. Trump hasn’t offered specifics.
Harris has repeatedly pledged to protect the ACA and renew expanded subsidies for monthly insurance premiums created by the Inflation Reduction Act. That aid is slated to expire next year.
The vice president has also voiced support for more government spending to buy and retire old medical debts for patients. In recent years, a number of states and cities have purchased medical debt on behalf of their residents.
These efforts have relieved debt for hundreds of thousands of people, though many patient and consumer advocates say retiring old debt is at best a short-term solution, as patients will continue to run up bills they cannot pay without more substantive action.
“It’s a boat with a hole in it,” said Katie Berge, a lobbyist for the Leukemia & Lymphoma Society. The patient group was among more than 50 organizations that last year sent letters to the Biden administration urging federal agencies to take more aggressive steps to protect Americans from medical debt.
“Medical debt is no longer a niche issue,” said Kirsten Sloan, who works on federal policy for the American Cancer Society’s Cancer Action Network. “It is key to the economic well-being of millions of Americans.”
The Consumer Financial Protection Bureau is developing regulations that would bar medical bills from consumer credit reports, which would boost credit scores and make it easier for millions of Americans to rent an apartment, get a job, or secure a car loan.
Harris, who has called medical debt “critical to the financial health and well-being of millions of Americans,” enthusiastically backed the proposed rule. “No one should be denied access to economic opportunity simply because they experienced a medical emergency,” she said in June.
Harris’ running mate, Minnesota Gov. Tim Walz, who has said his own family struggled with medical debt when he was young, signed a state law in June cracking down on debt collection.
CFPB officials said the regulations would be finalized early next year. Trump hasn’t indicated if he’d follow through on the medical debt protections. In his first term, the CFPB did little to address medical debt, and congressional Republicans have long criticized the regulatory agency.
If Harris prevails, many consumer groups want the CFPB to crack down even further, including tightening oversight of medical credit cards and other financial products that hospitals and other medical providers have started pushing on patients. These loans lock people into interest payments on top of their medical debt.
“We are seeing a variety of new medical financial products,” said April Kuehnhoff, a senior attorney at the National Consumer Law Center. “These can raise new concerns about consumer protections, and it is critical for the CFPB and other regulators to monitor these companies.”
Some advocates want other federal agencies to get involved, as well.
This includes the mammoth Health and Human Services department, which controls hundreds of billions of dollars through the Medicare and Medicaid programs. That money gives the federal government enormous leverage over hospitals and other medical providers.
Thus far, the Biden administration hasn’t used that leverage to tackle medical debt.
But in a potential preview of future actions, state leaders in North Carolina recently won federal approval for a medical debt initiative that will make hospitals take steps to alleviate patient debts in exchange for government aid. Harris praised the initiative.
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Harris apoya la reducción de la deuda médica. Los “conceptos” de Trump preocupan a defensores.
Defensores de pacientes y consumidores confían en que Kamala Harris acelere los esfuerzos federales para ayudar a las personas que luchan con deudas médicas, si gana en las elecciones presidenciales del próximo mes.
Y ven a la vicepresidenta y candidata demócrata como la mejor esperanza para preservar el acceso de los estadounidenses a seguros de salud. La cobertura integral que limita los costos directos de los pacientes es la mejor defensa contra el endeudamiento, dicen los expertos.
La administración Biden ha ampliado las protecciones financieras para los pacientes, incluyendo una propuesta histórica de la Oficina de Protección Financiera del Consumidor (CFPB) para eliminar la deuda médica de los informes de crédito de los consumidores.
En 2022, el presidente Joe Biden también firmó la Ley de Reducción de la Inflación, que limita cuánto deben pagar los afiliados de Medicare por medicamentos recetados, incluyendo un tope de $35 al mes para la insulina. Y en legislaturas de todo el país, demócratas y republicanos han trabajado juntos de manera discreta para promulgar leyes que frenen a los cobradores de deudas.
Sin embargo, defensores dicen que el gobierno federal podría hacer más para abordar un problema que afecta a 100 millones de estadounidenses, obligando a muchos a trabajar más, perder sus hogares y reducir el gasto en alimentos y otros artículos esenciales.
“Biden y Harris han hecho más para abordar la crisis de deuda médica en este país que cualquier otra administración”, dijo Mona Shah, directora senior de política y estrategia en Community Catalyst, una organización sin fines de lucro que ha liderado los esfuerzos nacionales para fortalecer las protecciones contra la deuda médica. “Pero hay más por hacer y debe ser una prioridad para el próximo Congreso y administración”.
Al mismo tiempo, los defensores de los pacientes temen que si el ex presidente Donald Trump gana un segundo mandato, debilitará las protecciones de los seguros permitiendo que los estados recorten sus programas de Medicaid o reduciendo la ayuda federal para que los estadounidenses compren cobertura médica. Eso pondría a millones de personas en mayor riesgo de endeudarse si enferman.
En su primer mandato, Trump y los republicanos del Congreso intentaron en 2017 derogar la Ley de Cuidado de Salud a Bajo Precio (ACA), un movimiento que, según analistas independientes, habría despojado de cobertura médica a millones de estadounidenses y habría aumentado los costos para las personas con afecciones preexistentes, como diabetes y cáncer.
Trump y sus aliados del Partido Republicano continúan atacando a ACA, y el ex presidente ha dicho que quiere revertir la Ley de Reducción de la Inflación, que también incluye ayuda para que los estadounidenses de bajos y medianos ingresos compren seguros de salud.
“Las personas enfrentarán una ola de deuda médica por pagar primas y precios de medicamentos recetados”, dijo Anthony Wright, director ejecutivo de Families USA, un grupo de consumidores que ha apoyado las protecciones federales de salud. “Los pacientes y el público deberían estar preocupados”.
La campaña de Trump no respondió a consultas sobre su agenda de salud. Y el ex presidente no suele hablar de atención médica o deuda médica en la campaña, aunque dijo en el debate del mes pasado que tenía “conceptos de un plan” para mejorar la ACA. Trump no ha ofrecido detalles.
Harris ha prometido repetidamente proteger ACA y renovar los subsidios ampliados para las primas mensuales del seguro creados por la Ley de Reducción de la Inflación. Esa ayuda está programada para expirar el próximo año.
La vicepresidenta también ha expresado su apoyo a un mayor gasto gubernamental para comprar y cancelar deudas médicas antiguas de los pacientes. En los últimos años, varios estados y ciudades han comprado deuda médica en nombre de sus residentes.
Estos esfuerzos han aliviado la deuda de cientos de miles de personas, aunque muchos defensores dicen que cancelar deudas antiguas es, en el mejor de los casos, una solución a corto plazo, ya que los pacientes seguirán acumulando facturas que no pueden pagar sin una acción más sustantiva.
“Es un bote con un agujero”, dijo Katie Berge, una cabildera de la Sociedad de Leucemia y Linfoma. Este grupo de pacientes fue una de más de 50 organizaciones que el año pasado enviaron cartas a la administración Biden instando a las agencias federales a tomar medidas más agresivas para proteger a los estadounidenses de la deuda médica.
“La deuda médica ya no es un problema de nicho”, dijo Kirsten Sloan, quien trabaja en política federal para la Red de Acción contra el Cáncer de la Sociedad Americana de Cáncer. “Es clave para el bienestar económico de millones de estadounidenses”.
La Oficina de Protección Financiera del Consumidor está desarrollando regulaciones que prohibirían que las facturas médicas aparezcan en los informes de crédito de los consumidores, lo que mejoraría los puntajes crediticios y facilitaría que millones de estadounidenses alquilen una vivienda, consigan un trabajo o consigan un préstamo para un automóvil.
Harris, quien ha calificado la deuda médica como “crítica para la salud financiera y el bienestar de millones de estadounidenses”, apoyó con entusiasmo la propuesta de regulación. “No se debería privar a nadie del acceso a oportunidades económicas simplemente porque experimentó una emergencia médica”, dijo en junio.
El compañero de fórmula de Harris, el gobernador de Minnesota, Tim Walz, quien ha dicho que su propia familia luchó con la deuda médica cuando era joven, firmó en junio una ley estatal que reprime el cobro de deudas.
Los funcionarios de la CFPB dijeron que las regulaciones se finalizarán a principios del próximo año. Trump no ha indicado si seguiría adelante con las protecciones contra la deuda médica. En su primer mandato, la CFPB hizo poco para abordarla, y los republicanos en el Congreso han criticado durante mucho tiempo a la agencia reguladora.
Si Harris gana, muchos grupos de consumidores quieren que la CFPB refuerce aún más las medidas, incluyendo una mayor supervisión de las tarjetas de crédito médicas y otros productos financieros que los hospitales y otros proveedores médicos han comenzado a ofrecer a los pacientes. Por estos préstamos, las personas están obligadas a pagar intereses adicionales sobre su deuda médica.
“Estamos viendo una variedad de nuevos productos financieros médicos”, dijo April Kuehnhoff, abogada senior del Centro Nacional de Derecho del Consumidor. “Estos pueden generar nuevas preocupaciones sobre las protecciones al consumidor, y es fundamental que la CFPB y otros reguladores supervisen a estas empresas”.
Algunos defensores quieren que otras agencias federales también se involucren.
Esto incluye al enorme Departamento de Salud y Servicios Humanos (HHS), que controla cientos de miles de millones de dólares a través de los programas de Medicare y Medicaid. Ese dinero otorga al gobierno federal una enorme influencia sobre los hospitales y otros proveedores médicos.
Hasta ahora, la administración Biden no ha utilizado esa influencia para abordar la deuda médica.
Pero en un posible anticipo de futuras acciones, los líderes estatales en Carolina del Norte recientemente obtuvieron la aprobación federal para una iniciativa de deuda médica que obligará a los hospitales a tomar medidas para aliviar las deudas de los pacientes a cambio de ayuda gubernamental. Harris elogió la iniciativa.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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Millions of Aging Americans Are Facing Dementia by Themselves
Sociologist Elena Portacolone was taken aback. Many of the older adults in San Francisco she visited at home for a research project were confused when she came to the door. They’d forgotten the appointment or couldn’t remember speaking to her.
It seemed clear they had some type of cognitive impairment. Yet they were living alone.
Portacolone, an associate professor at the University of California-San Francisco, wondered how common this was. Had anyone examined this group? How were they managing?
When she reviewed the research literature more than a decade ago, there was little there. “I realized this is a largely invisible population,” she said.
Portacolone got to work and now leads the Living Alone With Cognitive Impairment Project at UCSF. The project estimates that that at least 4.3 million people 55 or older who have cognitive impairment or dementia live alone in the United States.
About half have trouble with daily activities such as bathing, eating, cooking, shopping, taking medications, and managing money, according to their research. But only 1 in 3 received help with at least one such activity.
Compared with other older adults who live by themselves, people living alone with cognitive impairment are older, more likely to be women, and disproportionately Black or Latino, with lower levels of education, wealth, and homeownership. Yet only 21% qualify for publicly funded programs such as Medicaid that pay for aides to provide services in the home.
In a health care system that assumes older adults have family caregivers to help them, “we realized this population is destined to fall through the cracks,” Portacolone said.
Imagine what this means. As memory and thinking problems accelerate, these seniors can lose track of bills, have their electricity shut off, or be threatened with eviction. They might stop shopping (it’s too overwhelming) or cooking (it’s too hard to follow recipes). Or they might be unable to communicate clearly or navigate automated phone systems.
A variety of other problems can ensue, including social isolation, malnutrition, self-neglect, and susceptibility to scams. Without someone to watch over them, older adults on their own may experience worsening health without anyone noticing or struggle with dementia without ever being diagnosed.
Should vulnerable seniors live this way?
For years, Portacolone and her collaborators nationwide have followed nearly 100 older adults with cognitive impairment who live alone. She listed some concerns people told researchers they worried most about: “Who do I trust? When is the next time I’m going to forget? If I think I need more help, where do I find it? How do I hide my forgetfulness?”
Jane Lowers, an assistant professor at the Emory University School of Medicine, has been studying “kinless” adults in the early stages of dementia — those without a live-in partner or children nearby. Their top priority, she told me, is “remaining independent for as long as possible.”
Seeking to learn more about these seniors’ experiences, I contacted the National Council of Dementia Minds. The organization last year started a biweekly online group for people living alone with dementia. Its staffers arranged a Zoom conversation with five people, all with early-to-moderate dementia.
One was Kathleen Healy, 60, who has significant memory problems and lives alone in Fresno, California.
“One of the biggest challenges is that people don’t really see what’s going on with you,” she said. “Let’s say my house is a mess or I’m sick or I’m losing track of my bills. If I can get myself together, I can walk out the door and nobody knows what’s going on.”
An administrator with the city of Fresno for 28 years, Healy said she had to retire in 2019 “because my brain stopped working.” With her pension, she’s able to cover her expenses, but she doesn’t have significant savings or assets.
Healy said she can’t rely on family members who have troubles of their own. (Her 83-year-old mother has dementia and lives with Healy’s sister.) The person who checks on her most frequently is an ex-boyfriend.
“I don’t really have anybody,” she said, choking up.
David West, 62, is a divorced former social worker with Lewy body dementia, which can impair thinking and concentration and cause hallucinations. He lives alone in an apartment in downtown Fort Worth, Texas.
“I will not survive this in the end — I know that — but I’m going to meet this with resilience,” he said when I spoke with him by phone in June.
Since his diagnosis nearly three years ago, West has filled his life with exercise and joined three dementia support groups. He spends up to 20 hours a week volunteering, at a restaurant, a food bank, a museum, and Dementia Friendly Fort Worth.
Still, West knows that his illness will progress and that this period of relative independence is limited. What will he do then? Although he has three adult children, he said, he can’t expect them to take him in and become dementia caregivers — an extraordinarily stressful, time-intensive, financially draining commitment.
“I don’t know how it’s going to work out,” he said.
Denise Baker, 80, a former CIA analyst, lives in a 100-year-old house in Asheville, North Carolina, with her dog, Yolo. She has cognitive problems related to a stroke 28 years ago, Alzheimer’s disease, and serious vision impairment that prevents her from driving. Her adult daughters live in Massachusetts and Colorado.
“I’m a very independent person, and I find that I want to do everything I possibly can for myself,” Baker told me, months before Asheville was ravaged by severe flooding. “It makes me feel better about myself.”
She was lucky in the aftermath of Hurricane Helene: Baker lives on a hill in West Asheville that was untouched by floodwaters. In the week immediately after the storm, she filled water jugs every day at an old well near her house and brought them back in a wheelbarrow. Though her power was out, she had plenty of food and neighbors looked in on her.
“I’m absolutely fine,” she told me on the phone in early October after a member of Dementia Friendly Western North Carolina drove to Baker’s house to check in on her, upon my request. Baker is on the steering committee of that organization.
Baker once found it hard to ask for assistance, but these days she relies routinely on friends and hired help. A few examples: Elaine takes her grocery shopping every Monday. Roberta comes once a month to help with her mail and finances. Jack mows her lawn. Helen offers care management advice. Tom, a cab driver she connected with through Buncombe County’s transportation program for seniors, is her go-to guy for errands.
Her daughter Karen in Boston has the authority to make legal and health care decisions when Baker can no longer do so. When that day comes — and Baker knows it will — she expects her long-term care insurance policy to pay for home aides or memory care. Until then, “I plan to do as much as I can in the state I’m in,” she said.
Much can be done to better assist older adults with dementia who are on their own, said Elizabeth Gould, co-director of the National Alzheimer’s and Dementia Resource Center at RTI International, a nonprofit research institute. “If health care providers would just ask ‘Who do you live with?’” she said, “that could open the door to identifying who might need more help.”
We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care, and advice you need in dealing with the health care system. Visit kffhealthnews.org/columnists to submit your requests or tips.
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California Hospitals Scramble on Earthquake Retrofits as State Limits Extensions
More than half of the 410 hospitals in California have at least one building that likely wouldn’t be able to operate after a major earthquake hit their region, and with many institutions claiming they don’t have the money to meet a 2030 legal deadline for earthquake retrofits, the state is now granting relief to some while ramping up pressure on others to get the work done.
Gov. Gavin Newsom in September vetoed legislation championed by the California Hospital Association that would have allowed all hospitals to apply for an extension of the deadline for up to five years. Instead, the Democratic governor signed a more narrowly tailored bill that allows small, rural, or “distressed” hospitals to get an extension of up to three years.
“It’s an expensive thing and a complicated thing for hospitals — independent hospitals in particular,” said Elizabeth Mahler, an associate chief medical officer for Alameda Health System, which serves Northern California’s East Bay and is undertaking a $25 million retrofit of its hospital in Alameda, on an island beside Oakland.
The debate over how seismically safe California hospitals should be dates to the 1971 Sylmar quake near Los Angeles, which prompted a law requiring new hospitals to be built to withstand an earthquake and continue operating. In 1994, after the magnitude 6.7 Northridge quake killed at least 57 people, lawmakers required existing facilities to be upgraded.
The two laws have left California hospitals with two sets of standards to meet. The first — which originally had a deadline of 2008 but was pushed to 2020 — required hospital buildings to stay standing after an earthquake. About 20 facilities have yet to meet that requirement for at least one of their buildings, although some have received extensions from the state.
Many more — 674 buildings, spread across 251 licensed hospitals — do not meet the second set of standards, which require hospital facilities to remain functional in the event of a major earthquake. That work is supposed to be done by 2030.
“The importance of it is hard to argue with,” said Jonathan Stewart, a professor at UCLA’s Samueli School of Engineering, citing a 2023 earthquake in Turkey that damaged or destroyed multiple hospitals. “There were a number of hospitals that were intact but not usable. That’s better than a collapsed structure. But still not what you need at a time of emergency like that.”
The influential hospital industry has unsuccessfully lobbied lawmakers for years to extend the 2030 deadline, though the state has granted various extensions to specific facilities. Newsom’s signature on one of the three bills addressing the issue this year represents a partial victory for the industry.
Hospital administrators have long complained about the steep cost of seismic retrofits.
“While hospitals are working to meet these requirements, many will simply not make the 2030 deadline and be forced by state law to close,” wrote Carmela Coyle, president and CEO of the California Hospital Association, in a letter to Newsom before he vetoed the CHA bill. A 2019 Rand Corp. study paid for by the CHA pinned the price of meeting the 2030 standards at between $34 billion and $143 billion statewide.
Labor unions representing nurses and other medical workers, however, say the hospitals have had plenty of time to get their buildings into compliance, and that most have the money to do so.
“They’ve had 30 years to do this,” Cathy Kennedy, a nurse in Roseville and one of the presidents of the California Nurses Association, said in an interview prior to the governor’s action. “We are kicking the can down the road year after year, and unfortunately, lives are going to be lost.”
In his veto message on the CHA bill, Newsom wrote that a blanket five-year extension wasn’t justified, and that any extension “should be limited in scope, granted only on a case-by-case basis to hospitals with demonstrated need and a clear path to compliance, and in combination with strong accountability and enforcement mechanisms.”
He also vetoed a bill directed specifically at helping several hospitals operated by Providence, a Catholic hospital chain.
But he signed a third bill, which allows small, rural, and “critical access” hospitals, and some others, to apply for a three-year extension, and directs the Department of Health Care Access and Information to offer them “technical assistance” in meeting the deadline.
The state designates 37 hospitals as providing “critical access,” while 56 are considered “small,” meaning they have fewer than 50 beds, 59 are considered “rural,” and 32 are “district” hospitals, meaning they are funded by special government entities called “health care districts.” They can seek a three-year extension as long as they submit a seismic compliance plan and identify milestones for implementing it.
Debi Stebbins, executive director of the Alameda Health Care District, which owns the Alameda Hospital buildings, said small hospitals face a big challenge. Even though Alameda is very close to San Francisco and Oakland, the tunnels, bridges, and ferries that connect it to the mainland could easily be shut in an emergency, making the island’s hospital a lifeline.
“It’s an unfunded mandate,” Stebbins said of the state’s 2030 deadline.
The Rand study estimated the average cost of a retrofit at more than $92 million per building, but the amount could vary greatly depending on whether it’s a building that houses hospital beds.
Small and rural hospitals can get some aid from the state via grants financed by the California Electronic Cigarette Excise Tax, but HCAI spokesperson Andrew DiLuccia said it would yield just $2-3 million total annually. He added that the Small and Rural Hospital Relief Program has also received a one-time infusion of $50 million from a tax on health insurers to help with the seismic work.
Labor unions and critics of the extensions often point to the large profits that some hospitals reap: A California Health Care Foundation report published in August found that California’s hospitals made $3.2 billion in profit during the first quarter of 2024. The study notes that there “continues to be wide variation in financial performance among hospitals, with the bottom quartile showing a net income margin of -5%, compared to +13% for the top quartile.”
Stebbins has had to help her district figure out a plan.
After Newsom vetoed a bill in 2022 that would have granted an extension on the seismic retrofit deadline specifically for Alameda Hospital, the hospital system and its partner health care district used parcel tax money to help back a loan.
The cost to retrofit will be about $25 million, and the system is also investing millions more into other projects, such as a new skilled nursing facility. The construction work is set to be completed in 2027.
“No one wants things crashing in an earthquake or anything else, but at the same time, it’s a burden,” Mahler, the Alameda Health System associate chief medical officer, said. “How do we make sure that they get what they need to stay open?”
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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Journalists Talk Obesity, Oximeters, and Severe Weather’s Impact on Public Health
KFF Health News senior fellow and editor-at-large for public health Céline Gounder discussed how best to prepare for a storm on “CBS News 24/7” on Oct. 9.
KFF Health News chief Washington correspondent Julie Rovner discussed obesity on WAMU and NPR’s “1A” on Oct. 9.
KFF Health News senior correspondent Arthur Allen discussed pulse oximeter bias on KCBS Radio on Oct. 7.
- Click here to hear Allen on KCBS Radio
- Read Allen’s “FDA’s Promised Guidance on Pulse Oximeters Unlikely To End Decades of Racial Bias”
KFF Health News contributor Andy Miller discussed the impact of climate change on human health and a potential new hospital in Atlanta for WUGA’s “The Georgia Health Report” on Oct. 4 and Sept. 27, respectively. He also spoke on a panel about climate and public health aired on Atlanta Video Network on Sept. 30.
- Click here to hear Miller talk climate change on “The Georgia Health Report”
- Click here to hear Miller discuss a potential new hospital in Atlanta on “The Georgia Health Report”
- Click here to watch Miller on Atlanta Video Network
KFF Health News correspondent Daniel Chang discussed vaccine misinformation in Florida on Radio Bilingüe’s “Línea Abierta” on Oct. 2.
- Click here to hear Chang on “Línea Abierta”
- Read “Florida’s New Covid Booster Guidance Is Straight-Up Misinformation,” which Chang co-authored with Arthur Allen and Sam Whitehead
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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Fact Sheet: Biden-Harris Administration Takes Action to Ensure Americans Can Access Medical Supplies Following Hurricanes Helene and Milton
El aborto es el tema electoral más importante para las mujeres jóvenes, según una encuesta
El aborto se ha convertido en el tema más importante de las elecciones de noviembre para las mujeres menores de 30 años, según una encuesta de KFF. Se trata de un cambio notable desde finales de la primavera, antes que la vicepresidenta Kamala Harris entrara en la carrera presidencial.Casi 4 de cada 10 mujeres menores de 30 años encuestadas en septiembre y principios de octubre dijeron que el aborto es la cuestión más importante a la hora de emitir su voto. Cuando KFF realizó una encuesta similar entre finales de mayo y principios de junio, sólo el 20% señaló el aborto como un tema muy importante.
La nueva encuesta encontró otros cambios entre las mujeres votantes que pueden beneficiar a Harris, incluyendo un aumento de 24 puntos porcentuales en el número de mujeres que afirmaron estar satisfechas con la elección de sus candidatos y un aumento de 19 puntos en el número de las que dijeron estar más motivadas para votar que en anteriores elecciones presidenciales.
Los cambios sugieren que las mujeres dejaron de apoyar de manera significativa al ex presidente Donald Trump en solo unos meses.
“La situación parece peor para Donald Trump que en junio”, dijo Ashley Kirzinger, directora de metodología de encuestas en KFF, una organización sin fines de lucro sobre información de salud que incluye a KFF Health News. “Que Harris se convirtiera en la candidata presidencial demócrata dinamizó a las mujeres votantes de una forma que la candidatura de Biden no había conseguido”.El presidente Joe Biden abandonó su candidatura a la reelección el 21 de julio, presionado por los líderes del Partido Demócrata y tras una actuación llena de tropiezos en el debate de junio contra Trump, que reavivó las dudas sobre la aptitud del presidente de 81 años para un segundo mandato.
Aunque las mujeres se muestran más entusiastas a la hora de votar por Harris que por Biden, la elección sigue siendo reñida. Harris tiene una ventaja de 2,5 puntos en las encuestas nacionales, según un análisis de FiveThirtyEight. Otros sondeos han detectado una gran división de género en la elección, con una mayoría de mujeres que apoyan a Harris, y una mayoría de hombres que respaldan a Trump.
Harris ha sido durante mucho tiempo una de las principales defensoras del derecho al aborto del Partido Demócrata, y ha atacado a Trump por nombrar para la Corte Suprema a tres jueces conservadores que se sumaron a la sentencia de 2022 que anuló el caso Roe v. Wade, el dictamen histórico de 1973 que garantizó el acceso al aborto a nivel nacional.
Desde entonces, 13 estados han prohibido el aborto con pocas excepciones, según KFF.
Trump defiende que el fallo simplemente devolvió el controversial tema a los estados, y aunque sus posiciones han cambiado a menudo, recientemente ha prometido no convertir en ley una prohibición nacional del aborto. Harris ha repetido que ella firmaría una ley que restableciera el derecho al aborto en todo el país.
El ex presidente ha hecho, en ocasiones, extraños e incómodos llamamientos a las mujeres votantes.
“Estarán protegidas, y yo seré su protector”, dijo Trump, dirigiéndose a las mujeres votantes, en un mitín el 23 de septiembre en Indiana, Pennsylvania. “Las mujeres serán felices, sanas, tendrán seguridad y serán libres. Ya no pensarán en el aborto”.
El sondeo de KFF reveló que Harris le está ganando terreno a Trump entre las mujeres no sólo en materia de aborto —un tema al que el ex presidente trata de restar importancia, reconociendo su peligro político—, sino también en temas económicos, que Trump y sus asesores consideran uno de sus argumentos más sólidos para su regreso a la Casa Blanca.
Múltiples sondeos han mostrado que la economía sigue siendo un tema prioritario en las elecciones, especialmente para las mujeres afroamericanas e hispanas. Un 75% de las encuestadas en el sondeo de KFF dijeron que se preocupan por los gastos del hogar “mucho” o “algo”.
La inflación fue el principal problema para el 36% de las encuestadas del KFF, mientras que el 13% señaló el aborto como su prioridad.
Alrededor del 46% de las mujeres votantes en la nueva encuesta dijeron que confían en Harris sobre Trump para abordar los gastos del hogar, mientras que el 39% confía más en el ex presidente. El 16% dijo que ninguno de los dos.
En la encuesta anterior de KFF realizada con mujeres en primavera, las encuestadas se dividieron casi por igual en cuanto a qué partido confiaban más para abordar el aumento de los costos domésticos. Un 40% dijo que no confiaba en ninguno de los dos partidos.
En cuanto a los costos de salud, Harris mantiene una ventaja significativa sobre Trump en la nueva encuesta, con un 50% que confía más en ella en esta cuestión, un 34% que confía más en Trump y un 16% que no confía en ninguno de los dos.
Kirzinger señaló que las mujeres afroamericanas prefieren especialmente a Harris en cuestiones económicas; por ejemplo, confían en la vicepresidenta 7 a 1 sobre Trump en materia de inflación, dijo.
Más de la mitad de los votantes estadounidenses han sido mujeres en las dos últimas elecciones nacionales, según la Oficina del Censo.
“Un candidato demócrata necesita ganar a las mujeres en tasas muy altas y necesita entusiasmar a la base, que en gran parte está formada por mujeres”, indicó Kirzinger. “Lo que vimos a principios de junio fue que la candidatura de Biden no lo estaba consiguiendo. Ahora parece que la campaña de Harris lo está logrando en una variedad de temas; no se trata sólo del aborto. Es ella como candidata la que entusiasma a las mujeres”.
La encuesta de KFF se realizó desde el 12 de septiembre al 1 de octubre entre 649 mujeres que habían sido encuestadas en primavera, e incluyó una muestra suplementaria de 29 mujeres afroamericanas votantes registradas. El margen de error fue de más o menos 5 puntos.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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Extended-Stay Hotels, a Growing Option for Poor Families, Can Lead to Health Problems for Kids
STONE MOUNTAIN, Ga. — As principal of Dunaire Elementary School, Sean Deas has seen firsthand the struggles faced by children living in extended-stay hotels. About 10% of students at his school, just east of Atlanta, live in one.
The children, Deas said, often have been exposed to violence on hotel properties, exhibit aggression or anxiety from living in a crowded single room, and face food insecurity because some hotel rooms don’t have kitchens.
“Social trauma is the biggest challenge” when students first arrive, Deas said. “We hear a lot about sleep problems.” To meet students’ needs, Deas developed a schoolwide program featuring counselors, a food pantry, and special protocols for handling those who may fall asleep in class.
“Beyond the teaching, there’s a social part,” he said. “We have to find ways to support the families as well.”
Extended-stay hotels are often a last resort for low-income families trying to find housing. Nationally, more than 100,000 students lived in extended-stay hotels in 2022, according to the Department of Education, though officials say that is likely an undercount. Children living in hotels are considered homeless under federal law, and in some Atlanta-area counties about 40% of homeless students live in this kind of housing, according to local officials.
And with rising rents and evictions, and decreased access to federal public housing, the use of extended-stay hotels as a long-term option is becoming more frequent. Like other forms of homelessness, hotel living can lead to — or exacerbate — physical and mental health problems for children, say advocates for families and researchers who study homelessness.
In the Atlanta area, inspections of extended-stay hotels have revealed ventilation issues, insect infestations, mold, and other health threats. Children living there also can experience or witness crime and gun violence. The increasing use of extended-stay hotels is a warning sign, observers said, a reflection of the lack of sufficient affordable housing policy in the U.S.
And the crisis is having “lifelong consequences,” said Sarah Saadian of the National Low Income Housing Coalition. “The only way that we can really address that shortage is if there are significant federal resources at scale. Build more housing and bridge the gap between rents and wages.”
Often, evictions force families into hotels — and can keep them trapped there. Many landlords refuse to rent to people with evictions in their credit history, even if the tenant isn’t responsible for the displacement, said Joy Monroe, founder and CEO of the Single Parent Alliance & Resource Center, or SPARC, a nonprofit group in metro Atlanta that has helped hundreds of families move from hotels to apartments or rental homes.
Black women and other women of color, often with kids, are evicted at much higher rates and are more likely to find themselves living in extended-stay hotels, advocates say.
Some residents are also families fleeing domestic violence, they say.
Hotels often don’t require security deposits, application fees, or background checks, thus providing immediate relief for families seeking shelter. While there are higher-end options, the average rate for an economy-class extended-stay room was $56.68 a night during the first three months of 2024, according to the Highland Group, a research firm that focuses on the hotel sector — which works out to more than $1,700 a month.
And while the rooms offer respite from other forms of homelessness — like sleeping in a car or in a tent — a hotel “is no place to raise children,” said Michael Bryant, CEO of New Life Community Alliance, which helps families in South Dekalb, a part of metro Atlanta, move from hotels to homes.
Children living in hotels are often behind on vaccinations, and they may end up in the emergency room because of delays in care, said Gary Kirkilas, a pediatrician in Phoenix who helps children, teens, and families who are presently homeless or at risk of homelessness. About 75% of children with unstable housing whom he sees have at least one developmental delay, and others experience significant emotional and behavioral issues.
Tanazia Scott, who has bounced between two extended-stay hotels for several months, said her three children “feel depressed and upset” over hotel life.
An eviction sent Kassandra Norman, 58, and her two daughters into a months-long journey of staying in Atlanta-area hotels. For three months, they slept in a car outside a convenience store. “It’s hard to do homework in a car and in the hotel,” said 19-year-old Kazuri Taylor, Norman’s younger daughter.
Some hotels prohibit kids from playing outside in their parking lots, leading to additional stress, advocates say. That was the reason Yvonne Thomas, 45, and her family were evicted from an extended-stay hotel in DeKalb County, she said: “They put us out for nothing.”
And there are other problems. More than a dozen students at Dunaire Elementary live on an extended-stay property called Haven Hotel. In August, DeKalb County’s code enforcement division said the hotel had “not maintained minimum life safety standards.” Roaches and spiders live in rooms and breezeways, according to state health inspection reports. Residents say they have been charged $1 for a roll of toilet paper.
The hotel’s owner and manager could not be reached for comment after multiple attempts.
“No one is talking about these families,” said Sue Sullivan, a community advocate and a volunteer with the Motel to Home coalition in Atlanta, who brings toys, bookbags, food, and toiletries on her hotel visits.
A February public health inspection at another DeKalb County hotel found several rooms with poor ventilation, insect infestation, and mold, among other potential health threats. In May, two people were fatally shot there.
Children who witness violence can develop anxiety, depression, and other disorders, said Charles Moore, director of the Urban Health Initiative at Emory University School of Medicine. “They can feel emotional aftershocks,” said Moore, who has visited Atlanta-area hotels.
Closing such hotels, however, can hurt families, given the shortage of affordable housing, the absence of national federal renter protections, and a dearth of places to go, said Terri Lewinson, an associate professor at the Dartmouth Institute for Health Policy and Clinical Practice. Extended-stay hotels do “offer a low-barrier option for families who have no other options,” she said.
To alleviate the housing problem, county officials and nonprofit organizations around the country have been creatively filling the gap. In the Seattle area, for example, King County officials purchased hotels and converted them into affordable housing, said Mark Skinner of the Highland Group.
In metro Atlanta, SPARC and the local United Way’s Motel to Home offer funding to help people transition into an apartment.
In DeKalb County, where Dunaire Elementary School is located, more than a third of the 1,300 homeless students live in hotels, according to Commissioner Ted Terry.
“I hope we can rescue the children,” he said. “It’s not a safe environment for them.”
Advocates who seek to help people living in hotels propose the construction of more affordable housing and stronger protections for renters against eviction. The federal government has failed to invest in repairs needed to maintain current public housing units, and 25-year-old legislation effectively prohibits the construction of new public housing.
It’s also “extremely fast, easy, and cheap” to evict tenants in Georgia, said Taylor Shelton, an associate professor of geosciences at Georgia State University, whose research focuses on social inequalities and urban spaces. “The playing field is tilted heavily toward landlords.”
Under such circumstances, the cycle of poverty is difficult to break, said Jamie Rush, a senior staff attorney at the Southern Poverty Law Center. “Most parents would want their kids in a safe, stable home,” Rush said. “You can’t budget your way out of poverty.”
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Colorado’s Naloxone Fund Is Drying Up, Even as Opioid Settlement Money Rolls In
DENVER — On a bustling street corner one recent afternoon outside the offices of the Harm Reduction Action Center, employees of the education and advocacy nonprofit handed out free naloxone kits to passersby.
Distributing the opioid reversal medication is essential to the center’s work to reduce fatal overdoses in the community. But how long the group can continue doing so is in question. The center depends on Colorado’s Opioid Antagonist Bulk Purchase Fund, also known as the Naloxone Bulk Purchase Fund, which now lacks a recurring source of money — despite hundreds of millions of dollars in national opioid lawsuit settlement cash flowing into the state.
“Our concern is that we won’t have access to naloxone, and that means that more people will die of a very preventable overdose,” said Lisa Raville, executive director of the center.
The bulk fund was created in 2019 to provide free naloxone to organizations like the Harm Reduction Action Center. The fund’s annual budget grew from just over $300,000 in fiscal year 2019 to more than $8.5 million in fiscal 2022, according to legislative reports by the state’s Overdose Prevention Unit.
The fund has boosted the availability of the medication throughout Colorado, which passed a law in 2013 that gives legal immunity to medical providers who prescribe the drug and to any person who administers it to someone suffering an overdose. The fund currently provides more than $550,000 worth of naloxone kits to various entities each month.
Despite the increased availability of naloxone, fatal opioid overdoses continued to rise. In 2023, 1,292 people in Colorado died of an opioid overdose, according to data from the Colorado Department of Public Health and Environment. That was 132 more people than the year before.
And now, one of the fund’s major money sources, the American Rescue Plan passed by Congress in response to the covid-19 pandemic, is set to expire next year. As of September, the Colorado fund had $8.6 million left, according to Vanessa Bernal, a spokesperson for the state health department.
The fund got a boost in September when the state’s Behavioral Health Administration provided it with $3 million from a one-time Substance Use Prevention, Treatment, and Recovery Services Block Grant and nearly $850,000 through a State Opioid Response Grant. Colorado Attorney General Phil Weiser said his office will “ensure that the necessary budget remains in place for the next year.”
The amount of that funding and where it will come from has yet to be determined, and long-term solutions are still being weighed, as well. One option to shore up the fund beyond the next year is to use Colorado’s share of settlement funds from the national opioid lawsuits, said Mary Sylla, former director of overdose prevention policy and strategy at the National Harm Reduction Coalition.
“It’s just completely ironic that something that addresses the opioid overdose crisis is underfunded at the very same time that these settlement funds are flowing,” Sylla said. “There couldn’t be a better use for them.”
As of July, Colorado had received and distributed more than $110 million in opioid settlement money to regions, local governments, state entities, and infrastructure projects, according to the Colorado attorney general’s office, and the total is expected to reach more than $750 million by 2038.
However, more than half of the settlement money Colorado has received thus far has already been disbursed to its 19 Regional Opioid Abatement Councils, which have created their own plans to distribute money to programs such as substance abuse treatment centers, public education campaigns, and training for emergency providers.
For example, Denver’s council, which has received more than $18 million since 2022, has disbursed money to organizations in two- and three-year contracts, the majority not including the purchase of naloxone.
“We thought we could all continue to get [naloxone] from the state health department and the Naloxone Bulk Purchase Fund,” Raville said.
The Denver council is working on a plan for the coming years, expected to come out in mid-2025, and is considering the bulk fund’s dwindling money, said Marie Curran, program coordinator for Denver’s opioid abatement funds.
Lawrence Pacheco, a spokesperson for the attorney general’s office, which manages 10% of the state’s opioid settlement dollars, said the office “is working on options to ensure that this lifesaving medication can continue to be part of the state’s effort to abate the opioid crisis.” Those options have not yet been made public.
California, where Sylla works, has used settlement money for a distribution program that’s similar to Colorado’s. In Washington and Kentucky, as part of the states’ settlements with Teva Pharmaceuticals, tens of thousands of free naloxone kits will be available to residents. Each state uses its opioid settlement funds differently, and while many provide naloxone to residents in some manner, including via vending machines, there is no central tracking of naloxone distribution programs.
Over the past five years, Colorado’s fund has distributed more than half a million doses of the opioid reversal drug to hundreds of organizations and schools across the state. Last year, the Harm Reduction Action Center received 7,284 doses from the fund, which Raville estimates helped save more than 4,500 lives.
Unless additional money is found, the bulk fund runs the risk of having to further limit distribution, leaving the hundreds of organizations that rely on it with little or no access to free naloxone. While the medication became available over the counter nationally last fall, the $45 price tag per two-dose package means it can remain out of reach for some who need it most.
In May, the state announced a plan for prioritizing which groups get the medication from the bulk fund, with four categories, from “essential” to “low need,” based on how frequently an entity directly encounters people who are most at risk of experiencing or witnessing an overdose. The Harm Reduction Action Center has been classified in the “essential” category. School districts, as well as colleges and universities, are in the next-highest category.
Another organization, The Naloxone Project, said it was misclassified by not being put at the highest priority level. As a result, it said, it received just 1,200 naloxone doses from the fund this year, instead of the 6,000 it requested.
“We would argue that we would fall under ‘essential’ because many of our programs are public-facing and consistently provide naloxone for people who use drugs and who are at the highest risk of experiencing overdose,” said Rachael Duncan, associate director of The Naloxone Project.
The group, which has chapters in 12 states, provides nasal and injectable forms of naloxone to more than 90% of Colorado’s hospitals, to give to patients before they are discharged from the emergency department or from labor and delivery units. More than half of the 12,000 naloxone kits the project has distributed to Colorado medical entities have come from the bulk fund.
Another organization, UCHealth’s Center for Dependency, Addiction and Rehabilitation, known as CeDAR, which offers residential, outpatient, and telehealth treatment, is no longer eligible to receive free naloxone, because its patients typically are insured or can pay out-of-pocket.
Karli Yarnell, a CeDAR physician assistant, said that even when someone can pay for it, that doesn’t mean they can get to a pharmacy to pick up the medicine.
And Duncan is concerned about what the loss of doses will mean for organizations like The Naloxone Project and CeDAR.
“What I fear will happen is a scarcity mindset of organizations competing for funding,” Duncan said. “But I also worry about places that are used to getting it so reliably running out.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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Abortion Emerges as Most Important Election Issue for Young Women, Poll Finds
Abortion has emerged as the most important issue in the November election for women under 30, according to a survey by KFF — a notable change since late spring, before Vice President Kamala Harris entered the presidential race.
Nearly 4 in 10 women under 30 surveyed in September and early October told pollsters that abortion is the most important issue to their vote. Just 20% named abortion as their top issue when KFF conducted a similar survey in late May and early June.
The new survey found other shifts among women voters that stand to benefit Harris, including an increase of 24 percentage points in the number of women who said they were satisfied with their choice of candidates and a 19-point increase in the number who said they were more motivated to vote than in previous presidential elections. The changes suggest a significant setback among women in just a few months for former President Donald Trump.
“It looks worse for Donald Trump than it did back in June,” said Ashley Kirzinger, director of survey methodology at KFF, a health information nonprofit that includes KFF Health News. “Harris becoming the Democratic presidential nominee energized women voters in a way that the Biden candidacy had not.”
President Joe Biden abandoned his reelection bid on July 21, under pressure from Democratic Party leaders, after a stumbling performance in a June debate against Trump that reignited concerns about the 81-year-old’s fitness for a second term.
While women are more enthusiastic about voting for Harris than they were for Biden, the election remains close. Harris has a 2.5-point edge in national polls, according to a FiveThirtyEight analysis. Other polls have found a large gender divide in the election, with a majority of women backing Harris and a majority of men backing Trump.
Harris has long been one of the Democratic Party’s foremost advocates for abortion rights, and she has assailed Trump for appointing three conservative justices to the Supreme Court who joined in the 2022 ruling that overturned Roe v. Wade, the landmark 1973 opinion that guaranteed abortion access nationally. Thirteen states have since banned abortion with few exceptions, according to KFF.
Trump says the ruling merely returned the issue to states, and though his positions have often shifted, he has recently promised not to sign a national abortion ban. Harris says she would sign a law restoring nationwide abortion rights.
The former president has made sometimes awkward appeals to women voters.
“You will be protected, and I will be your protector,” Trump told women voters at a rally Sept. 23 in Indiana, Pennsylvania. “Women will be happy, healthy, confident, and free. You will no longer be thinking about abortion.”
The KFF poll found that Harris is gaining on Trump among women not just on abortion — a subject the former president tries to downplay, acknowledging its political peril — but also on economic issues, which Trump and his advisers regard as among their strongest arguments for his return to the White House.
Multiple polls have shown that the economy remains a top issue in the election, especially for Black and Hispanic women. About 75% of respondents in the KFF survey said they worry about household expenses “a lot” or “some.”
Inflation was the top issue for 36% of KFF survey respondents overall, while 13% identified abortion as their priority.
About 46% of women voters in the new poll said they trust Harris over Trump to address household costs, while 39% trust the former president more. Sixteen percent said neither.
In KFF’s previous poll of women in the spring, respondents were nearly evenly split on which party they trusted more to address rising household costs. About 40% said they trusted neither party.
On health care costs, Harris holds a significant lead over Trump in the new poll, with 50% trusting her more on the issue, 34% trusting Trump more, and 16% trusting neither.
Kirzinger said Black women especially prefer Harris on economic issues; for example, they trust the vice president 7-to-1 over Trump on inflation, she said.
More than half of U.S. voters have been women in the last two national elections, according to the Census Bureau.
“A Democratic candidate needs to win women at very high rates and needs to enthuse the base — which largely consists of women,” Kirzinger said. “What we saw in early June was, the Biden candidacy was not doing that. Now it seems the Harris campaign is doing that in multiple different ways; it’s not just abortion. It’s her as a candidate making women more enthusiastic.”
The KFF poll was conducted Sept. 12 to Oct. 1 among 649 women who had been surveyed in the spring, as well as a supplemental sample of 29 Black women registered voters. The margin of error was plus or minus 5 points.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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Watch: Biggest Dangers and Health Concerns From Hurricane Milton
Some Florida residents riding out Hurricane Milton as it batters the state have medical needs to account for during the storm, such as dialysis treatment or keeping insulin refrigerated amid power outages. On CBS News, Céline Gounder, editor-at-large for public health at KFF Health News, shared advice on how to prepare before a major weather event.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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KFF Health News' 'What the Health?': Yet Another Promise for Long-Term Care Coverage
As part of a media blitz aimed at women voters, Vice President Kamala Harris this week rolled out a plan for Medicare to provide in-home long-term care services. It’s popular, particularly for families struggling to care for both young children and older relatives, but its enormous expense has prevented similar plans from being implemented for decades.
Meanwhile, President Joe Biden called out former President Donald Trump by name for having “led the onslaught of lies” about the federal efforts to help people affected by hurricanes Helene and Milton. Even some Republican officials say the misinformation about hurricane relief efforts is threatening public health.
This week’s panelists are Julie Rovner of KFF Health News, Shefali Luthra of The 19th, Jessie Hellmann of CQ Roll Call, and Joanne Kenen of the Johns Hopkins schools of public health and nursing and Politico.
Panelists Jessie Hellmann CQ Roll Call @jessiehellmann Read Jessie's stories. Joanne Kenen Johns Hopkins University and Politico @JoanneKenen Read Joanne's stories. Shefali Luthra The 19th @shefalil Read Shefali's stories.Among the takeaways from this week’s episode:
- Vice President Kamala Harris’ plan to expand Medicare to cover more long-term care is popular but not new, and in the past has proved prohibitively expensive.
- Former President Donald Trump has abandoned support for a drug price policy he pursued during his first term. The idea, which would lower drug prices in the U.S. to their levels in other industrialized countries, is vehemently opposed by the drug industry, raising the question of whether Trump is softening his hard line on the issue.
- Abortion continues to be the biggest health policy issue of 2024, as Republican candidates — in what seems to be a replay of 2022 — try to distance themselves from their support of abortion bans and other limits. Voters continue to favor reproductive rights, which creates a brand problem for the GOP. Trump’s going back and forth on his abortion positions is an exception to the tack other candidates have taken.
- The Supreme Court returned from its summer break and immediately declined to hear two abortion-related cases. One case pits Texas’ near-total abortion ban against a federal law that requires emergency abortions to be performed in certain cases. The other challenges a ruling earlier this year from the Alabama Supreme Court finding that embryos frozen for in vitro fertilization have the same legal rights as born humans.
- The 2024 KFF annual employer health benefits survey, released this week, showed a roughly 7% increase in premiums, with average family premiums now topping $25,000 per year. And that’s with most employers not covering two popular but expensive medical interventions: GLP-1 drugs for weight loss and IVF.
Also this week, excerpts from a KFF lunch with “Shark Tank” panelist and generic drug discounter Mark Cuban, who has been consulting with the Harris campaign about health care issues.
Plus, for “extra credit,” the panelists suggest health policy stories they read this week they think you should read, too:
Julie Rovner: KFF Health News’ “A Boy’s Bicycling Death Haunts a Black Neighborhood. 35 Years Later, There’s Still No Sidewalk,” by Renuka Rayasam and Fred Clasen-Kelly.
Shefali Luthra: The 19th’s “Arizona’s Ballot Measure Could Shift the Narrative on Latinas and Abortion,” by Mel Leonor Barclay.
Jessie Hellmann: The Assembly’s “Helene Left Some NC Elder-Care Homes Without Power,” by Carli Brosseau.
Joanne Kenen: The New York Times’ “Her Face Was Unrecognizable After an Explosion. A Placenta Restored It,” by Kate Morgan.
Also mentioned on this week’s podcast:
- The New York Times’ “Biden Accuses Trump of ‘Outright Lies’ About Hurricane Response,” by Michael D. Shear.
- The Miami Herald’s “Florida Threatens To Prosecute TV Stations Over Abortion Ad. FCC Head Calls It ‘Dangerous,’” by Claire Healy and Ana Ceballos.
- KFF’s “2024 Employer Health Benefits Survey.”
To hear all our podcasts, click here.
And subscribe to KFF Health News’ “What the Health?” on Spotify, Apple Podcasts, Pocket Casts, or wherever you listen to podcasts.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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Cash Shortages and Complex Rules Impede Native American Health-Care Access
Each year, the Indian Health Service rejects tens of thousands of requests to fund outside care that it doesn’t provide, forcing patients to go without treatment or pay big medical bills themselves.
The IHS is supposed to provide free care to Native Americans, but it does so only at scattered clinics and hospitals the agency funds and then manages or turns over to tribes to operate. Many of those are in rural areas and offer limited services. They might not provide cancer treatment or pregnancy care, for example.
That’s where the agency’s Purchased/Referred Care program is supposed to come in.
But funding shortages, complex rules and administrative fumbles impede access to the program, my colleague Katheryn Houghton and I reported after speaking with patients, elected officials and people who work with the federal agency.
Native Americans qualify for the referred-care program if they live on tribal land — only 13 percent do — or within their tribe’s “delivery area,” which usually includes surrounding counties. Those who live in another delivery area are eligible in some cases.
Jonni Kroll, a member of the Little Shell Tribe of Chippewa Indians of Montana, doesn’t qualify, because she lives in Washington state, nearly 400 miles from her tribe’s headquarters.
Tying program eligibility to tribal lands, Kroll said, echoes old government policies meant to keep Indigenous people in one place, even if it means reduced access to jobs, education and health care.
“What do we do? Sell our homes, leave our families and our jobs?” she said.
What about eligible Native Americans? They aren’t guaranteed funding or timely help. Some of the IHS’s 170 units exhaust their annual pool of referred-care funding or reserve it for the most serious medical concerns.
In fiscal 2022, for example, the program denied or deferred nearly $552 million in spending for about 120,000 requests from eligible patients.
Connie Brushbreaker, a member of the Rosebud Sioux Tribe in South Dakota, has been denied or wait-listed for funding at least 14 times since 2018. In March, she received a letter saying her referred-care program is reserved for patients at imminent risk of dying. It doesn’t make sense to her that the agency refuses to pay for treatment that will be approved once a health problem becomes more serious and expensive.
Another obstacle is the estimated 34 percent of program staffing positions that are vacant.
Multiple patients told us that staff rarely pick up the phone or return messages, or that they share confusing information about eligibility and the application process.
Brendan White, an agency spokesperson, said improving the referred-care program is a top IHS goal. He said about 83 percent of the health units it manages have approved all eligible funding requests this year.
The agency is tackling staff shortages and recently improved how funding is prioritized, he said. The IHS is also studying whether it can afford to create statewide eligibility in the Dakotas.
But many advocates say the only way to improve the referred-care program is to fully fund it — or even better, fully fund the IHS so patients don’t need as much outside care in the first place.
This article is not available for syndication due to republishing restrictions. If you have questions about the availability of this or other content for republication, please contact NewsWeb@kff.org.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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HHS Office for Civil Rights Secures Agreement with the State of Maryland to Make Programs More Accessible for Persons with Disabilities
Incluso los rivales políticos coinciden en que es urgente resolver el problema de la deuda médica
Mientras temas candentes de atención médica como el aborto y la Ley de Cuidado de la Salud a Bajo Precio (ACA) agitan la carrera presidencial, silenciosamente, en las legislaturas estatales de todo el país, demócratas y republicanos han estado trabajando juntos para abordar la crisis de la deuda médica en la nación.
Desde 2021, en más de 20 estados se han promulgado nuevas leyes para frenar la facturación abusiva de los hospitales, ampliar la atención caritativa a los pacientes con ingresos más bajos y frenar a los recaudadores de deudas.
Los demócratas impulsaron la mayoría de las medidas. Pero estas iniciativas legislativas a menudo fueron aprobadas también con el apoyo de los republicanos. Incluso, en algunos estados, los legisladores republicanos lideraron los proyectos para ampliar la protección a los pacientes.
“Independientemente de cuál sea su partido político, independientemente de su origen… cualquier procedimiento médico importante puede llevar a las personas a la bancarrota”, dijo en una entrevista el presidente de la Cámara de Representantes de Florida, Paul Renner, un republicano conservador. “Este es un problema real”.
Renner, que ha liderado controversiales medidas para frenar el derecho al aborto y ampliar la pena de muerte en Florida, también encabezó este año un proyecto para limitar los casos en los que los hospitales podían enviar las cuentas impagas de los pacientes a agencias de cobros. Obtuvo el apoyo unánime de la Legislatura de Florida.
Las medidas bipartidistas adoptadas en otros estados han ido más lejos, prohibiendo que estas facturas médicas figuren en los informes crediticios de los consumidores y restringiendo la posibilidad de que los proveedores médicos embarguen las viviendas de los pacientes.
Según KFF Health News, unas 100 millones de personas en el país están agobiadas por algún tipo de deuda relacionada con la atención médica, lo que obliga a millones a utilizar sus ahorros, pedir segundas hipotecas o recortar los gastos en alimentos y otros artículos de primera necesidad. Una cuarta parte de quienes tienen deudas debían más de $5.000 en 2022.
“En la Legislatura, los republicanos parecen más abiertos a proteger a la gente de la deuda médica que de cualquier otro tipo de deuda”, opinó Marceline White, directora ejecutiva de Economic Action Maryland, una organización sin fines de lucro que ayudó a liderar los esfuerzos en ese estado para detener a los proveedores médicos que pretendían embargar los salarios de los pacientes de bajos ingresos. El proyecto de ley recibió el apoyo unánime de demócratas y republicanos.
“Parece existir un amplio consenso en que no se debe perder la casa o los ahorros de toda la vida por haberse enfermado”, dijo White. “Es un nivel básico de justicia”.
La deuda médica sigue siendo un tema controversial en Washington, donde la administración Biden ha impulsado varias iniciativas para abordar el problema, incluida una propuesta de reglamentación por parte de la Oficina de Protección Financiera del Consumidor (CFPB), que prohibiría que cualquier deuda médica aparezca en los informes de crédito de los consumidores.
La vicepresidenta Kamala Harris, que encabeza la iniciativa del gobierno contra la deuda médica, se ha referido a estas iniciativas en la campaña presidencial. Harris también ha pedido que se refuercen las medidas para ayudar a millones de estadounidenses a pagar su deuda médica.
El ex presidente Donald Trump no suele hablar de la deuda médica cuando hace campaña. Pero los congresistas republicanos han criticado la propuesta de la CFPB, que el presidente del Comité de Servicios Financieros de la Cámara, Patrick McHenry (del Comité Nacional Republicano), calificó de “extralimitación regulatoria”.
Sin embargo, el encuestador Michael Perry, que ha investigado ampliamente lo que opinan los estadounidenses sobre la atención médica, comentó que los votantes conservadores, que suelen desconfiar del gobierno, parecen ver la deuda médica de otra manera. “Creo que sienten que está todo tan en su contra que ellos, como pacientes, realmente no tienen voz”, explicó. “Las divisiones políticas que normalmente vemos, en esta cuestión simplemente no están presentes”.
Cuando los defensores de los consumidores de Arizona propusieron en las boletas electorales de 2022 una medida para limitar los tipos de interés de las deudas médicas, el 72% de los votantes se pronunció a favor de la iniciativa.
Del mismo modo, encuestas a nivel nacional han revelado que más del 80% de los republicanos y demócratas respaldan la implementación de límites en los cobros de deudas médicas y que se fijen requisitos más estrictos para que los hospitales ofrezcan ayuda financiera a los pacientes.
Perry sacó a relucir otro factor que puede estar impulsando el interés de ambos partidos por la deuda médica: la creciente desconfianza de los ciudadanos a medida que los sistemas de salud se hacen más grandes y actúan como grandes corporaciones. “Los hospitales ya no son lo que eran”, dijo. “Eso está dejando claro que el lucro y la codicia son los que están dirigiendo gran parte de la toma de decisiones”.
No obstante, no todos los esfuerzos estatales para hacer frente a la deuda médica han obtenido un amplio apoyo tanto de demócratas como de republicanos.
El año pasado, cuando Colorado se convirtió en el primer estado que prohibió la inclusión de las deudas médicas en los informes de crédito de los residentes, sólo un legislador republicano respaldó la medida.
Y en Minnesota un proyecto de ley similar se aprobó este año sin un solo voto del Partido Republicano.
En otros lugares, medidas igual de estrictas se han aprobado sin inconvenientes.
Por ejemplo en Illinois, este año, se votó por unanimidad en el senado estatal, y se aprobó por 109 votos a favor y dos en contra en la Cámara de Representantes, un proyecto de ley que prohíbe el reporte de deuda médica en los informes de crédito.
En Rhode Island ningún legislador del Partido Republicano se opuso a la prohibición del reporte de crédito.
Finalmente, cuando la Legislatura de California examinó un proyecto de ley de 2021 para exigir a los hospitales del estado que proporcionen más asistencia financiera a los pacientes, la propuesta fue aprobada por 72 votos a favor y ninguno en contra en la Asamblea estatal y por 39 a 0 en el Senado.
Incluso algunos estados conservadores, como Oklahoma, han tomado medidas, aunque más modestas. Una nueva ley prohíbe a los proveedores médicos reclamar deudas a los pacientes si no han hecho públicas sus tarifas. La resolución, firmada por el gobernador republicano del estado, fue apoyada por unanimidad.
Steve Neville, senador republicano por Nuevo México, que respaldó una ley para restringir los cobros abusivos a pacientes de bajos ingresos en ese estado, dijo que simplemente estaba siendo pragmático.
“No era muy beneficioso dedicar mucho tiempo a intentar cobrar a pacientes indigentes”, dijo Neville. “Si no tienen dinero, no tienen dinero”. Tres de los 12 senadores republicanos apoyaron la medida.
El tesorero estatal de Carolina del Norte, Dale Folwell, republicano que como legislador estatal encabezó en 2012 un intento para prohibir el matrimonio entre personas del mismo sexo, dijo que todos los funcionarios electos, sin que importe su partido, deberían preocuparse por el modo en que las deudas médicas están afectando a los pacientes.
“No importa si, como conservador, estoy diciendo estas cosas, o si Bernie Sanders está diciendo estas mismas cosas”, dijo Folwell, en referencia al senador liberal de Vermont. “Al fin y al cabo, todos deberíamos asumir la responsabilidad de defender a aquellos que permanecen invisibles ante la sociedad”.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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Older Men’s Connections Often Wither When They’re on Their Own
At age 66, South Carolina physician Paul Rousseau decided to retire after tending for decades to the suffering of people who were seriously ill or dying. It was a difficult and emotionally fraught transition.
“I didn’t know what I was going to do, where I was going to go,” he told me, describing a period of crisis that began in 2017.
Seeking a change of venue, Rousseau moved to the mountains of North Carolina, the start of an extended period of wandering. Soon, a sense of emptiness enveloped him. He had no friends or hobbies — his work as a doctor had been all-consuming. Former colleagues didn’t get in touch, nor did he reach out.
His wife had passed away after a painful illness a decade earlier. Rousseau was estranged from one adult daughter and in only occasional contact with another. His isolation mounted as his three dogs, his most reliable companions, died.
Rousseau was completely alone — without friends, family, or a professional identity — and overcome by a sense of loss.
“I was a somewhat distinguished physician with a 60-page resume,” Rousseau, now 73, wrote in the Journal of the American Geriatrics Society in May. “Now, I’m ‘no one,’ a retired, forgotten old man who dithers away the days.”
In some ways, older men living alone are disadvantaged compared with older women in similar circumstances. Research shows that men tend to have fewer friends than women and be less inclined to make new friends. Often, they’re reluctant to ask for help.
“Men have a harder time being connected and reaching out,” said Robert Waldinger, a psychiatrist who directs the Harvard Study of Adult Development, which has traced the arc of hundreds of men’s lives over a span of more than eight decades. The men in the study who fared the worst, Waldinger said, “didn’t have friendships and things they were interested in — and couldn’t find them.” He recommends that men invest in their “social fitness” in addition to their physical fitness to ensure they have satisfying social interactions.
Slightly more than 1 in every 5 men ages 65 to 74 live alone, according to 2022 Census Bureau data. That rises to nearly 1 in 4 for those 75 or older. Nearly 40% of these men are divorced, 31% are widowed, and 21% never married.
That’s a significant change from 2000, when only 1 in 6 older men lived by themselves. Longer life spans for men and rising divorce rates are contributing to the trend. It’s difficult to find information about this group — which is dwarfed by the number of women who live alone — because it hasn’t been studied in depth. But psychologists and psychiatrists say these older men can be quite vulnerable.
When men are widowed, their health and well-being tend to decline more than women’s.
“Older men have a tendency to ruminate, to get into our heads with worries and fears and to feel more lonely and isolated,” said Jed Diamond, 80, a therapist and the author of “Surviving Male Menopause” and “The Irritable Male Syndrome.”
Add in the decline of civic institutions where men used to congregate — think of the Elks or the Shriners — and older men’s reduced ability to participate in athletic activities, and the result is a lack of stimulation and the loss of a sense of belonging.
Depression can ensue, fueling excessive alcohol use, accidents, or, in the most extreme cases, suicide. Of all age groups in the United States, men over age 75 have the highest suicide rate, by far.
For this column, I spoke at length to several older men who live alone. All but two (who’d been divorced) were widowed. Their experiences don’t represent all men who live alone. But still, they’re revealing.
The first person I called was Art Koff, 88, of Chicago, a longtime marketing executive I’d known for several years. When I reached out in January, I learned that Koff’s wife, Norma, had died the year before, leaving him hobbled by grief. Uninterested in eating and beset by unremitting loneliness, Koff lost 45 pounds.
“I’ve had a long and wonderful life, and I have lots of family and lots of friends who are terrific,” Koff told me. But now, he said, “nothing is of interest to me any longer.”
“I’m not happy living this life,” he said.
Nine days later, I learned that Koff had died. His nephew, Alexander Koff, said he had passed out and was gone within a day. The death certificate cited “end stage protein calorie malnutrition” as the cause.
The transition from being coupled to being single can be profoundly disorienting for older men. Lodovico Balducci, 80, was married to his wife, Claudia, for 52 years before she died in October 2023. Balducci, a renowned physician known as the “patriarch of geriatric oncology,” wrote about his emotional reaction in the Journal of the American Geriatrics Society, likening Claudia’s death to an “amputation.”
“I find myself talking to her all the time, most of the time in my head,” Balducci told me in a phone conversation. When I asked him whom he confides in, he admitted, “Maybe I don’t have any close friends.”
Disoriented and disorganized since Claudia died, he said his “anxiety has exploded.”
We spoke in late February. Two weeks later, Balducci moved from Tampa to New Orleans, to be near his son and daughter-in-law and their two teenagers.
“I am planning to help as much as possible with my grandchildren,” he said. “Life has to go on.”
Verne Ostrander, a carpenter in the small town of Willits, California, about 140 miles north of San Francisco, was reflective when I spoke with him, also in late February. His second wife, Cindy Morninglight, died four years ago after a long battle with cancer.
“Here I am, almost 80 years old — alone,” Ostrander said. “Who would have guessed?”
When Ostrander isn’t painting watercolors, composing music, or playing guitar, “I fall into this lonely state, and I cry quite a bit,” he told me. “I don’t ignore those feelings. I let myself feel them. It’s like therapy.”
Ostrander has lived in Willits for nearly 50 years and belongs to a men’s group and a couples’ group that’s been meeting for 20 years. He’s in remarkably good health and in close touch with his three adult children, who live within easy driving distance.
“The hard part of living alone is missing Cindy,” he told me. “The good part is the freedom to do whatever I want. My goal is to live another 20 to 30 years and become a better artist and get to know my kids when they get older.”
The Rev. Johnny Walker, 76, lives in a low-income apartment building in a financially challenged neighborhood on Chicago’s West Side. Twice divorced, he’s been on his own for five years. He, too, has close family connections. At least one of his several children and grandchildren checks in on him every day.
Walker says he had a life-changing religious conversion in 1993. Since then, he has depended on his faith and his church for a sense of meaning and community.
“It’s not hard being alone,” Walker said when I asked whether he was lonely. “I accept Christ in my life, and he said that he would never leave us or forsake us. When I wake up in the morning, that’s a new blessing. I just thank God that he has brought me this far.”
Waldinger recommended that men “make an effort every day to be in touch with people. Find what you love — golf, gardening, birdwatching, pickleball, working on a political campaign — and pursue it,” he said. “Put yourself in a situation where you’re going to see the same people over and over again. Because that’s the most natural way conversations get struck up and friendships start to develop.”
Rousseau, the retired South Carolina doctor, said he doesn’t think about the future much. After feeling lost for several years, he moved across the country to Jackson, Wyoming, in the summer of 2023. He embraced solitude, choosing a remarkably isolated spot to live — a 150-square-foot cabin with no running water and no bathroom, surrounded by 25,000 undeveloped acres of public and privately owned land.
“Yes, I’m still lonely, but the nature and the beauty here totally changed me and focused me on what’s really important,” he told me, describing a feeling of redemption in his solitude.
Rousseau realizes that the death of his parents and a very close friend in his childhood left him with a sense of loss that he kept at bay for most of his life. Now, he said, rather than denying his vulnerability, he’s trying to live with it. “There’s only so long you can put off dealing with all the things you’re trying to escape from.”
It’s not the life he envisioned, but it’s one that fits him, Rousseau said. He stays busy with volunteer activities — cleaning tanks and running tours at Jackson’s fish hatchery, serving as a part-time park ranger, and maintaining trails in nearby national forests. Those activities put him in touch with other people, mostly strangers, only intermittently.
What will happen to him when this way of living is no longer possible?
“I wish I had an answer, but I don’t,” Rousseau said. “I don’t see my daughters taking care of me. As far as someone else, I don’t think there’s anyone else who’s going to help me.”
We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care, and advice you need in dealing with the health care system. Visit kffhealthnews.org/columnists to submit your requests or tips.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
USE OUR CONTENTThis story can be republished for free (details).
Watch: ‘Breaking the Silence Is a Step’ — Beyond the Lens of ‘Silence in Sikeston’
KFF Health News Midwest correspondent Cara Anthony took a reporting trip to the small southeastern Missouri city of Sikeston and heard a mention of its hidden past. That led her on a multiyear reporting journey to explore the connections between a 1942 lynching and a 2020 police killing there — and what they say about the nation’s silencing of racial trauma. Along the way, she learned about her own family’s history with such trauma.
This formed the multimedia “Silence in Sikeston” project from KFF Health News, Retro Report, and WORLD as told through a documentary film, educational videos, digital articles, and a limited-series podcast. Hear about Anthony’s journey and join this conversation about the toll of racialized violence on our health and our communities.
Explore more of the “Silence in Sikeston”project:
LISTEN: The limited-series podcast is available on PRX, Apple Podcasts, Spotify, iHeart, or wherever you get your podcasts.
- Episode 1: “Racism Can Make You Sick”
- Episode 2: “Hush, Fix Your Face”
- Episode 3: “Trauma Lives in the Body”
- Episode 4: “Is There a Cure for Racism”
WATCH: The documentary film “Silence in Sikeston,” a co-production of KFF Health News and Retro Report, is now available to stream on WORLD’s YouTube channel, WORLDchannel.org, and the PBS app.
READ: KFF Health News Midwest correspondent Cara Anthony wrote an essay about what her reporting for this project helped her learn about her own family’s hidden past.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
USE OUR CONTENTThis story can be republished for free (details).
Montana Looks To Fast-Track Medicaid Access for Older Applicants
Montana lawmakers are looking to fast-track Medicaid coverage for older adults who need help with daily life. LISTEN here:
Montana is looking to fast-track Medicaid access for older adults who need help to stay in their homes or towns.
Medicaid, the joint federal-state health care program for low-income Americans, opens the door to services such as paying for help to prepare meals or shower safely. But applying for and obtaining that coverage can take weeks or months, leaving aging people in a dangerous limbo: too vulnerable to live at home without assistance, but too healthy to merit a hospital or nursing home bed.
Montana lawmakers drafted a bill for the legislative session that begins in January that would create a shortcut to that care. The Children, Families, Health, and Human Services Interim Committee’s proposal would allow older people and those with a physical disability who are likely eligible for Medicaid to start receiving in-home and community-based care while awaiting final approval.
The goal of presumptive eligibility is to avoid delays in providing stabilizing care outside of medical facilities. Supporters of the plan say local care is also a lot less expensive than hospital or nursing home care.
Montana would join at least 11 states that have presumptive eligibility for seniors and people with disabilities to access in-home care, according to AARP. Washington state began expediting Medicaid coverage in 2023 for people recently discharged from a hospital and plans to expand coverage further. Rhode Island authorizes such benefits to new long-term care applicants. And a law signed last winter in New Jersey means seniors there will have similar access.
People who are hospitalized or checked into a nursing home can struggle to find the middle-ground option for care they need.
Katy Mack, a spokesperson for the Montana Hospital Association, said bottlenecks in the process are difficult for patients, long-term care providers, and hospitals.
“Many elderly patients do ‘get stuck’ in hospitals waiting for transfer to a more appropriate level of care,” Mack said in an email. “This is due to a variety of issues, including staffing, bed availability, and appropriate payments from the patient’s source of health coverage.”
Tyler Amundson, executive director of Big Sky Senior Services, a nonprofit that helps seniors stay in their home, said in one case, a couple without the support they needed ended up in the hospital dozens of times over two months.
“There are a lot of seniors in our community struggling,” Amundson said. “They’ll go home from a hospital with just enough care to get by for a little while.”
The nation’s pool of older Americans is getting bigger. With age comes more medical complications. People 65 or older have the highest rate of preventable hospitalizations, and medical emergencies risk worse health outcomes.
Rising health care costs are fueling anxiety among tens of millions of seniors, with 1 in 10 living below the federal poverty level. Older adults are struggling to pay the combined cost of housing and medical care, and some become homeless.
For years, states have had the option through the Affordable Care Act to allow qualified hospitals to extend presumptive eligibility to some adults based on their income, on top of the opportunity that most states give pregnant women and children. But in states such as Montana, people 65 and older haven’t been included. States need a federal waiver to expand who qualifies for that early access.
Alice Burns, who researches Medicaid issues at KFF, a health information nonprofit that includes KFF Health News, said widening presumptive eligibility for in-home and community-based care gained momentum during the covid-19 pandemic.
“It’s easy to understand why,” Burns said. “When we had the fatality rates in nursing facilities that we did, it was like, OK, we cannot send these people to the nursing facilities unnecessarily.”
The Montana proposal would, after state training, allow tribal entities, area agencies on aging, and hospitals, among others, to screen patients for presumptive eligibility. Approved patients would begin receiving services while state health officials review their applications.
The draft bill spells out some covered services, such as meal delivery and in-home medical equipment. Lawmakers noted it’s not clear if the proposal would help people move into long-term care, such as assisted living facilities, which offer daily support rather than medical treatment.
Montana officials don’t have an estimate for how much the temporary coverage would cost. Jon Ebelt, a spokesperson for the Montana Department of Public Health and Human Services, declined to comment on the proposal.
Mike White is a co-owner of Caslen Living Centers, which has six small assisted living facilities across central and southwestern Montana. His company no longer accepts Medicaid applicants until their coverage is final, and White said it’s not alone. He said that process can take anywhere from three to six months due to cumbersome paperwork, which he said is too long for small businesses to go without pay.
State officials have said delays in Medicaid approval often stem from ongoing communication with applicants.
The state’s Medicaid program has gone through major upheaval in the past year as states nationwide reviewed eligibility for everyone on the program. Montana officials dropped more than 115,300 people from coverage in that process, according to the state’s final report. Those disenrollments continued as nonprofits and patients alike cited problems in the state’s process, including delays in application processing and access to help for other safety net services.
Now, state lawmakers predict a major political fight during the legislative session over whether to continue to allow expanded Medicaid access to people who earn up to 138% of the federal poverty level, or about $43,000 a year for a family of four.
State Rep. Mike Yakawich, the Billings Republican behind the presumptive eligibility proposal, said he wants to keep some of its language vague. He’s leaving room for negotiations and potential amendments during the legislative session and beyond.
“The focus is to keep people at home, and it’s still going to be a hard lift to get it past the session,” Yakawich said. “We can add more to it two years from now.”
Not everyone on the interim committee was on board.
Sen. Daniel Emrich, a Republican from Great Falls, voted against the policy, saying it sounded too much like a gamble for families.
“We run the risk of taking and providing a service that’s then going to be pulled out from under them,” Emrich said.
The counterargument is that such cases would be rare. Burns, with KFF, said there is no reliable data nationally to show how often people are denied Medicaid after being presumed eligible. Presumptive access to Medicaid in-home programs is relatively new. And, from hospital data for other patients, it’s difficult to know whether a person was denied Medicaid because they didn’t qualify or because they didn’t complete the paperwork after leaving the hospital.
“There’s all these places where the ball could get dropped,” Burns said.
She said the difference with measures like Montana’s is that support services follow patients in their daily life, making it less likely patients would fall off the radar.
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Happening in Springfield: New Immigrants Offer Economic Promise, Health System Challenges
When Republican vice presidential candidate JD Vance claimed Haitian immigrants had caused infectious-disease rates to “skyrocket” in Springfield, Ohio, local health commissioner Chris Cook checked the records.
They showed that in 2023, for example, there were four active tuberculosis cases in Clark County, which includes Springfield, up from three in 2022. HIV cases had risen, but sexually transmitted illnesses overall were decreasing.
“I wouldn’t call it skyrocketing,” said Cook, noting that there were 190 active cases in 2023 in all of Ohio. “You hear the rhetoric. But as a whole, reportable infectious diseases to the health department are decreasing.”
Tensions are running high in this industrial town of about 58,000 people. Bomb threats closed schools and public buildings after GOP presidential nominee Donald Trump falsely claimed that Haitian immigrants — who he alleged were there illegally — were stealing and eating household pets. City and county officials disputed the claims the former president levied during his Sept. 10 debate with Vice President Kamala Harris, his Democratic opponent.
Trump was amplifying comments made by Vance that — along with his claims about the immigration status of this population — were broadly panned as false. When asked during a CNN interview about the debunked pet-eating rumor, Vance, a U.S. senator from Ohio, acknowledged that the image he created was based not on facts but on “firsthand accounts from my constituents.” He said he was willing “to create” stories to focus attention on how immigration can overrun communities.
But Ohio Gov. Mike DeWine, also a Republican, has said immigrants have been an economic boon to Springfield. Many began arriving because businesses in the town, which had seen its population decrease, needed labor.
Largely lost in the political rancor is the way Springfield and the surrounding area responded to the influx of Haitian immigrants. Local health institutions tried to address the needs of this new population, which had lacked basic public health care such as immunization and often didn’t understand the U.S. health system.
The town is a microcosm of how immigration is reshaping communities throughout the United States. In the Springfield area, Catholic charities, other philanthropies, volunteers, and county agencies have banded together over the past three to four years to tackle the challenge and connect immigrants who have critical health needs with providers and care.
For instance, a community health center added Haitian Creole interpreters. The county health department opened a refugee health testing clinic to provide immunizations and basic health screenings, operating on such a shoestring budget that it’s open only two days a week.
And a coalition of groups to aid the Haitian community was created about two years ago to identify and respond to immigrant community needs. The group meets once a month with about 55 or 60 participants. On Sept. 18, about a week after Trump ramped up the furor at the debate, a record 138 participants joined in.
“We have all learned the necessity of collaboration,” said Casey Rollins, director of Springfield’s St. Vincent de Paul, a nonprofit Catholic social services organization that has become a lifeline for many of the town’s Haitian immigrants. “There’s a lot of medical need. Many of the people have high blood pressure, or they frequently have diabetes.”
Several factors have led Haitians to leave their Caribbean country for the United States, including a devastating earthquake in 2010, political unrest after the 2021 assassination of Haiti’s president, and ongoing gang violence. Even when health facilities in the country are open, it can be too treacherous for Haitians to travel for treatment.
“The gangs typically leave us alone, but it’s not a guarantee,” said Paul Glover, who helps oversee the St. Vincent’s Center for children with disabilities in Haiti. “We had a 3,000-square-foot clinic. It was destroyed. So was the X-ray machine. People have been putting off health care.”
An estimated 12,000 to 15,000 Haitian immigrants live in Clark County, officials said. About 700,000 Haitian immigrants lived in the United States in 2022, according to U.S. Census data.
Those who have settled in the Springfield area are generally in the country legally under a federal program that lets noncitizens temporarily enter and stay in the United States under certain circumstances, such as for urgent humanitarian reasons, according to city officials.
The influx of immigrants created a learning curve for hospitals and primary care providers in Springfield, as well as for the newcomers themselves. In Haiti, people often go directly to a hospital to receive care for all sorts of maladies, and county officials and advocacy groups said many of the immigrants were unfamiliar with the U.S. system of seeing primary care doctors first or making appointments for treatment.
Many sought care at Rocking Horse Community Health Center, a nonprofit, federally qualified health center that provides mental health, primary, and preventive care to people regardless of their insurance status or ability to pay. Federally qualified health centers serve medically underserved areas and populations.
The center treated 410 patients from Haiti in 2022, up more than 250% from 115 in 2021, according to Nettie Carter-Smith, the center’s director of community relations. Because the patients required interpreters, visits often stretched twice as long.
Rocking Horse hired patient navigators fluent in Haitian Creole, one of the two official languages of Haiti. Its roving purple bus provides on-site health screenings, vaccinations, and management of chronic conditions. And this school year, it’s operating a $2 million health clinic at Springfield High.
Many Haitians in Springfield have reported threats since Trump and Vance made their town a focus of the campaign. Community organizations were unable to identify any immigrants willing to be interviewed for this story.
Hospitals have also felt the impact. Mercy Health’s Springfield Regional Medical Center also saw a rapid influx of patients, spokesperson Jennifer Robinson said, with high utilization of emergency, primary care, and women’s health services.
This year, hospitals also have seen several readmissions for newborns struggling to thrive as some new mothers have trouble breastfeeding or getting supplemental formula, county officials said. One reason: New Haitian immigrants must wait six to eight weeks to get into a program that provides supplemental food for low-income pregnant, breastfeeding, or non-breastfeeding postpartum women, as well as for children and infants.
At Kettering Health Springfield, Haitian immigrants come to the emergency department for nonemergency care. Nurses are working on two related projects, one focusing on cultural awareness for staff and another exploring ways to improve communication with Haitian immigrants during discharge and in scheduling follow-up appointments.
Many of the immigrants are able to get health insurance. Haitian entrants generally qualify for Medicaid, the state-federal program for the low-income and disabled. For hospitals, that means lower reimbursement rates than with traditional insurance.
During 2023, 60,494 people in Clark County were enrolled in Medicaid, about 25% of whom were Black, according to state data. That’s up from 50,112 in 2017, when 17% of the enrollees were Black. That increase coincides with the rise of the Haitian population.
In September, DeWine pledged $2.5 million to help health centers and the county health department meet the Haitian and broader community’s needs. The Republican governor has pushed back on the recent national focus on the town, saying the spread of false rumors has been hurtful for the community.
Ken Gordon, a spokesperson for the Ohio Department of Health, acknowledged the difficulties Springfield’s health systems have faced and said the department is monitoring to avert potential outbreaks of measles, whooping cough, and even polio.
People diagnosed with HIV in the county increased from 142 residents in 2018 to 178 to 2022, according to state health department data. Cook, the Clark County health commissioner, said the data lags by about 1.5 years.
But Cook said, “as a whole, all reportable infections to the health department are not increasing.” Last year, he said, no one died of tuberculosis. “But 42 people died of covid.”
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 CONTENTThis story can be republished for free (details).