Midwest Bureau Archives - KFF Health News https://kffhealthnews.org/topics/states/midwest-bureau/ Tue, 15 Oct 2024 19:56:30 +0000 en-US hourly 1 https://wordpress.org/?v=6.5.5 https://kffhealthnews.org/wp-content/uploads/sites/2/2023/04/kffhealthnews-icon.png?w=32 Midwest Bureau Archives - KFF Health News https://kffhealthnews.org/topics/states/midwest-bureau/ 32 32 161476233 Older Men’s Connections Often Wither When They’re on Their Own https://kffhealthnews.org/news/article/older-men-connections-isolation-loneliness-navigating-aging/ Thu, 10 Oct 2024 09:00:00 +0000 https://kffhealthnews.org/?post_type=article&p=1917945 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.

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]]> 1917945 Happening in Springfield: New Immigrants Offer Economic Promise, Health System Challenges https://kffhealthnews.org/news/article/springfield-ohio-haitian-immigrants-trump-vance/ Thu, 10 Oct 2024 09:00:00 +0000 https://kffhealthnews.org/?post_type=article&p=1927089 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.

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]]> 1927089 Watch: ‘Breaking the Silence Is a Step’ — Beyond the Lens of ‘Silence in Sikeston’ https://kffhealthnews.org/news/article/watch-beyond-the-lens-silence-in-sikeston/ Thu, 10 Oct 2024 09:00:00 +0000 https://kffhealthnews.org/?post_type=article&p=1928306 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.

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.

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]]> 1928306 Silence in Sikeston: Is There a Cure for Racism? https://kffhealthnews.org/news/podcast/is-there-a-cure-for-racism/ Tue, 08 Oct 2024 09:00:00 +0000 https://kffhealthnews.org/?p=1910343&post_type=podcast&preview_id=1910343 SIKESTON, Mo. — In the summer of 2021, Sikeston residents organized the biggest Juneteenth party in the city’s history. Sikeston police officers came too, both to provide security for the event and to try to build bridges with the community. But after decades of mistrust, some residents questioned their motives. 

In the series finale of the podcast, a confident, outspoken Sikeston teenager shares her feelings in an uncommonly frank conversation with Chief James McMillen, head of Sikeston’s Department of Public Safety, which includes Sikeston police. 

Host Cara Anthony asks what kind of systemic change is possible to reduce the burden of racism on the health of Black Americans. Health equity expert Gail Christopher says it starts with institutional leaders who recognize the problem, measure it, and take concrete steps to change things. 

“It is a process, and it’s not enough to march and get a victory,” Christopher said. “We have to transform the systems of inequity in this country.” 

Host

Cara Anthony Midwest correspondent, KFF Health News @CaraRAnthony Read Cara's stories Cara is an Edward R. Murrow and National Association of Black Journalists award-winning reporter from East St. Louis, Illinois. Her work has appeared in The New York Times, Time magazine, NPR, and other outlets nationwide. Her reporting trip to the Missouri Bootheel in August 2020 launched the “Silence in Sikeston” project. She is a producer on the documentary and the podcast’s host.

In Conversation With …

Gail Christopher Public health leader and health equity expert  click to open the transcript Transcript: Is There a Cure for Racism?

Editor’s note: If you are able, we encourage you to listen to the audio of “Silence in Sikeston,” which includes emotion and emphasis not found in the transcript. This transcript, generated using transcription software, has been edited for style and clarity. Please use the transcript as a tool but check the corresponding audio before quoting the podcast. 

[Ambient sounds from Sikeston, Missouri’s 2021 Juneteenth celebration — a DJ making an announcement over funky music, people chatting — begin playing.] 

Cara Anthony: It’s 2021. It’s hot and humid. We’re at a park in the heart of Sunset — Sikeston, Missouri’s historically Black neighborhood. 

Emory: Today is Juneteenth, baby. 

Cara Anthony: The basketball courts are jumping. And old-school funk is blaring from the speakers. Kids are playing. 

Cara Anthony: [Laughter] Are you enjoying the water?  

Cara Anthony: People are lining up for barbecue. 

I’ve been here reporting on the toll racism and violence can take on a community’s health. But today, I’m hoping to capture a little bit of Sikeston’s joy.  

Taneshia Pulley: When I look out to the crowd of my people, I see strength. I see power. I just see all magic. 

Cara Anthony: I drift over to a tent where people are getting their blood pressure, weight, and height checked … health screenings for free. 

Cara Anthony: I’m a journalist. 

Community Health Worker: Ooooh! Hi! Hi! 

Cara Anthony: The ladies working the booth are excited I’m there to report on the event. 

Cara Anthony: OK, and I’m a health journalist. 

Community health worker: Baby, that’s what I told them. Yeah, she healthy. [Laughter] 

[Dramatic instrumental music plays.] 

Cara Anthony: This Juneteenth gathering is happening a little over a year after Sikeston police officers shot and killed 23-year-old Denzel Taylor. 

We made a documentary about Denzel’s death and the death of another young Black man — also killed in Sikeston. 

Denzel was shot by police. Nearly 80 years earlier, Cleo Wright was lynched by a white mob. 

Both were killed before they got their day in court. 

In these years of reporting, what I’ve found is that many Black families worry that their kids don’t have an equal chance of growing up healthy and safe in Sikeston. 

[Dramatic instrumental ends.] 

Rosemary Owens: Being Black in the Bootheel can get you killed at any age. 

Cara Anthony: That’s Rosemary Owens. She raised her children here in Southeast Missouri. 

Cara Anthony: About 10 Sikeston police officers showed up to Juneteenth — for security and to connect with the community. Some are in uniform; some are in plain clothes. 

Rosemary has her doubts about why they came today. 

Cara Anthony: You see the police chief talking to people. What’s going through your mind as you see them milling about? 

Rosemary Owens: I hope they are real and wanting to close the gap between the African Americans and the white people. 

Anybody can come out and shake hands. But at the end of the day, did you mean what you said? Because things are still going on here in Sikeston, Missouri. 

Cara Anthony: For Rosemary, this brings to mind an encounter with the police from years ago. 

[Slow, minor, instrumental music plays softly.] 

When her son was maybe 16 years old, she says, she and her sister gave their boys the keys to their new cars — told them they could hang out in them. 

Rosemary had gotten her new car for Mother’s Day. 

Rosemary Owens: A brand-new red Dodge Caravan. We, we knew the boys were just going from the van to the car. You know, just showing out — they were boys. They weren’t driving. 

Cara Anthony: Someone nearby saw the boys …  

Rosemary Owens: … called and told the police that two Black men were robbing cars. 

 When the boys saw the police come up, there was three police cars. So they were like, something’s going on. So their intention, they were like, they were trying to run to us. And my brother said, stop. When they looked back, when the police got out of the car, they already had their guns drawn on my son and my nephew.  Cara Anthony: That’s what Rosemary thinks about when she sees Sikeston police at Juneteenth. 

[Slow, minor, instrumental music ends.] 

[“Silence in Sikeston” theme song plays.]  Cara Anthony: In this podcast series, we’ve talked about some of the ways racism makes Black people sick. But Juneteenth has me thinking about how we get free — how we STOP racism from making us sick. 

The public health experts say it’s going to take systemwide, institutional change. 

In this episode, we’re going to examine what that community-level change looks like — or at least what it looks like to make a start. 

From WORLD Channel and KFF Health News, distributed by PRX, this is “Silence in Sikeston.” 

Episode 4 is our final episode: “Is There a Cure for Racism?” 

[“Silence in Sikeston” theme song ends.] 

James McMillen: How you doing? 

Juneteenth celebration attendee: Good. Good.  

James McMillen: Good to see you, man.  

Juneteenth celebration attendee: What’s up? How are you?   

Cara Anthony: When I spot Sikeston’s director of public safety in his cowboy hat, sipping soda from a can, I head over to talk.  James McMillen: Well, you know, I just, I, I’m glad to be … on the inside of this. 

Cara Anthony: James McMillen leads the police department. He says he made it a point to come to Juneteenth. And he encouraged his officers to come, too. 

James McMillen: I remember as being a young officer coming to work here, not knowing anybody, driving by a park and seeing several Black people out there. And I remember feeling, you know, somewhat intimidated by that. And I don’t really know why. 

I hadn’t always been, um, that active in the community. And, um, I, I have been the last several years and I’m just wanting to teach officers to do the same thing. 

Cara Anthony: The chief told me showing up was part of his department’s efforts to repair relations with Sikeston’s Black residents. 

James McMillen: What’s important about this is, being out here and actually knowing people, I think it builds that trust that we need to have to prevent and solve crimes. 

Cara Anthony: A few minutes into our conversation, I notice a teenager and her friend nearby, listening. 

Cara Anthony: Yeah, we have two people who are watching us pretty closely. Come over here. Come over here. Tell us your names. 

Lauren: My name is Lauren. 

Michaiahes: My name is Michaiahes. 

Cara Anthony: Yeah. And what are you all … ? 

James McMillen: I saw you over there. 

Cara Anthony: So, what do you think about all of this?  

Michaiahes: Personally, I don’t even know who this is because I don’t mess with police because, because of what’s happened in the past with the police. But, um … 

Cara Anthony: As she starts to trail off, I encourage her to keep going. 

Cara Anthony: He’s right here. He’s in charge of all of those people. 

Michaiahes: Well, in my opinion, y’all should start caring about the community more. 

Cara Anthony: What are you hearing? She’s speaking from the heart here, Chief. What are you hearing? 

James McMillen: Well, you know what? I agree with everything she said there. 

Cara Anthony: She’s confident now, looking the chief in the eye. 

Michaiahes: And let’s just be honest: Some of these police officers don’t even want to be here today. They’re just here to think they’re doing something for the community. 

James McMillen: Let’s be honest. Some of these are assumptions that y’all are making about police that y’all don’t really know. 

[Subtle propulsive music begins playing.] 

Michaiahes: If we seen you protecting community, if we seen you doing what you supposed to do, then we wouldn’t have these assumptions about you. 

James McMillen: I just want to say that people are individuals. We have supervisors that try to keep them to hold a standard. And you shouldn’t judge the whole department, but, but just don’t judge the whole department off of a few. No more than I should judge the whole community off of a few. 

Cara Anthony: But here’s the thing … in our conversations over the years, Chief McMillen has been candid with me about how, as a rookie cop, he had judged Sikeston’s Black residents based on interactions with just a few. 

James McMillen: Some of, um, my first calls in the Black community were dealing with, obviously, criminals, you know? So if first impressions mean anything, that one set a bad one. I had, um, really unfairly judging the whole community based on the few interactions that I had, again, with majority of criminals. 

Cara Anthony: The chief says he’s moved past that way of thinking and he’s trying to help his officers move past their assumptions. 

And he told me about other things he wants to do …  

Hire more Black officers. Invest in racial-bias awareness education for the department. And open up more lines of communication with the community. 

James McMillen: I know that we are not going to see progress or we’re not going to see success without a little bit of pain and discomfort on our part. 

Cara Anthony: I don’t think I’ve ever heard the chief use the term institutional change, but the promises and the plans he’s making sound like steps in that direction. 

Except … here’s something else the chief says he wants …  

[Subtle propulsive music ends with a flourish.] 

James McMillen: As a police officer, I would like to hear more people talk about, um, just complying with the officer. 

Cara Anthony: That phrase is chilling to me. 

[Quiet, dark music starts playing.] 

When I hear “just comply” … a litany of names cross my mind. 

Philando Castile. 

Sonya Massey. 

Tyre Nichols. 

Cara Anthony: After Denzel Taylor was killed, people felt unsafe. I talked to a lot of residents on the record about them feeling like they didn’t know if they could be next. 

One thing that you told me was, like, well, one thing that people can do is comply with the officers, you know, if they find themselves having an interaction with law enforcement. 

James McMillen: Well, I mean, I think that’s, that’s a good idea to do. 

And if the person is not complying, that officer has got to be thinking, is this person trying to hurt me? So, asking people to comply with the officer’s command — that’s a reasonable statement. 

Cara Anthony: But, it’s well documented: Black Americans are more likely than our white peers to be perceived as dangerous by police. 

That perception increases the chances we’ll be the victim of deadly force. Whether we comply — or not. 

[Quiet, dark music ends.] 

That’s all to say … even with the promise of more Black officers in Sikeston and all the chief’s other plans, I’m not sure institutional change in policing is coming soon to Sikeston. 

[Sparse electronic music starts playing.] 

Cara Anthony: I took that worry to Gail Christopher. She has spent her long career trying to address the causes of institutional racism. 

Cara Anthony: We’ve been calling most of our guests by their first name, but what’s your preference? I don’t want to get in trouble with my mom on this, you know? [Cara laughs.] 

Gail Christopher: If you don’t mind, Dr. Christopher is good. 

Cara Anthony: OK. All right. That sounds good. I’m glad I asked. 

Cara Anthony: Dr. Christopher thinks a lot about the connections between race and health. And she’s executive director of the National Collaborative for Health Equity. Her nonprofit designs strategies for social change. 

She says the way to think about starting to fix structural racism … is to think about the future. 

Gail Christopher: What do you want for your daughter? What do I want for my children? I want them not to have interactions with the police, No. 1, right? 

Uh, so I want them to have safe places to be, to play, to be educated … equal access to the opportunity to be healthy. 

Cara Anthony: But I wonder if that future is even possible. 

[Sparse electronic music ends.] 

Cara Anthony: Is there a cure for racism? And I know it’s not that simple, but is there a cure? 

Gail Christopher: I love the question, right? And my answer to you would be yes. It is a process, and it’s not enough to march and get a victory. We have to transform the systems of inequity in this country. 

Cara Anthony: And Dr. Christopher says it is possible. Because racism is a belief system. 

[Hopeful instrumental music plays.] 

Gail Christopher: There is a methodology that’s grounded in psychological research and social science for altering our beliefs and subsequently altering our behaviors that are driven by those beliefs. 

Cara Anthony: To get there, she says, institutions need a rigorous commitment to look closely at what they are doing — and the outcomes they’re creating. 

Gail Christopher: Data tracking and monitoring and being accountable for what’s going on. 

We can’t solve a problem if we don’t admit that it exists. 

Cara Anthony: One of her favorite examples of what it looks like to make a start toward systemic change comes from the health care world. 

I know we’ve been talking about policing so far, but — bear with me here — we’re going to pivot to another way institutional bias kills people. 

A few years ago, a team of researchers at the Brigham and Women’s Hospital in Boston reviewed admission records for patients with heart failure. They found that Black and Latinx people were less likely than white patients to be admitted to specialized cardiology units. 

Gail Christopher: Without calling people racist, they saw the absolute data that showed that, wait a minute, we’re sending the white people to get the specialty care and we’re not sending the people of color. 

Cara Anthony: So, Brigham and Women’s launched a pilot program. 

When a doctor requests a bed for a Black or Latinx patient with heart failure, the computer system notifies them that, historically, Black and Latinx patients haven’t had equal access to specialty care. 

The computer system then recommends the patient be admitted to the cardiology unit. It’s still up to the doctor to actually do that. 

The hard data’s not published yet, but we checked in with the hospital, and they say the program seems to be making a difference. 

Gail Christopher: It starts with leadership. Someone in that system has the authority and makes the decision to hold themselves accountable for new results. 

[Hopeful instrumental music ends.] 

Cara Anthony: OK, so it could be working at a hospital. Let’s shift back to policing now. 

Gail Christopher: There should be an accountability board in that community, a citizens’ accountability board, where they are setting measurable and achievable goals and they are holding that police department accountable for achieving those goals. 

Cara Anthony: But, like, do Black people have to participate in this? Because we’re tired. 

Gail Christopher: Listen, do I know that we’re tired! Am I tired? After 50 years? Uh, I think that there is work that all people have to do. This business of learning to see ourselves in one another, to be fully human — it’s all of our work. 

[Warm, optimistic instrumental music plays.] 

Now, does that preclude checking out at times and taking care of yourself? I can’t tell you how many people my age who are no longer alive today, who were my colleagues and friends in the movement. But they died prematurely because of this lack of permission to take care of ourselves. 

Cara Anthony: Rest when you need to, she says, but keep going. 

Gail Christopher: We have to do that because it is our injury. It is our pain. And I think we have the stamina and the desire to see it change. 

Cara Anthony: Yep. Heard. It’s all of our work. 

Dr. Christopher has me thinking about all the Black people in Sikeston who aren’t sitting around waiting for someone else to change the institutions that are hurting them. 

People protested when Denzel Taylor was killed even with all the pressure to stay quiet about it. 

Protesters: Justice for Denzel on 3. 1, 2, 3 … Justice for Denzel! Again! 1, 2, 3 …  Justice for Denzel! 

Cara Anthony: And I’m thinking about the people who were living in the Sunset neighborhood of Sikeston in 1942 when Cleo Wright was lynched. 

Harry Howard: They picked up rocks and bricks and crowbars and just anything to protect our community. 

Cara Anthony: And Sunset did not burn. 

[Warm, optimistic instrumental music begins fading out.] 

[Piano starts warming up.] 

Cara Anthony: After nearly 80 years of mostly staying quiet about Cleo’s lynching, Sikeston residents organized a service to mark what happened to him — and their community. 

Reverend: We are so honored and humbled to be the host church this evening for the remembrance and reconciliation service of Mr. Cleo Wright. 

[Piano plays along with Pershard singing.] 

Pershard Owens: [Singing] It’s been a long, long time coming, but I know a change gonna come, oh yes it will. It’s been too hard a-livin but I’m afraid to die and I don’t know what’s up next, beyond the sky … 

[Pershard singing and piano accompaniment fade out.] 

Cara Anthony: I want to introduce you to that guy who was just singing then. His name is Pershard Owens. 

Remember Rosemary Owens? The woman who told us about someone calling the police on her son and nephew when they were playing with their parents’ new cars? Pershard is Rosemary’s younger son. 

Pershard Owens: Yeah, I definitely remember that. 

Cara Anthony: Even after all this time, other people didn’t want to talk to us about it. We couldn’t find news coverage of the incident. But Pershard remembers. He was in his weekly karate practice when it happened. He was 10 or 11 years old. 

Pershard Owens: My brother and cousin were, like, they were teens. So what do you think people are going to feel about the police when they do that, no questions asked, just guns drawn? 

Cara Anthony: Pershard’s dad works as a police officer on a different police force in the Bootheel. Pershard knows police. But that didn’t make it any less scary for him. 

Pershard Owens: You know, my parents still had to sit us down and talk and be like, “Hey, this is, that’s not OK, but you can’t, you can’t be a victim. You can’t be upset.” That’s how I was taught. So we acknowledge the past. But we don’t, we don’t stay down. 

Cara Anthony: So years later, when Chief James McMillen started a program as a more formal way for people in Sikeston and the police to build better relationships, Pershard signed up. They started meeting in 2020. 

The group is called Police and Community Together, or PACT for short. 

  [Sparse, tentative music begins playing.] 

Pershard Owens: It was a little tense that first couple of meetings because nobody knew what it was going to be. 

Cara Anthony: This was only five months after Sikeston police killed Denzel Taylor. 

PACT is not a citizens’ accountability board. The police don’t have to answer to it. 

The committee met every month. For a while. But they haven’t met in over a year now. 

Pershard Owens: We would have steps forward and then we would have three steps back. 

Cara Anthony: People have different accounts for why that is. Busy schedules. Mutual suspicion. Other things police officers have done that shook the trust of Black residents in Sikeston. 

Pershard Owens: And people were like, bro, like, how can you work with these people? 

The community is like, I can’t fully get behind it because I know what you did to my little cousin and them. Like, I know what the department did back in, you know, 15 years ago, and it’s hard to get past that. 

So, I mean, I’m getting both sides, like, constantly, and listen, that is, that is tough. 

[Sparse, tentative music ends.] 

Cara Anthony: But Pershard says something important changed because he started working with PACT. 

Pershard Owens: Chief did not like me at first [Pershard laughs]. He did not. 

Chief didn’t … me and Chief did not see eye to eye. Because he had heard things about me and he — people had told him that I was, I was anti-police and hated police officers, and he came in with a defense up. 

So, it took a minute for me and him to, like, start seeing each other in a different way. But it all happened when we sat down and had a conversation. 

[Slow instrumental music begins playing.] 

Cara Anthony: Just have a conversation. It sounds so simple; you’re probably rolling your eyes right now hearing it. 

But Pershard says … it could be meaningful. 

Pershard Owens: I truly want and believe that we can be together and we can work together and we can have a positive relationship where you see police and y’all dap each other up and y’all legit mean it. I think that can happen, but a lot of people have to change their mindsets. 

Cara Anthony: That’s a challenge Pershard is offering to police AND community members: Have a conversation with someone different from you. See if that changes the way you think about the person you’re talking to. See if it changes your beliefs. 

The more people do that, the more systems can change. 

Pershard Owens: We got to look in the mirror and say, “Am I doing what I can to try and change the dynamic of Sikeston, even if it does hurt?” 

Cara Anthony: Pershard says he’s going to keep putting himself out there. He ran for City Council in 2021. And even though he lost, he says he doesn’t regret it. 

Pershard Owens: When you’re dealing with a place like Sikeston, it’s not going to change overnight. 

Cara Anthony: And he’s glad he worked with PACT. Even if the community dialogue has fizzled for now, he’s pleased with the new relationship he built with Chief McMillen. And all of this has broadened his view of what kind of change is possible. 

[Slow instrumental music ends.] 

Pershard Owens: If you want something that has never been done, you have to go places that you’ve never been. 

[“Silence in Sikeston” theme music plays.] 

Cara Anthony: Places that you’ve never been … stories that you’ve never told out loud … maybe all of that helps build a Sikeston where Black residents can feel safer. Where Black people can live healthier lives. 

A world you might not be able to imagine yet, but one that could exist for the next generation. 

[“Silence in Sikeston” theme music ends.] 

[Upbeat instrumental music plays.] 

Cara Anthony: Thanks for listening to “Silence in Sikeston.” 

Next, go watch the documentary — it’s a joint production from Retro Report and KFF Health News, presented in partnership with WORLD. 

Subscribe to WORLD Channel on YouTube. That’s where you can find the film “Silence in Sikeston,” a Local, USA special. 

If you made it this far, thank you. Let me know how you’re feeling. 

I’d love to hear more about the conversations this podcast has sparked in your life. Leave us a voicemail at (202) 654-1366. 

And thanks to everyone in Sikeston for sharing your stories with us. 

This podcast is a co-production of WORLD Channel and KFF Health News and distributed by PRX. 

It was produced with support from PRX and made possible in part by a grant from the John S. and James L. Knight Foundation. 

This audio series was reported and hosted by me, Cara Anthony. 

Audio production by me, Zach Dyer. And me, Taylor Cook. 

Editing by me, Simone Popperl. 

And me, managing editor Taunya English. 

Sound design, mixing, and original music by me, Lonnie Ro. 

Podcast art design by Colin Mahoney and Tania Castro-Daunais. 

Tarena Lofton and Hannah Norman are engagement and social media producers for the show. 

Oona Zenda and Lydia Zuraw are the landing page designers. 

Lynne Shallcross is the photo editor, with photography from Michael B. Thomas. 

Thank you to vocal coach Viki Merrick. 

And thank you to my parents for all their support over the four years of this project. 

Music in this episode is from Epidemic Sound and Blue Dot Sessions. 

Some of the audio you heard across the podcast is also in the film. 

For that, special thanks to Adam Zletz, Matt Gettemeier, Roger Herr, and Philip Geyelin. 

Kyra Darnton is executive producer at Retro Report. 

I was a producer on the film. 

Jill Rosenbaum directed the documentary. 

Kytja Weir is national editor at KFF Health News. 

WORLD Channel’s editor-in-chief and executive producer is Chris Hastings. 

Help us get the word out about “Silence in Sikeston.” Write a review or give us a quick rating wherever you listen to this podcast. 

Thank you! It makes a difference. 

Oh yeah! And tell your friends in real life too!  

[Upbeat instrumental music ends.] 

Credits

Taunya English Managing editor @TaunyaEnglish Taunya is deputy managing editor for broadcast at KFF Health News, where she leads enterprise audio projects. Simone Popperl Line editor @simoneppprl Simone is broadcast editor at KFF Health News, where she shapes stories that air on Marketplace, NPR, and CBS News Radio, and she co-manages a national reporting collaborative. Zach Dyer Senior producer @zkdyer Zach is senior producer for audio with KFF Health News, where he supervises all levels of podcast production. Taylor Cook Associate producer @taylormcook7 Taylor is an independent producer who does research, books guests, contributes writing, and fact-checks episodes for several KFF Health News podcasts. Lonnie Ro Sound designer @lonnielibrary Lonnie Ro is an audio engineer and a composer who brings audio stories to life through original music and expert sound design for platforms like Spotify, Audible, and KFF Health News.

Additional Newsroom Support

Lynne Shallcross, photo editorOona Zenda, illustrator and web producerLydia Zuraw, web producerTarena Lofton, audience engagement producer Hannah Norman, video producer and visual reporter Chaseedaw Giles, audience engagement editor and digital strategistKytja Weir, national editor Mary Agnes Carey, managing editor Alex Wayne, executive editorDavid Rousseau, publisher Terry Byrne, copy chief Gabe Brison-Trezise, deputy copy chief Tammie Smith, communications officer 

The “Silence in Sikeston” podcast is a production of KFF Health News and WORLD. Distributed by PRX. Subscribe and listen on Apple Podcasts, Spotify, Amazon Music, iHeart, or wherever you get your podcasts.

Watch the accompanying documentary from WORLD, Retro Report, and KFF here.

To hear other KFF Health News podcasts, click 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.

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]]> 1910343 Even Political Rivals Agree That Medical Debt Is an Urgent Issue https://kffhealthnews.org/news/article/medical-debt-bipartisan-issue-urgent/ Mon, 07 Oct 2024 09:00:00 +0000 https://kffhealthnews.org/?post_type=article&p=1921871 While hot-button health care issues such as abortion and the Affordable Care Act roil the presidential race, Democrats and Republicans in statehouses around the country have been quietly working together to tackle the nation’s medical debt crisis.

New laws to curb aggressive hospital billing, to expand charity care for lower-income patients, and to rein in debt collectors have been enacted in more than 20 states since 2021.

Democrats championed most measures. But the legislative efforts often passed with Republican support. In a few states, GOP lawmakers led the push to expand patient protections.

“Regardless of their party, regardless of their background … any significant medical procedure can place people into bankruptcy,” Florida House Speaker Paul Renner, a conservative Republican, said in an interview. “This is a real issue.”

Renner, who has shepherded controversial measures to curb abortion rights and expand the death penalty in Florida, this year also led an effort to limit when hospitals could send patients to collections. It garnered unanimous support in the Florida Legislature.

Bipartisan measures in other states have gone further, barring unpaid medical bills from consumer credit reports and restricting medical providers from placing liens on patients’ homes.

About 100 million people in the U.S. are burdened by some form of health care debt, forcing millions to drain savings, take out second mortgages, or cut back on food and other essentials, KFF Health News has found. A quarter of those with debt owed more than $5,000 in 2022.

“Republicans in the legislature seem more open to protecting people from medical debt than from other kinds of debt,” said Marceline White, executive director of Economic Action Maryland, which helped lead efforts in that state to stop medical providers from garnishing the wages of low-income patients. That bill drew unanimous support from Democrats and Republicans

“There seems to be broad agreement that you shouldn’t lose your home or your life savings because you got ill,” White said. “That’s just a basic level of fairness.”

Medical debt remains a more polarizing issue in Washington, where the Biden administration has pushed several efforts to tackle the issue, including a proposed rule by the Consumer Financial Protection Bureau, or CFPB, to bar all medical debt from consumer credit reports.

Vice President Kamala Harris, who is spearheading the administration’s medical debt campaign, has touted the work on the presidential campaign trail while calling for new efforts to retire health care debt for millions of Americans.

Former President Donald Trump doesn’t typically talk about medical debt while stumping. But congressional Republicans have blasted the CFPB proposal, which House Financial Services Committee Chairman Patrick McHenry (R-N.C.) called “regulatory overreach.”

Nevertheless, pollster Michael Perry, who has surveyed Americans extensively about health care, said that conservative voters typically wary of government seem to view medical debt through another lens. “I think they feel it’s so stacked against them that they, as patients, don’t really have a voice,” he said. “The partisan divides we normally see just aren’t there.”

When Arizona consumer advocates put a measure on the ballot in 2022 to cap interest rates on medical debt, 72% of voters backed the initiative.

Similarly, nationwide polls have found more than 80% of Republicans and Democrats back limits on medical debt collections and stronger requirements that hospitals provide financial aid to patients.

Perry surfaced something else that may be driving bipartisan interest in medical debt: growing mistrust as health systems get bigger and act more like major corporations. “Hospitals aren’t what they used to be,” he said. “That is making it clear that profit and greed are driving lots of the decision-making.”

Not every state effort to address medical debt has garnered broad bipartisan support.

When Colorado last year became the first state to bar medical debt from residents’ credit reports, just one Republican lawmaker backed the measure. A Minnesota bill that did the same thing this year passed without a single GOP vote.

But elsewhere, similarly tough measures have sailed through.

A 2024 Illinois bill to bar credit reporting for medical debt passed unanimously in the state Senate and cleared the House of Representatives 109-2. In Rhode Island, not a single GOP lawmaker opposed a credit reporting ban.

And when the California Legislature took up a 2021 bill to require hospitals in the state to provide more financial assistance to patients, it passed 72-0 in the state Assembly and 39-0 in the Senate.

Even some conservative states, such as Oklahoma, have taken steps, albeit more modest. A new law there bars medical providers from pursuing patients for debts if the provider has not publicly posted its prices. The measure, signed by the state’s Republican governor, passed unanimously.

New Mexico state Sen. Steve Neville, a Republican who backed legislation to restrict aggressive collections against low-income patients in that state, said he was simply being pragmatic.

“There was not much advantage to spending a lot of time trying to do collections on indigent patients,” Neville said. “If they don’t have the money, they don’t have the money.” Three of 12 GOP senators supported the measure.

North Carolina state Treasurer Dale Folwell, a Republican who as a state legislator spearheaded a 2012 effort to ban same-sex marriage, said all elected officials, no matter their party, should care about what medical debt is doing to patients.

“It doesn’t matter if, as a conservative, I’m saying these things, or if Bernie Sanders is saying these things,” Folwell said, referencing Vermont’s liberal U.S. senator. “At the end of the day, it should be all our jobs to advocate for the invisible.”

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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]]> 1921871 Trump Leads, and His Party Follows, on Vaccine Skepticism https://kffhealthnews.org/news/article/trump-vaccine-skepticism-mandates-republican-platform/ Fri, 04 Oct 2024 09:00:00 +0000 https://kffhealthnews.org/?post_type=article&p=1921479 More than four years ago, former President Donald Trump’s administration accelerated the development and rollout of the covid-19 vaccine. The project, dubbed Operation Warp Speed, likely saved millions of lives. But a substantial number of Republican voters now identify as vaccine skeptics — and Trump rarely mentions what’s considered one of the great public health accomplishments in recent memory.

“The Republicans don’t want to claim it,” Trump told an interviewer in late September.

Instead, on at least 17 occasions this year, Trump has promised to cut funding to schools that mandate vaccines. Campaign spokespeople have previously said that pledge would apply only to schools with covid mandates. But speeches reviewed by KFF Health News included no such distinction — raising the possibility Trump would also target vaccination rules for common, potentially lethal childhood diseases like polio and measles.

The Trump campaign did not respond to requests for comment on this article.

Trump has presided over a landslide shift in his party’s views on vaccines, reflected this campaign season in false claims by Republican candidates during the primaries and puzzling conspiracies from prominent conservative voices. Republicans increasingly express worry about the risks of vaccines. A September 2023 poll from Politico and Morning Consult showed a narrow majority of those voters cared more about the risks than the benefits of getting inoculated.

A surge in anti-vaccine policy in statehouses has followed the rhetoric. Boston University political scientist Matt Motta, who tracks public health policy, said preliminary data shows that states enacted at least 42 anti-vaccine bills in 2023 — nearly a ninefold surge since 2019.

In some states, it has the look of a crusade: The 2024 Texas GOP platform, for example, proposes a ban on mRNA technology, the innovation behind some covid-19 vaccines that scientists believe could have significant applications for cancer care.

Last month, Trump made an appeal to anti-vaccine voters by landing the endorsement of Robert F. Kennedy Jr., one of the nation’s most prominent vaccine skeptics — and appointing him to his transition team. In a recent tour with former Fox News broadcaster Tucker Carlson, Kennedy said he was “going to be deeply involved in helping to choose the people who run FDA, NIH, and CDC.”

Trump’s outreach can be more discreet: He recently met with a delegation of vaccine-skeptical activists — including one group pushing an end to mandates and certain types of vaccines — at his New Jersey golf club; the discussion was publicized by the conservative blog “Gateway Pundit.”

Trump has options in advancing anti-vaccine goals as president, such as by sowing further doubt and undermining the federal government’s ability to make vaccine recommendations. He has promised to appoint Kennedy, along with “top experts,” to a panel exploring chronic diseases, some of which Kennedy’s nonprofit has linked to inoculations. “Nobody’s done more” to advocate for “the health of our families and our children,” Trump declared at a rally accepting Kennedy’s endorsement.

Still, it’s hard to tell how Trump’s most frequently made proposal — defunding schools that mandate vaccinations — would translate into action, said Judith Winston, former general counsel of the Department of Education during the Obama administration.

Currently, the Department of Education lacks the power to turn off public school funding all at once, she said — meaning a second Trump administration would have to take away money program by program.

And the legal basis for such a move isn’t clear. “I am unaware of any federal law that mandates school districts either provide or not provide a vaccine,” Winston said, adding it would probably require congressional action.

All 50 states have a vaccine requirement tied to school attendance.

Trump’s outreach to anti-vaccine constituencies comes as vaccine hesitancy increases and preventable disease surges. This summer, Oregon experienced its worst outbreak of measles since 1991.

The situation could get worse, said Tom Frieden, a former director of the Centers for Disease Control and Prevention: In the Nineties, during a time when vaccine skepticism also proliferated, the U.S. saw thousands of measles cases. According to the CDC, we haven’t yet returned to those bad old days — but the number of measles cases recorded this year is already quadruple that of last year.

“It was highly disruptive,” he said. “Many children who had measles ended up with hearing problems or cognitive problems that were lifelong. A small number died in this country.”

Worldwide, the disease killed over 100,000 in 2022, mostly among children under age 5, according to the World Health Organization.

Polling shows a substantial minority of Americans, concentrated in the Republican Party, hold vaccine-skeptical positions, said Harvard professor and health politics expert Robert Blendon. And skepticism about covid vaccines is blossoming into suspicion of vaccines generally among that group, he said. “It follows from this rebellion against the covid vaccine mandates.”

Vaccine opposition has divided the GOP. Florida Gov. Ron DeSantis made opposition to vaccines a core part of his ill-fated campaign for the GOP presidential nomination. In states such as Wyoming and Missouri, pitched primary campaigns centered on anti-vaccine themes this year.

Bob Onder, a physician and Republican candidate for Congress in Missouri, was accused in Facebook ads placed by his top opponent of taking millions from pharmaceutical companies to test vaccines. “He profited from our pain,” one ad said. “You suffered the consequences.”

Onder “has never done covid vaccine research” and opposes covid vaccine mandates, his campaign manager, Charley Lovett, told KFF Health News. (Lovett said Onder “conducted” one study sponsored by AstraZeneca on preventing covid in high-risk patients using monoclonal antibodies, not vaccines.)

Onder won the Republican primary, but his vaccine-disparaging opponent still scored just over 37% of the vote.

Anti-vaccine candidates typically become anti-vaccine policymakers. The impact can be seen in Texas, where vaccine politics were once a bipartisan matter. According to researchers, from 2009 to 2019, legislators there passed 19 pro-vaccine bills, such as a measure allowing pharmacists to administer immunizations.

But that consensus began to shift toward the end of the decade. Small groups, often nurtured on Facebook, made their influence felt. One such group, Texans for Vaccine Choice, spurred testimony before the state legislature in 2021 and targeted pro-immunization legislators, some of whom fell in their GOP primaries.

Misinformation has fueled the anti-vaccine turn in Texas, alongside traditional conservative attitudes about individual autonomy, said Summer Wise, a former executive committee member of the state’s Republican Party — particularly misconceptions about the use of fetal cells in vaccine development; falsified research about a link between vaccines and autism; and conspiracy theories about Bill Gates, the billionaire philanthropist who has championed vaccination.

“Politicians see vaccines as an easy foil to propagate fear among the electorate, which can then be leveraged and directed to control a voting bloc,” Wise said.

In addition to calling for a ban on mRNA technology, the Texas GOP’s 2024 platform features a laundry list of policies that could undermine vaccination, including allowing medical residents and physicians the ability to opt out of administering shots for religious reasons. It also calls for enshrining a patient’s ability to opt out of vaccine mandates in the state’s Bill of Rights.

Nationally, anti-immunization policies could take an aggressive turn under a second Trump administration.

Roger Severino, formerly head of the Department of Health and Human Services’ Office of Civil Rights and now with the Heritage Foundation, penned the health agency section of Project 2025, the Heritage Foundation-led initiative to plan for a Republican administration.

Among other ideas, the document proposes clipping CDC authority to issue vaccine or quarantine guidance of a “prescriptive” nature, targeted at schools or elsewhere.

A spokesperson for the Heritage Foundation noted Severino has said the agency’s credibility has been hurt, and it has a burden to explain “all the vaccines on the schedule being taken in combination.”

The proposal misunderstands CDC’s history and powers, said Lawrence Gostin, a public health law professor at Georgetown University. The agency “rarely if ever” makes binding recommendations, he said.

“When the next pandemic hits, we will look to CDC to offer guidance based on the best-known evidence,” he said. “We don’t want a disempowered agency in a public health emergency.”

Some Republican intellectuals have spun dystopian visions surrounding vaccines. Take “Dawn’s Early Light,” a yet-to-be-published book by Heritage president Kevin Roberts. The tome — which earned a glowing foreword by Republican vice presidential nominee JD Vance — reserves especially sharp words for vaccines.

In one section of the book, Roberts imagines that the federal government would somehow use alleged new capabilities to “deplatform drivers” of cars for “failing to follow the latest vaccine mandate.”

“Yet another powerful tool of social control falls into place,” he wrote.

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.

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]]> 1921479 More Restrooms Have Adult-Size Changing Tables To Help People With Disabilities https://kffhealthnews.org/news/article/adult-size-changing-tables-public-restrooms-disabilities-access/ Thu, 03 Oct 2024 09:00:00 +0000 https://kffhealthnews.org/?post_type=article&p=1922558 ADAIR, Iowa — The blue-and-white highway sign for the eastbound rest stop near here displays more than the standard icon of a person in a wheelchair, indicating facilities are accessible to people who can’t walk. The sign also shows a person standing behind a horizontal rectangle, preparing to perform a task.

The second icon signals that this rest area along Interstate 80 in western Iowa has a bathroom equipped with a full-size changing table, making it an oasis for adults and older children who use diapers because of disabilities.

“It’s a beacon of hope,” said Nancy Baker Curtis, whose 9-year-old son, Charlie, has a disability that can leave him incontinent. “I’m like, ‘Oh my gosh, we’re finally there.’”

The white changing table is 6 feet long and can be lowered and raised with a handheld controller wired to an electric motor. When not in use, the table folds up against the wall.

The table was recently installed as part of a national effort to make public bathrooms more accessible in places like airports, parks, arenas, and gas stations. Without such options, people with disabilities often wind up being changed on bathroom floors, in cars, or even on the ground outside.

Many families hesitate to go out because of the lack of accessible restrooms. “We all know somebody who’s tethered to their home by bathroom needs,” Baker Curtis said. She doesn’t want her son’s life to be limited that way. “Charlie deserves to be out in the community.”

She said the need can be particularly acute when people are traveling in rural areas, where bathroom options are sparse.

Baker Curtis, who lives near Des Moines, leads the Iowa chapter of a national group called “Changing Spaces,” which advocates for adult-size changing tables. The group offers an online map showing scores of locations where they’ve been installed.

Advocates say such tables are not explicitly required by the federal Americans with Disabilities Act. But a new federal law will mandate them in many airports in coming years, and states can adopt building codes that call for them. California, for example, requires them in new or renovated auditoriums, arenas, amusement parks, and similar facilities with capacities of at least 2,500 people. Ohio requires them in some settings, including large public facilities and highway rest stops. Arizona, Illinois, Maryland, Minnesota, and New Hampshire also have taken steps to require them in some public buildings.

Justin Boatner of Arlington, Virginia, advocates for more full-size changing tables in the Washington, D.C., area. Boatner, 26, uses a wheelchair because of a disability similar to muscular dystrophy. He uses diapers, which he often changes himself.

He can lower an adjustable changing table to the height of his wheelchair, then pull himself onto it. Doing that is much easier and more hygienic than getting down on the floor, changing himself, and then crawling back into the wheelchair, he said.

Boatner said it’s important to talk about incontinence, even though it can be embarrassing. “There’s so much stigma around it,” he said.

He said adult changing tables are still scarce, including in health care facilities, but he’s optimistic that more will be installed. Without them, he sometimes delays changing his diaper for hours until he can get home. That has led to serious rashes, he said. “It’s extremely uncomfortable.”

Iowa legislators in recent years have considered requiring adult changing tables in some public restrooms. They declined to pass such a bill, but the discussion made Iowa Department of Transportation leaders aware of the problem. “I’m sorry to say, it was one of those things we’d just never thought of,” said Michael Kennerly, director of the department’s design bureau.

Kennerly oversees planning for rest stops. He recalls an Iowan telling him about changing a family member outside in the rain, with only an umbrella for shelter. Others told him how they changed their loved ones on bathroom floors. “It was just appalling,” he said.

Iowa began installing adult changing tables in rest stops in 2022, and it has committed to including them in new or remodeled facilities. So far, nine have been installed or are in the process of being added. Nine others are planned, with more to come, Kennerly said. Iowa has 38 rest areas equipped with bathrooms.

Kennerly estimated it costs up to $14,000 to remodel an existing rest-stop bathroom to include a height-adjustable adult changing table. Incorporating adult changing tables into a new rest stop building should cost less than that, he said.

Several organizations offer portable changing tables, which can be set up at public events. Some are included in mobile, accessible bathrooms carried on trailers or trucks. Most permanent adult changing tables are set up in “family restrooms,” which have one toilet and are open to people of any gender. That’s good, because the act of changing an adult is “very intimate and private,” Baker Curtis said. It’s also important for the tables to be height-adjustable because it’s difficult to lift an adult onto a fixed-height table, she said.

Advocates hope adult changing tables will become nearly as common as infant changing tables, which once were rare in public bathrooms.

Jennifer Corcoran, who lives near Dayton, Ohio, has been advocating for adult changing tables for a decade and has seen interest rise in recent years.

Corcoran’s 24-year-old son, Matthew, was born with brain development issues. He uses a wheelchair and is unable to speak, but he accompanies her when she lobbies for improved services.

Corcoran said Ohio leaders this year designated $4.4 million in federal pandemic relief money to be distributed as grants for changing-table projects. The program has led to installations at Dayton’s airport and art museum, plus libraries and entertainment venues, she said.

Ohio also is adding adult changing tables to rest stops. Corcoran said those tables are priceless because they make it easier for people with disabilities to travel. “Matthew hasn’t been on a vacation outside of Ohio for more than five years,” she said.

Kaylan Dunlap serves on a committee that has worked to add changing-table requirements to the International Building Code, which state and local officials often use as a model for their rules.

Dunlap, who lives in Alabama, works for an architecture firm and reviews building projects to ensure they comply with access standards. She expects more public agencies and companies will voluntarily install changing tables. Maybe someday they will be a routine part of public bathrooms, she said. “But I think that’s a long way out in the future, unfortunately.”

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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]]> 1922558 Vance-Walz Debate Highlighted Clear Health Policy Differences https://kffhealthnews.org/news/article/vance-walz-debate-highlighted-clear-health-policy-differences/ Wed, 02 Oct 2024 14:57:54 +0000 https://kffhealthnews.org/?post_type=article&p=1925352 Ohio Republican Sen. JD Vance and Minnesota Democratic Gov. Tim Walz met in an Oct. 1 vice presidential debate hosted by CBS News that was cordial and heavy on policy discussion — a striking change from the Sept. 10 debate between Vice President Kamala Harris and former President Donald Trump. 

Vance and Walz acknowledged occasional agreement on policy points and respectfully addressed each other throughout the debate. But they were more pointed in their attacks on their rival’s running mate for challenges facing the country, including immigration and inflation.

The moderators, “CBS Evening News” anchor Norah O’Donnell and “Face the Nation” host Margaret Brennan, had said they planned to encourage candidates to fact-check each other, but sometimes clarified statements from the candidates.

After Vance made assertions about Springfield, Ohio, being overrun by “illegal immigrants,” Brennan pointed out that a large number of Haitian immigrants in Springfield, Ohio, are in the country legally. Vance objected and, eventually, CBS exercised the debate ground rule that allowed the network to cut off the candidates’ microphones.

Most points were not fact-checked in real time by the moderators. Vance resurfaced a recent health care theme — that as president, Donald Trump sought to save the Affordable Care Act — and acknowledged that he would support a national abortion ban.

Walz described how health care looked before the ACA compared with today. Vance offered details about Trump’s health care “concepts of a plan” — a reference to comments Trump made during the presidential debate that drew jeers and criticism for the former president, who for years said he had a plan to replace the ACA that never surfaced. Vance pointed to regulatory changes advanced during the Trump administration, used weedy phrases like “reinsurance regulations,” and floated the idea of allowing states “to experiment a little bit on how to cover both the chronically ill but the non-chronically ill.”

Walz responded with a quick quip: “Here’s where being an old guy gives you some history. I was there at the creation of the ACA.” He said that before then insurers had more power to kick people off their plans. Then he detailed Trump’s efforts to undo the ACA as well as why the law’s preexisting condition protections were important.

“What Sen. Vance just explained might be worse than a concept, because what he explained is pre-Obamacare,” Walz said.

The candidates sparred on numerous topics. Our PolitiFact partners fact-checked the debate here and on their live blog.

The health-related excerpts follow.

The Affordable Care Act:

Vance: “Donald Trump could have destroyed the [Affordable Care Act]. Instead, he worked in a bipartisan way to ensure that Americans had access to affordable care.”

False.

As president, Trump worked to undermine and repeal the Affordable Care Act. He cut millions of dollars in federal funding for ACA outreach and navigators who help people sign up for health coverage. He enabled the sale of short-term health plans that don’t comply with the ACA consumer protections and allowed them to be sold for longer durations, which siphoned people away from the health law’s marketplaces.

Trump’s administration also backed state Medicaid waivers that imposed first-ever work requirements, reducing enrollment. He also ended insurance company subsidies that helped offset costs for low-income enrollees. He backed an unsuccessful repeal of the landmark 2010 health law and he backed the demise of a penalty imposed for failing to purchase health insurance.

Affordable Care Act enrollment declined by more than 2 million people during Trump’s presidency, and the number of uninsured Americans rose by 2.3 million, including 726,000 children, from 2016 to 2019, the U.S. Census Bureau reported; that includes three years of Trump’s presidency.  The number of insured Americans rose again during the Biden administration.

Abortion and Reproductive Health:

Vance: “As I read the Minnesota law that [Walz] signed into law … it says that a doctor who presides over an abortion where the baby survives, the doctor is under no obligation to provide lifesaving care to a baby who survives a botched late-term abortion.”

False.

Experts said cases in which a baby is born following an attempted abortion are rare. Less than 1% of abortions nationwide occur in the third trimester. And infanticide, the crime of killing a child within a year of its birth, is illegal in every state.

In May 2023, Walz, as Minnesota governor, signed legislation updating a state law for “infants who are born alive.” It said babies are “fully recognized” as human people and therefore protected under state law. The change did not alter regulations that already required doctors to provide patients with appropriate care.

Previously, state law said, “All reasonable measures consistent with good medical practice, including the compilation of appropriate medical records, shall be taken by the responsible medical personnel to preserve the life and health of the born alive infant.” The law was updated to instead say medical personnel must “care for the infant who is born alive.”

When there are fetal anomalies that make it likely the fetus will die before or soon after birth, some parents decide to terminate the pregnancy by inducing childbirth so that they can hold their dying baby, Democratic Minnesota state Sen. Erin Maye Quade told PolitiFact in September.

This update to the law means infants who are “born alive” receive appropriate medical care dependent on the pregnancy’s circumstances, Maye Quade said.

Vance supported a national abortion ban before becoming Trump’s running mate.

CBS News moderator Margaret Brennan told Vance, “You have supported a federal ban on abortion after 15 weeks. In fact, you said if someone can’t support legislation like that, quote, ‘you are making the United States the most barbaric pro-abortion regime anywhere in the entire world.’ My question is, why have you changed your position?”

Vance said that he “never supported a national ban” and, instead, previously supported setting “some minimum national standard.”

But in a January 2022 podcast interview, Vance said, “I certainly would like abortion to be illegal nationally.” In November, he told reporters that “we can’t give in to the idea that the federal Congress has no role in this matter.”

Since joining the Trump ticket, Vance has aligned his abortion rhetoric to match Trump’s and has said that abortion legislation should be left up to the states.

— Samantha Putterman of PolitiFact, on the live blog

A woman’s 2022 death in Georgia following the state passing its six-week abortion ban was deemed “preventable.”

Walz talked about the death of 28-year-old Amber Thurman, a Georgia woman who died after her care was delayed because of the state’s six-week abortion law. A judge called the law unconstitutional this week.

A Sept. 16 ProPublica report found that Thurman had taken abortion pills and encountered a rare complication. She sought care at Piedmont Henry Hospital in Atlanta to clear excess fetal tissue from her uterus, called a dilation and curettage, or D&C. The procedure is commonly used in abortions, and any doctor who violated Georgia’s law could be prosecuted and face up to a decade in prison.

Doctors waited 20 hours to finally operate, when Thurman’s organs were already failing, ProPublica reported. A panel of health experts tasked with examining pregnancy-related deaths to improve maternal health deemed Thurman’s death “preventable,” according to the report, and said the hospital’s delay in performing the procedure had a “large” impact.

— Samantha Putterman of PolitiFact, on the live blog

What Project 2025 Says About Some Forms of Contraception, Fertility Treatments

Walz said that Project 2025 would “make it more difficult, if not impossible, to get contraception and limit access, if not eliminate access, to fertility treatments.”

Mostly False. The Project 2025 document doesn’t call for restricting standard contraceptive methods, such as birth control pills, but it defines emergency contraceptives as “abortifacients” and says they should be eliminated from the Affordable Care Act’s covered preventive services. Emergency contraception, such as Plan B and ella, are not considered abortifacients, according to medical experts.

PolitiFact did not find any mention of in vitro fertilization throughout the document, or specific recommendations to curtail the practice in the U.S., but it contains language that supports legal rights for fetuses and embryos. Experts say this language can threaten family planning methods, including IVF and some forms of contraception.

— Samantha Putterman of PolitiFact, on the live blog

Walz: “Their Project 2025 is gonna have a registry of pregnancies.”

False. 

Project 2025 recommends that states submit more detailed abortion reporting to the federal government. It calls for more information about how and when abortions took place, as well as other statistics for miscarriages and stillbirths.

The manual does not mention, nor call for, a new federal agency tasked with registering pregnant women.

Fentanyl and Opioids:

Vance: “Kamala Harris let in fentanyl into our communities at record levels.”

Mostly False.

Illicit fentanyl seizures have been rising for years and reached record highs under Biden’s administration. In fiscal year 2015, for example, U.S. Customs and Border Protection seized 70 pounds of fentanyl. As of August 2024, agents have seized more than 19,000 pounds of fentanyl in fiscal year 2024, which ended in September.

But these are fentanyl seizures — not the amount of the narcotic being “let” into the United States. 

Vance made this claim while criticizing Harris’ immigration policies. But fentanyl enters the U.S. through the southern border mainly at official ports of entry. It’s mostly smuggled in by U.S. citizens, according to the U.S. Sentencing Commission. Most illicit fentanyl in the U.S. comes from Mexico made with chemicals from Chinese labs.

Drug policy experts have said that the illicit fentanyl crisis began years before Biden’s administration and that Biden’s border policies are not to blame for overdose deaths. 

Experts have also said Congress plays a role in reducing illicit fentanyl. Congressional funding for more vehicle scanners would help law enforcement seize more of the fentanyl that comes into the U.S. Harris has called for increased enforcement against illicit fentanyl use.

Walz: “And the good news on this is, is the last 12 months saw the largest decrease in opioid deaths in our nation’s history.”

Mostly True.

Overdose deaths involving opioids decreased from an estimated 84,181 in 2022 to 81,083 in 2023, based on the most recent provisional data from the Centers for Disease Control and Prevention. This decrease, which took place in the second half of 2023, followed a 67% increase in opioid-related deaths between 2017 and 2023.

The U.S. had an estimated 107,543 drug overdose deaths in 2023 — a 3% decrease from the 111,029 deaths estimated in 2022. This is the first annual decrease in overall drug overdose deaths since 2018. Nevertheless, the opioid death toll remains much higher than just a few years ago, according to KFF. 

More Health-Related Comments:

Vance Said ‘Hospitals Are Overwhelmed.’ Local Officials Disagree.

We asked health officials ahead of the debate what they thought about Vance’s claims about Springfield’s emergency rooms being overwhelmed.

“This claim is not accurate,” said Chris Cook, health commissioner for Springfield’s Clark County.

Comparison data from the Centers for Medicare & Medicaid Services tracks how many patients are “left without being seen” as part of its effort to characterize whether ERs are able to handle their patient loads. High percentages usually signal that the facility doesn’t have the staff or resources to provide timely and effective emergency care.

Cook said that the full-service hospital, Mercy Health Springfield Regional Medical Center, reports its emergency department is at or better than industry standard when it comes to this metric.

In July 2024, 3% of Mercy Health’s patients were counted in the “left-without-being-seen” category — the same level as both the state and national average for high-volume hospitals. In July 2019, Mercy Health tallied 2% of patients who “left without being seen.” That year, the state and national averages were 1% and 2%, respectively.  Another CMS 2024 data point shows Mercy Health patients spent less time in the ER per visit on average — 152 minutes — compared with state and national figures: 183 minutes and 211 minutes, respectively. Even so, Springfield Regional Medical Center’s Jennifer Robinson noted that Mercy Health has seen high utilization of women’s health, emergency, and primary care services. 

— Stephanie Armour, Holly Hacker, and Stephanie Stapleton of KFF Health News, on the live blog

Minnesota’s Paid Leave Takes Effect in 2026

Walz signed paid family leave into law in 2023 and it will take effect in 2026.

The law will provide employees up to 12 weeks of paid medical leave and up to 12 weeks of paid family leave, which includes bonding with a child, caring for a family member, supporting survivors of domestic violence or sexual assault, and supporting active-duty deployments. A maximum 20 weeks are available in a benefit year if someone takes both medical and family leave.

Minnesota used a projected budget surplus to jump-start the program; funding will then shift to a payroll tax split between employers and workers. 

— Amy Sherman of PolitiFact, on the live blog

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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]]> 1925352 Harris’ Emphasis on Maternal Health Care Is Paying Dividends With Black Women Voters https://kffhealthnews.org/news/article/kamala-harris-maternal-health-care-guns-black-women/ Wed, 02 Oct 2024 09:00:00 +0000 https://kffhealthnews.org/?post_type=article&p=1917911 Vice President Kamala Harris is seeing a surge of support from Black women voters, galvanized in part by her work on health care issues such as maternal mortality, reproductive rights, and gun control.

The enthusiasm may be key for Democratic turnout at the polls in critical battleground states.

Black women have always been among the most reliable voters in the Democratic base and were central to former President Barack Obama’s victories in 2008 and 2012. Enthusiasm was also robust for President Joe Biden in 2020. But this year, before he bowed out of the race and Harris became the Democratic nominee, his support among this critical demographic had been fading, which could have dampened turnout in swing states.

Black voters’ support for the top of the Democratic ticket has since increased. In July, before he left the race, 64% of Black voters supported Biden, according to the Pew Research Center. Seventy-seven percent of Black voters supported Harris in August.

Black voter turnout, especially in rural areas of Georgia, North Carolina, and Pennsylvania, could help propel Harris to victory. That support — especially among Black women — has swelled since Biden’s departure, polling shows.

“This is a renaissance,” said Holli Holliday, a lawyer in the Washington, D.C., area who is president of Sisters Lead Sisters Vote, a group that works to advance Black women’s political leadership. “We’re partnering with a collective of Black women organizations to collaborate and collectively move like we never have before.”

Gun safety issues could especially resonate in Georgia, where both Harris and the Republican nominee, former President Donald Trump, are vying for the support of Black voters. A Sept. 4 shooting at Apalachee High School near Winder, Georgia, killed four people and left nine hospitalized with injuries, with scores more facing mental and emotional scars.

Eighty-two percent of Black women voters had a favorable view of Harris in August, according to the Pew Research Center, up from 67% in May.

And more Black women than before say they will go to the polls. Almost 70% of Black women said in August they were extremely or very motivated to vote, according to Pew, up from 51% in July. Sixteen million Black women in the U.S. are eligible to vote and 67% of them are registered, according to Higher Heights, a political action committee focused on mobilizing and electing Black women.

Trump has also sought support from Black women voters. His campaign released a video in August showcasing Black women pledging to support him over Harris, pointing to his economic policies as a key reason.

Still, only 8% of Black women voters say the Republican Party does a better job of looking out for their interests, according to a poll done in May and June by KFF, a health information nonprofit that includes KFF Health News.

Harris’ attention to health issues particularly important to Black women is helping to draw their support, said Kimberly Peeler-Allen, a co-founder of Higher Heights. In 2021, the vice president called for a more robust government response to the nation’s high maternal mortality rates.

The Centers for Disease Control and Prevention says Black women are three times as likely to die from pregnancy-related complications as white women. The disparity is driven in part by differing access to quality health care, underlying health conditions, bias, and racism.

“The vice president’s focus on Black maternal morbidity has gotten a lot of attention and gratitude,” Peeler-Allen said. “High-quality and affordable care, as well as the economy, are one of the top issues that drive Black women voters to get to the polls.”

As a senator, Harris co-sponsored a package of legislation aimed at improving maternal health, with a focus on Black women. The Biden administration pushed to expand maternal health initiatives in rural communities and improve bias training for health care providers, including by awarding more than $103 million in grants in 2023 to support and expand access to maternal health care.

Trump in 2018 signed legislation intended to reduce the maternal mortality rate that provided $58 million a year for five years to help states investigate and prevent pregnancy-related deaths.

As vice president, Harris also pushed states to extend postpartum care in Medicaid, the state-federal health program for low-income and disabled people. Biden signed legislation that temporarily gave states the option to expand the coverage to a full year from the required 60 days, with federal matching funds, and later signed a law allowing states to make the extended benefits permanent.

Illinois, New Jersey, and Virginia were the only states providing 12 months of postpartum Medicaid coverage when Harris became vice president. Today, the yearlong benefit has been adopted by at least 46 states and Washington, D.C., according to KFF.

“I am so thrilled out of my mind. I didn’t think we’d get there that quick,” said Rep. Robin Kelly (D-Ill.), who has helped lead congressional efforts to reduce mortality and morbidity among mothers and pregnant women, especially Black women. “It helps having everybody at the Senate, House, and White House working together. I am optimistic we are going to have someone at the top who gets it. We still have a ways to go.”

Harris’ support for measures to stem gun violence also helps her appeal to Black women. Harris said during her debate with Trump last month that she’s a gun owner. But she has pressed for banning what are often known as assault weapons and to implement universal background checks ahead of gun purchases — issues that may resonate in Georgia, especially, after the Apalachee shooting.

Eighty-four percent of Black women favor Harris on gun reform over Trump, according to a 2024 poll conducted for The Highland Project, a women-led coalition focused on creating multigenerational wealth in Black communities.

Trump’s campaign advisers have said he would protect access to guns by appointing federal judges who oppose restrictions. He has supported gun rights despite two apparent assassination attempts during the campaign, and as president in 2017 he reversed a controversial Obama administration regulation making it harder for people with mental health issues to purchase guns.

Win With Black Women, a network of Black women leaders, hosted a planning call with Black women the day Biden withdrew from the race. About 44,000 participants joined the meeting.

Waning enthusiasm for the Democratic ticket among Black women before Harris entered the race could have undermined turnout. And turnout matters: In the 2020 presidential race, seven states were won by less than three percentage points each.

“To have 44,000 black women on a phone call that Sunday night? That enthusiasm, that’s good for Democrats,” said Kelly Dittmar, research director at Rutgers’ Center for American Women and Politics. “If Democrats selected someone with less enthusiastic backing, a lot of women who supported Biden may have stayed home.”

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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]]> 1917911 How Minnesota Figures Into the Presidential Politics of Insulin Prices https://kffhealthnews.org/news/article/insulin-prices-diabetes-patient-advocates-minnesota-presidential-politics/ Tue, 01 Oct 2024 09:00:00 +0000 https://kffhealthnews.org/?post_type=article&p=1923801 In June 2019, Lija Greenseid handed Minnesota Gov. Tim Walz an empty vial of insulin that her 13-year-old daughter had painted gold.

Greenseid’s daughter has Type 1 diabetes, which means she requires daily injections of manufactured insulin to stay alive. The price of a single vial of insulin rose by about 1,200% between 1996 and 2018, and the gold vial was a reminder, Greenseid said, that this lifesaving pharmaceutical shouldn’t be as expensive as precious metal.

“What I heard is that that gold vial remained on his desk at the governor’s office, and he brought it up throughout that summer and fall when he was trying to talk to legislators to get them moving,” Greenseid said.

Ten months later, in April 2020, Walz signed the Alec Smith Insulin Affordability Act. The law was named after the 26-year-old Minnesotan whose 2017 death from rationing insulin became a catalyst for the patient advocates who turned the high cost of insulin in the U.S. into a national political priority.

Now it’s an issue in the presidential campaign. Both former President Donald Trump and Vice President Kamala Harris and her running mate, Walz, have sought to appeal to the nation’s 8.4 million insulin users and their families by touting policies that make insulin cheaper for some patients.

But advocates for diabetes patients fret that neither presidential candidate would go as far as Walz’s Minnesota law, which helps patients even if they are uninsured, despite the law being under legal attack by the drug industry.

The landscape on insulin pricing has already changed significantly in the past five years. One month after Walz signed the Minnesota law, the Trump administration announced a voluntary program for Medicare prescription drug plans to cap copayments for some insulin products at $35. Two years later, President Joe Biden signed a law requiring all Medicare drug plans to cap copayments for insulin at $35 a month.

Now, amid the current presidential campaign, Harris has proposed extending that $35 cap on insulin copayments to Americans with commercial health insurance.

The Trump campaign’s national press secretary, Karoline Leavitt, touted his efforts on prescription drug prices when he was in the White House, including approval of a pathway for prescription drugs to be imported from Canada as well as the voluntary $35 insulin Medicare copayment cap. But she did not offer new insulin-specific initiatives for his possible second stint as president.

“President Trump will finish what he started in his first term,” Leavitt wrote in a statement.

Copayment caps, which have been enacted by 25 states, are popular policies because they provide an immediate financial benefit that many patients see at the pharmacy, according to University of Southern California economist Neeraj Sood. They’re also relatively easy to implement.

But copayment caps don’t address the high list price of insulin itself, so uninsured patients don’t benefit from such rules. About 1 in 12 Americans lacked health insurance last year.

That’s what makes Minnesota’s insulin safety net different. The system has two parts: an emergency program that allows individuals to get a one-time, 30-day supply of insulin for $35, and a continuing need program that provides insulin to eligible patients for a year at no more than $50 for a 90-day supply.

By contrast, list prices for a 30-day supply of insulin can easily top $215, depending on the insulin.

The bill that created Minnesota’s program was bipartisan out of necessity. Republicans controlled the state Senate at the time, while the Minnesota Democratic-Farmer-Labor Party held the House and governor’s office.

Nicole Smith-Holt, whose son the bill was named after, watched in tears as it finally passed the state legislature in 2020.

“I was happy. I was relieved,” Smith-Holt said. “I was sad that it took Alec dying to get to the point where people could walk into the pharmacy and pick up their prescription for an affordable price.”

But because Minnesota’s program requires insulin manufacturers to provide the insulin, it has prompted a backlash from manufacturers. Pharmaceutical industry lobbying group PhRMA filed a lawsuit in 2020 to block the Minnesota law, arguing it violates the “takings clause” of the U.S. Constitution, which says private property can’t be taken for public use “without just compensation.”

That suit is ongoing, yet the state program is up and running and by the end of 2023 it had been used over 1,500 times.

PhRMA spokesperson Reid Porter said his group is committed to helping patients afford medicines. Insulin makers voluntarily dropped list prices last year and now offer patient assistance programs for affording the drugs. And the CEO of insulin maker Eli Lilly first proposed the voluntary Medicare copay cap Trump announced in 2020.

Porter said insulin costs have been driven up by insurance companies and pharmacy benefit managers, also known as PBMs — the middlemen between insurance plans or employers and drug manufacturers — when they pocket the discounts from the list price of drugs that they negotiate with manufacturers.

“Minnesota’s insulin program does not solve this problem and is unconstitutional,” Porter said. “This is not how the system should work, and why it’s critical that policymakers should prioritize reforming the PBM system, a solution that puts patient health over politics.”

In 2021, Sood co-authored a study that found that, despite insulin list prices rising between 2014 and 2018, income received by drugmakers decreased while increasing for intermediaries like PBMs and pharmacies.

In September, the Federal Trade Commission announced a lawsuit against the nation’s three biggest PBMs, alleging they created a system that inflated insulin prices. The companies denied the claims.

Jing Luo, a physician at the University of Pittsburgh, said that regardless of who wins in November he doesn’t expect existing insulin policies like Medicare’s popular copay cap to be rolled back, due in part to the advocacy of people like Smith-Holt and Greenseid.

“They’ve been really effective at tying high insulin prices with really bad, morally repugnant outcomes,” Luo said.

The key in Minnesota was including real stories, Greenseid said.

“We had enough real people who reached out and had conversations and helped to show politicians the extent of the problem,” Greenseid said, “and they listened.”

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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