Opinion writers weigh in on these public health issues and others.
Editorial pages focus on the quality and high cost of health care.
Media outlets report on news from North Carolina, California, Massachusetts, Iowa, Ohio, Missouri, Georgia, and Minnesota.
“I still await guidance from the White House as to what [Trump] thinks he’s comfortable signing,” said Senate Majority Leader Mitch McConnell (R-Ky.).
There are several options that lawmakers are considering when it comes to surprise medical bills, including a bipartisan measure that would put a federally mandated rate cap on the amount that insurers have to pay doctors for out-of-network emergency care.
The VA placed the regional leader, chief medical officer and seven staff members on administrative leave while launching an investigation into the nursing home. “His room had ants, the ceiling, the walls, the beds. They were everywhere,” said Laquna Ross the patient’s daughter.
Experts say that because rates have also dropped in states that haven’t enacted strict regulations, the decrease is more likely due to increase contraception use and fewer pregnancies over all. “If restrictions were the main driver across the board, we’d expect birthrates to increase,” said Elizabeth Nash, senior state policy manager at the Guttmacher Institute.
The plan’s likelihood of ever being implemented, however, remains largely unknown. To date, no state has been given permission to rely solely on block grants to cover Medicaid expenses. Gov. Bill Lee, however, remains hopeful, pointing to the fact that the Trump administration has been encouraging states to take more control of their programs.
U.S. District Judge Rosemary Collyer said in her ruling that the Trump administration overstepped its authority when issuing its so-called site-neutral pay policy. The decision is a big win for hospitals, who in their original complaint led by the American Hospital Association projected cuts of about $380 million this year and $760 million in 2020. In other CMS news: skilled-nursing facilities and bundled radiation therapy payments.
The report highlights a “lack of continued political will” from national leaders who aren’t devoting enough energy and resources to disaster preparation. Other public health news looks at declining childhood mortality, online recruiting by white supremacists, fetuses harmed by pollution, caring physicians on the border, food safety at pork plants, additional treatment for Alex Trebek, erotica, and poop shame, as well.
Today’s early morning highlights from the major news organizations.
SACRAMENTO, Calif. — Demographers, gerontologists and government officials are counting down to 2030.
That’s the year America’s youngest baby boomers will reach retirement age.
The country already is feeling the effects of an aging population, but its most populous state is bracing for a hard hit as retirement collides with increasing poverty and the high cost of living. By 2030, an estimated 1 in 5 Californians will be 65 or older, representing a segment of the population growing faster than working-age Californians, according to the Public Policy Institute of California.
“As we grow in the number of older Californians, we actually shrink in the number of younger Californians” who will make up the workforce, Dr. Mark Ghaly, secretary of California’s Health and Human Services agency, said Monday at a forum hosted by The SCAN Foundation, which advocates for the welfare of older adults. (Kaiser Health News, which publishes California Healthline, receives support for its coverage of aging and long-term care issues from The SCAN Foundation.)
“We can’t just wait to watch it happen, but we have to plan ahead.”
The forum revolved around the creation of a statewide Master Plan for Aging, due in October 2020, that is intended to address how California must adapt to the needs of its aging residents. California Gov. Gavin Newsom issued an executive order in June calling for the plan, which would coordinate and improve the confusing web of existing programs — and create more, if necessary.
The committee that will formulate the master plan was set to meet for the first time Tuesday in Sacramento. The meeting is open to the public.
Newsom’s call for a master plan follows the lead of four other states — Colorado, Connecticut, Minnesota and Washington — which have published similar plans, according to The SCAN Foundation. All document the changes needed in every aspect of daily life, from finances to transportation, to help aging people remain as active, mobile and independent as possible.
“The states that have something that looks like a master plan, or strategic plan around aging, perform better” on measures of long-term care services, said Dr. Bruce Chernof, president and CEO of the foundation.
This may be because states with master plans tend to measure how their programs are improving the lives of older adults and their families, which means local and state governments are more accountable when they invest public money, Chernof said.
California Healthline interviewed state and local officials, researchers, advocates and older adults who attended Monday’s forum to ask what they’d like to see in the master plan.
A key issue for several participants was California’s affordable housing crisis.
Oakland resident Jerome McIntosh, 62, went on disability three years ago after suffering a massive heart attack. He survives on $1,070 a month, and lives with eight other people in a transitional home for seniors operated by St. Mary’s Center in Oakland. McIntosh is looking for an affordable place of his own that costs about one-third of his income. But in the past year, he has received only one callback on an apartment application. The monthly rent was $1,065.
“Housing is about the hardest thing,” McIntosh said. “Right now I’m in a transitional house, but I’m still homeless.”
Janny Castillo is an organizer and program coordinator at St. Mary’s Center, which serves about 1,000 low-income seniors in Oakland, including some who are homeless. Many of them, like McIntosh, get by on about $1,000 a month, which makes it almost impossible to afford housing in the Bay Area, Castillo said. She believes rent subsidies could help solve the problem.
“One of the things that is really critical right now is to address the seniors that are living outside,” Castillo said. “We’re losing them earlier than we need to, because of how hard it is to live outside.”
Even Californians who aren’t at risk of homelessness may not be able to remain in their homes if they get sick.
Almost one-third of seniors in the U.S. have nothing saved for retirement, while two-thirds of baby boomers are carrying an average of about $110,000 in credit card, student loan or mortgage debt, according to the Stanford Center on Longevity.
If Californians don’t qualify for Medi-Cal, the state’s Medicaid program for low-income people, which funds some in-home care for eligible people, the high cost of in-home care falls on individuals and their families, said Lorna Van Ackeren, a marketing and community liaison at Hillendale Home Care, which hires out state licensed caregivers.
The business pays caregivers $15.50 to $19 per hour, based on experience, Van Ackeren said.
“But we charge the families $31 an hour, so it’s a real problem,” she said. The difference covers the agency’s legal obligations, such as maintaining their state licenses and insurance.
“It would be nice to have some kind of assistance for the middle class,” she said.
By 2030, more than 1 million seniors in California will require some in-home help, and more than 100,000 will need to live in a nursing home, according to the Public Policy Institute of California.
A severe labor shortage for caregivers also looms. By 2030, California will need as many as 3.2 million additional workers to care for seniors at home.
Richard Figueroa, a deputy Cabinet secretary in Newsom’s administration, said the governor wants the plan to include recommendations on how to help people age at home. “What can we do to help people stay in their homes as long as they can? Because there will be more and more folks in that situation, and our services and programs and opportunities are going to have to adapt to that,” he said.
California already has services for its aging population, but “people need to be able to navigate the system more easily without jumping through hoops,” said Christina Mills, executive director of the California Foundation for Independent Living Centers.
“Increasing the number of aging and disability resource centers across the state of California” could help, she said. “There are currently about eight, but there’s potential to be about 30,” she said.
State Assemblyman Joaquin Arambula (D-Fresno) said the needs of older Californians differ by region and cultural background. “I’d like to make sure that the needs and wishes of our immigrant and rural communities are taken care of,” he said. “We need to be both culturally and linguistically sensitive to the needs of various communities. We should make sure the surveys we are doing are reaching all communities and in languages they can understand.”
Austin is about to become the nation’s first city to fund groups that help women seeking abortions pay for related logistical costs, such as a babysitter, a hotel room or transportation.
The move pushes back against a Texas law that took effect Sept. 1. The state law bans local governments from giving money to organizations that provide abortions — even if that money doesn’t pay for the procedure.
Last week, the Austin City Council approved the related line item in the city’s latest budget. Starting Oct. 1, it sets aside $150,000 to be passed along to nonprofits that provide “logistical support services” for low-income women in the city seeking an abortion.
None of the groups provide abortion, so supporters of the new city budget item describe it as a unique workaround to the state’s law.
“The city has to find creative ways to help vulnerable communities in our city, and I see this as just another way,” said Councilwoman Delia Garza.
John Seago, the legislative director for Texas Right to Life, said that though Austin is not violating the letter of the state law, its leaders are clearly violating “the principle” behind it.
“The legislature did not believe that it is ethical to use taxpayer dollars to benefit the abortion industry,” Seago said. “So whether it is the clinic itself, whether it is paying for the procedure itself, there is an industry built around that that we don’t want to use taxpayer dollars to benefit.”
Shortly after the city’s budget passed, former Austin Councilman Don Zimmerman sued the city in an effort to block the funding. In his lawsuit, filed in a Travis County district court, Zimmerman claimed “this expenditure of taxpayer money violates the state’s abortion laws.”
Supporters of Austin’s effort say the budget item is on solid legal ground. They also say it’s an important step to ensure that low-income women, at least locally, can obtain legal abortions in a state that has been steadily restricting access to the procedure in the past decade.
Erika Galindo, an organizer with the Lilith Fund, told the Austin City Council during a meeting this summer that Austin should take a stand as some cities pass all-out bans on abortion. Earlier in the summer, Waskom — a small city in East Texas — banned the procedure and declared itself the state’s first “sanctuary city for the unborn.”
“The city of Austin has an opportunity to set a new standard for creative and equitable solutions for communities at a time when state lawmakers and local governments like Waskom’s city council have turned their backs on low-wage workers and women of color,” Galindo said.
Austin’s city leaders said the makeup of their city council likely played a role in the decision to fund programs that provide logistical support. While Waskom’s ban was passed by an all-male council, Austin has a majority-female city council.
“I don’t think it’s any coincidence that you have a majority-female council making these kinds of issues a priority,” Garza said. “We have seen how this right has been chipped away at — all kinds of barriers being placed in front of women who are simply seeking an option that is still a constitutional right in this country.”
More than half of the abortion clinics in Texas have closed since 2013, going from 40 clinics to 17. Broad swaths of the huge state have no abortion providers.
City leaders and staff in Austin are still working out how women will qualify for the money and what groups to contract with, but groups already doing this work across the state will likely get some of the city funding.
Among those groups is Fund Texas Choice, a statewide nonprofit that provides travel arrangements for abortion appointments for women in Texas who can’t afford them. Organizer Sarah Lopez said the group’s help can include providing women with gas money, bus tickets or ride-sharing — and sometimes a hotel room to recuperate in.
More often than not, Lopez said, she’s helping women who are already parents and who can barely afford the abortion procedure itself — let alone the costs that come with making it to the appointment. For many of these women, she said, a little help goes a long way.
“I was chatting with someone yesterday,” Lopez said. “She had just made her appointment but then rescheduled because she was like, ‘Oh, I didn’t realize I would have to be gone for three or four days — so I had to push my appointment another week and a half in order to find child care.’”
Texas law requires at least two office visits before a woman can get an abortion. And women living in rural parts of the state often have to travel 200 miles away, or more, to the closest abortion clinic.
In 2013, Texas lawmakers passed a controversial law that imposed strict restrictions on abortion providers in the state. That law, known as House Bill 2, required clinics to be equipped and staffed like surgical centers, and it required doctors who provide abortions to have admitting privileges at a nearby hospital. Following that law’s passage, many clinics around the state shut their doors.
Now women who live outside major cities often face big travel barriers when they seek an abortion. The new funds allocated by Austin are only for women who reside within the city.
Women living in parts of the state that don’t have a clinic will continue to rely on statewide programs such as the one run by Lopez’s group.
Lopez said Austin’s effort takes off some of the financial pressure on groups like hers and frees up more money for women living in rural areas.
“I think it’s incredible,” Lopez said of the Austin decision. “I really hope to see that other cities in Texas kind of follow suit.”
KHN’s coverage of women’s health care issues is supported in part by The David and Lucile Packard Foundation.
Editorial pages focus on the health care topics and others.
Media outlets report on news from Utah, Tennessee, Oklahoma, Massachusetts, California, Connecticut, Ohio, Georgia, Wisconsin, California, Arizona and New Hampshire.
However, Oklahoma has agreed not to enforce the ban until the state Supreme Court considers an emergency motion from the plaintiffs. Meanwhile, U.S. senators are asking Google to make sure its maps are accurately pointing users to abortion providers rather than crisis pregnancy centers. Abortion news comes out of Texas and Indiana, as well.
Back in March, the organization has kicked-off a multi-million dollar campaign against the pharmaceutical industry. Since then they’ve stormed lawmakers’ offices, ramped up their ad campaigns, and even rented planes to fly over beaches. “I can’t really think of another time when there’s been this strong a message in opposition to an entire industry,” said John Rother, the group’s former head of policy.
The institute was funded almost entirely by Goliaths of the agribusiness, food and pharmaceutical industries nearly four-decades ago. “What could possibly go wrong?” Amit Srivastava, the coordinator of the advocacy group India Resource Center, asked sarcastically. “To have a covert food lobby group deciding public health policy is wrong and a blatant conflict of interest.” In other public health news: the fading measles outbreak; thoughts and prayers; deaths among children; pregnancy and more.
More than 3 million women experienced rape as their first sexual encounter, according to a new study, which surveyed women ages 18 to 44 in the U.S. For many who work in field of rape prevention, the number wasn’t surprising. “This study quantifies what we see . . . every day,” said Gina Scaramella, executive director of the Boston Area Rape Crisis Center.
President Donald Trump met again with aides Monday to discuss proposals to address gun violence in an effort to create a plan, the details of which he’s been playing close to the vest. The White House expects to release the package of proposals this week. House Majority Leader Nancy Pelosi (D-Calif.) and Senate Minority Leader Chuck Schumer (D-N.Y.) have been vocal this week about pressing the president to include the House-passed universal checks.
Connecticut is one of 31 states that reported measles cases this year, part of the worst outbreak of the disease in the U.S. since 1992. Meanwhile, in California, Gov. Gavin Newsom defends his eleventh-hour changes to a controversial vaccination law.
Medical records have become a hot target for hackers looking for troves of data. ProPublica launched an investigation into just how easy the servers are to breach. Meanwhile, a San Diego couple is being charge with stealing trade secrets allegedly to use the information to market their biotech company.
The “public charge” rule makes it more likely that a legal immigrant who uses benefits such as Medicaid, food stamps and housing assistance will be identified as a “public charge,” jeopardizing their potential to get a green card and become a U.S. citizen. The Trump administration policy has already drawn legal challenges from nearly 20 states.
Today’s early morning highlights from the major news organizations.
In a recent New York Times opinion column, dietitian Christy Harrison, an “intuitive eating coach” and author, responded to a fellow clinician who had questioned some of her thoughts on the link between being overweight and developing other medical conditions.
Harrison noted that although most health professionals have been taught that higher body mass index (BMI) causes poor health outcomes, she wrote, “unfortunately, that just isn’t true.”
She added: “We have a host of issues associated with high B.M.I.s. But correlation doesn’t prove causation, and there’s a significant body of research showing that weight stigma and weight cycling can explain most if not all of the associations we see between higher weights and poor health outcomes.”
We decided to investigate the point she was making, which is at the center of a larger, often-heated debate about whether it is possible to be overweight and healthy at the same time — a perspective advocated by the “Health at Every Size” movement, of which Harrison is a part. With nearly 72% of U.S. adults considered overweight or obese, this is a pressing issue.
When we reached out to Harrison to find out the basis of her statement, she responded quickly, citing two papers as her main sources.
The first, a 2011 piece published in the Nutrition Journal, argues it might be better to shift away from weight-loss efforts to improving health in other ways that are weight-neutral.
Its lead author, Linda Bacon, a professor at the University of California-Davis, wrote “Health at Every Size: The Surprising Truth About Your Weight,” a 2010 book embraced by “fat acceptance” advocates.
It addresses Harrison’s first point with this: “While it is well established that obesity is associated with increased risk for many diseases, causation is less well-established.”
The other paper, a 2014 piece in the Journal of Obesity, makes similar arguments.
Causation, Correlation, Association: Let’s Unpack That
There is an old saw used by most statisticians: Correlation does not equal causation.
But what does that mean? Let’s use a fake example: Some people have trouble seeing at night. Turns out all those people ate carrots. Ergo, there could be a correlation between eating carrots and night vision problems.
That doesn’t prove anything else, though, such as causation. Correlation is necessary when trying to determine causation, but doesn’t prove it.
“Epidemiological studies never show causation, only association,” said Dr. Samuel Klein, director of the Center for Human Nutrition at Washington University School of Medicine in St. Louis.
To establish cause, epidemiologists need more evidence.
The best way, considered the “gold standard,” is to randomly assign people to one group or another ― feeding one group carrots and withholding carrots from the other. Researchers would then monitor any difference in how many people develop night vision problems.
That’s nifty, but not always possible or ethical. One could not, for example, randomly assign some people to a group and then cause them to become overweight.
Instead, researchers use different types of studies, such as those that compare groups of people who already have the characteristic — say, carrot eating or being overweight — with those who don’t to see if patterns emerge.
They use methods to control for things that might affect the results, such as age, gender, income level, whether a person smokes and other factors. Then they can estimate how strong of an association or correlation they see.
With smoking and lung cancer, very strong associations were seen, leading to the conclusion that, yes, smoking causes lung cancer. But does excess weight cause other health conditions, such as diabetes, heart disease, cancer, sleep apnea or joint problems?
“With the case of weight, the associations are much weaker,” said Kendrin Sonneville, assistant professor of nutritional sciences at the University of Michigan School of Public Health.
So on this point, Henderson’s statement holds up. Current scientific research supports a correlation between being overweight and suffering poor health outcomes, but it does not definitively establish causation.
But others, especially clinicians, say there is little doubt that being overweight strongly raises the risk of developing such health problems.
“This isn’t up for debate,” said Dr. Harold Bays, chief science officer for the Obesity Medicine Association, which represents practitioners who treat overweight patients.
“The overwhelming amount of clinical and scientific data supports obesity as a disease, both as a direct and indirect contributor to a large number of adverse metabolic and other health consequences,” he said.
A 2018 Endocrine Society scientific statement, for example, looked across many studies of overweight and obesity, concluding that the two contribute to “type 2 diabetes mellitus, cardiovascular disease, some cancers, kidney disease, obstructive sleep apnea, gout, osteoarthritis, and hepatobiliary disease, among others.”
Then things get murky.
Bays and the other experts agreed that some people who are overweight might not develop other conditions.
“It is absolutely true that not all cases of diabetes, hypertension, cancer and fatty liver are due to obesity,” said Bays.
They acknowledged that people who fall into the category of being obese or overweight may even appear healthy metabolically — at least for a while.
But there’s also a caution.
“If you say, ‘Wait a minute, is their blood sugar where we want it … aren’t their triglycerides a little high and what about their blood pressure?’ And that’s not even to mention pain to the joints or sleep apnea,” Bays said. “When you drill down, very few people would truly meet the criteria of being metabolically healthy but obese, and if you follow them for five or 10 years, now the majority are going to have something.”
What About The Stigma?
There’s been less research around Harrison’s second point: that most, if not all, of the diseases associated with being obese or overweight are caused instead by the stigma heavy people face, or the yo-yo effect of dieting, losing weight and then gaining it back again, in regular cycles.
She pointed to research included in the paper by Bacon reporting that weight cycling could lead to hypertension, or high blood pressure. The research, however, found associations though not specific causation.
Similarly, in another study Harrison provided, people who reported weight discrimination ― 6% of the sample studied — had twice the risk of physiological stress over nearly 10 years. Such stress can be associated with Type 2 diabetes, hypertension and cardiovascular disease, the study said.
But most of those we spoke with strongly disputed the sweeping statement that so many chronic conditions can be caused by stigma and weight cycling.
While those two things can factor into health problems, they are not responsible for most of the health outcomes seen by her patients, said Dr. Fatima Cody Stanford, an obesity medicine physician and an assistant professor of medicine and pediatrics at Harvard Medical School.
Stanford also takes issue with advocates who promote the idea that being overweight isn’t a big health risk factor.
“The Health at Every Size movement goes against what we know about obesity as a disease,” Stanford said. “Their aim in that movement is to not learn the science.”
Harrison said the notion that a higher BMI causes poor health outcomes “just isn’t true” ― adding that “we have a host of issues associated with high BMIs. But correlation doesn’t prove causation, and there’s a significant body of research showing that weight stigma and weight cycling can explain most if not all of the associations we see between higher weights and poor health outcomes.”
On a strict reading of the science, she has a point. It is very difficult to prove definitively what causes disease, and showing “correlation” is a different finding than causation. However, she appears to apply this standard selectively, using it both to undermine the relationship between high BMI and poor health outcomes, and as evidence of how weight cycling and stigma are linked to certain chronic health conditions.
But in the case of obesity, researchers in multiple studies nationally and worldwide have shown definite links between being overweight and developing diseases, such as diabetes, and conditions, such as painful joints. There is far less evidence for the role that weight stigma and yo-yo dieting has in the development of those medical problems, although the experts urge continuing research into those questions.
We rate Harrison’s statement as Mostly False.