Category: Medicine and Health

KFF Health News’ ‘What the Health?’: SCOTUS Rejects Abortion Pill Challenge — For Now 

The Host

A unanimous Supreme Court turned back a challenge to the FDA’s approval and rules for the abortion pill mifepristone, finding that the anti-abortion doctor group that sued lacked standing to do so. But abortion foes have other ways they intend to curtail availability of the pill, which is commonly used in medication abortions, which now make up nearly two-thirds of abortions in the U.S.

Meanwhile, the Biden administration is proposing regulations that would bar credit agencies from including medical debt on individual credit reports. And former President Donald Trump, signaling that drug prices remain a potent campaign issue, attempts to take credit for the $35-a-month cap on insulin for Medicare beneficiaries — which was backed and signed into law by Biden.

This week’s panelists are Julie Rovner of KFF Health News, Anna Edney of Bloomberg News, Rachana Pradhan of KFF Health News, and Emmarie Huetteman of KFF Health News.

Among the takeaways from this week’s episode:

  • All nine Supreme Court justices on June 13 rejected a challenge to the abortion pill mifepristone, ruling the plaintiffs did not have standing to sue. But that may not be the last word: The decision leaves open the possibility that different plaintiffs — including three states already part of the case — could raise a similar challenge in the future, and that the court could then vote to block access to the pill.
  • As the presidential race heats up, President Joe Biden and former President Donald Trump are angling for health care voters. The Biden administration this week proposed eliminating all medical debt from Americans’ credit scores, which would expand on the previous, voluntary move by the major credit agencies to erase from credit reports medical bills under $500. Meanwhile, Trump continues to court vaccine skeptics and wrongly claimed credit for Medicare’s $35 monthly cap on insulin — enacted under a law backed and signed by Biden.
  • Problems are compounding at the pharmacy counter. Pharmacists and drugmakers are reporting the highest numbers of drug shortages in more than 20 years. And independent pharmacists in particular say they are struggling to keep drugs on the shelves, pointing to a recent Biden administration policy change that reduces costs for seniors — but also cash flow for pharmacies.
  • And the Southern Baptist Convention, the nation’s largest branch of Protestantism, voted this week to restrict the use of in vitro fertilization. As evidenced by recent flip-flopping stances on abortion, Republican candidates are feeling pressed to satisfy a wide range of perspectives within even their own party.

Also this week, Rovner interviews KFF president and CEO Drew Altman about KFF’s new “Health Policy 101” primer. You can learn more about it here.

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

Julie Rovner: HuffPost’s “How America’s Mental Health Crisis Became This Family’s Worst Nightmare,” by Jonathan Cohn.

Anna Edney: Stat News’ “Four Tops Singer’s Lawsuit Says He Visited ER for Chest Pain, Ended Up in Straitjacket,” by Tara Bannow.

Rachana Pradhan: The New York Times’ “Abortion Groups Say Tech Companies Suppress Posts and Accounts,” by Emily Schmall and Sapna Maheshwari.

Emmarie Huetteman: CBS News’ “As FDA Urges Crackdown on Bird Flu in Raw Milk, Some States Say Their Hands Are Tied,” by Alexander Tin.

Also mentioned on this week’s podcast:

To hear all our podcasts, click here.

And subscribe to KFF Health News’ “What the Health?” on SpotifyApple PodcastsPocket Casts, or wherever you listen to podcasts.

Watch: California Pays Drug Users To Stay Clean

KFF Health News senior correspondent Angela Hart appeared on Spectrum News 1’s “LA Times Today” last week to explain how California is trying to help hard-drug users kick their habit by paying them to stay clean.

California was the first state to expand access to this cutting-edge addiction treatment, called “contingency management,” in its Medicaid program. Washington and Montana have since followed.

California is focusing on stimulants like meth and cocaine. Under the program, participants must pee into a cup regularly, and if the urine is free of stimulants, they get paid with a gift card, starting at $10 for the first test. The longer they abstain, the more they’re paid — up to $599 a year.

Click here to watch Hart discuss the treatment on “LA Times Today.”

You can read Hart’s in-depth article about California’s initiative. She also wrote about national efforts to encourage other states to adopt the novel approach.

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

Biden’s on Target About What Repealing ACA Would Mean for Preexisting Condition Protections

If the Affordable Care Act were terminated, “that would mean over a hundred million Americans will lose protections for preexisting conditions.”

President Joe Biden in a campaign advertisement, May 8

President Joe Biden’s reelection campaign wants voters to contrast his record on health care policy with his predecessor’s. In May, Biden’s campaign began airing a monthlong, $14 million ad campaign targeting swing-state voters and minority groups with spots on TV, digital, and radio.

In the ad, titled “Terminate,” Biden assails former President Donald Trump for his past promises to overturn the Affordable Care Act, also known as Obamacare. Biden also warns of the potential effect if Trump is returned to office and again pursues repeal.

“That would mean over a hundred million Americans will lose protections for preexisting conditions,” Biden said in the ad.

Less than six months from Election Day, polls show Trump narrowly leading Biden in a head-to-head race in most swing states. And voters trust Trump to better handle issues such as inflation, crime, and the economy by significant margins.

An ABC News/Ipsos poll of about 2,200 adults, released in early May, shows the only major policy issues on which Biden received higher marks than Trump were health care and abortion access. It’s no surprise, then, that the campaign is making those topics central to Biden’s pitch to voters.

As such, we dug into the facts surrounding Biden’s claim.

Preexisting Condition Calculations

The idea that 100 million Americans are living with one or more preexisting conditions is not new. It was the subject of a back-and-forth between then-candidate Biden and then-President Trump during their previous race, in 2020. After Biden cited that statistic in a presidential debate, Trump responded, “There aren’t a hundred million people with preexisting conditions.”

A KFF Health News/PolitiFact HealthCheck at the time rated Biden’s claim to be “mostly true,” finding a fairly large range of estimates — from 54 million to 135 million — of the number of Americans with preexisting conditions. Estimates on the lower end tend to consider “preexisting conditions” to be more severe chronic conditions such as cancer or cystic fibrosis. Estimates at the spectrum’s higher end include people with more common health problems such as asthma and obesity, and behavioral health disorders such as substance use disorder or depression.

Biden’s May ad focuses on how many people would be vulnerable if protections for people with preexisting conditions were lost. This is a matter of some debate. To understand it, we need to break down the protections put in place by the ACA, and those that exist separately.

Before and After

Before the ACA’s preexisting condition protections took effect in 2014, insurers in the individual market — people buying coverage for themselves or their families — could charge higher premiums to people with particular conditions, restrict coverage of specific procedures or medications, set annual and lifetime coverage limits on benefits, or deny people coverage.

“There were a number of practices used by insurance companies to essentially protect themselves from the costs associated with people who have preexisting conditions,” said Sabrina Corlette, a co-director of the Center on Health Insurance Reforms at Georgetown University and an expert on the health insurance marketplace.

Insurers providing coverage to large employers could impose long waiting periods before employees’ benefits kicked in. And though employer-sponsored plans couldn’t discriminate against individual employees based on their health conditions, small-group plans for businesses with fewer than 50 employees could raise costs across the board if large numbers of employees in a given company had such conditions. That could prompt some employers to stop offering coverage.

“The insurer would say, ‘Well, because you have three people with cancer, we are going to raise your premium dramatically,’ and therefore make it hard for the small employer to continue to offer coverage to its workers because the coverage is simply unaffordable,” recalled Edwin Park, a research professor at Georgetown University’s McCourt School of Public Policy who researches public health insurance markets.

As a result, many people with preexisting conditions experienced what some researchers dubbed “job lock.” People felt trapped in their jobs because they feared they wouldn’t be able to get health insurance anywhere else.

Some basic preexisting condition protections exist independent of the ACA. The 1996 Health Insurance Portability and Accountability Act, for example, restricted how insurers could limit coverage and mandated that employer-sponsored group plans can’t refuse to cover someone because of a health condition. Medicare and Medicaid similarly can’t deny coverage based on health background, though age and income-based eligibility requirements mean many Americans don’t qualify for that coverage.

Once the ACA’s preexisting condition protections kicked in, plans sold on the individual market had to provide a comprehensive package of benefits to all purchasers, no matter their health status.

Still, some conservatives say Biden’s claim overstates how many people are affected by Obamacare protections.

Even if you consider the broadest definition of the number of Americans living with such conditions, “there is zero way you could justify that 100 million people would lose coverage” without ACA protections, said Theo Merkel, who was a Trump administration health policy adviser and is now a senior research fellow with the Paragon Health Institute and a senior fellow at the Manhattan Institute for Policy Research, a conservative think tank.

Joseph Antos, a senior fellow at the American Enterprise Institute, a conservative think tank, called the ad’s preexisting conditions claim “the usual bluster.” To reach 100 million people affected, he said, “you have to assume that a large number of people would lose coverage.” And that’s unlikely to happen, he said.

That’s because most people — about 55% of Americans, according to the most recent government data — receive health insurance through their employers. As such, they’re protected by the Health Insurance Portability and Accountability Act rules, and their plans likely wouldn’t change, at least in the short term, if the ACA went away.

Antos said major insurance companies, which have operated under the ACA for more than a decade, would likely maintain the status quo even without such protections. “The negative publicity would be amazing,” he said.

People who lose their jobs, he said, would be vulnerable.

But Corlette argued that losing ACA protections could lead to Americans being priced out of their plans, as health insurers again begin medical underwriting in the individual market.

Park predicted that many businesses could also gradually find themselves priced out of their policies.

“For those firms with older, less healthy workers than other small employers, they would see their premiums rise,” he told KFF Health News.

Moreover, Park said, anytime people lost work or switched jobs, they’d risk losing their insurance, reverting to the old days of job lock.

“In any given year, the number [of people affected] will be much smaller than the 100 million, but all of those 100 million would be at risk of being discriminated against because of their preexisting condition,” Park said.

Our Ruling

We previously ruled Biden’s claim that 100 million Americans have preexisting conditions as in the ballpark, and nothing suggests that’s changed. Depending on the definition, the number could be smaller, but it also could be even greater and is likely to have increased since 2014.

Though Biden’s claim about the number of people who would be affected if those protections went away seems accurate, it is unclear how a return to the pre-ACA situation would manifest.

On the campaign trail this year, Trump has promised — as he did many times in the past — to replace the health law with something better. But he’s never produced a replacement plan. Biden’s claim shouldn’t be judged based on his lack of specificity.

We rate Biden’s claim Mostly True.

our sources

ABC News/Ipsos Poll, “Six Months Out, a Tight Presidential Race With a Battle Between Issues & Attributes,” May 5, 2024

Avalere, “Repeal of ACA’s Pre-Existing Condition Protections Could Affect Health Security of Over 100 Million People,” Oct. 23, 2018

Biden-Harris 2024 campaign email, “NEW AD: Biden-Harris 2024 Launches ‘Terminate’ Slamming Trump for Attacks on Health Care,” May 8, 2024

Center for American Progress, “Number of Americans With Preexisting Conditions by District for the 116th Congress,” Oct. 2, 2019

Census Bureau, “Health Insurance Coverage in the United States: 2022,” September 2023

CNN, “Trump Administration Gives States New Power to Weaken Obamacare,” Oct. 22, 2018

Department of Health and Human Services, “Health Insurance Coverage for Americans with Pre-Existing Conditions: The Impact of the Affordable Care Act,” Jan. 5, 2017

Department of Health and Human Services, “The Health Insurance Portability and Accountability Act (HIPAA) of 1996 Helpful Tips,” accessed May 15, 2024

Email exchanges with Biden-Harris 2024 campaign official, May 13-15, 2024

Email exchange with Karoline Leavitt, Trump 2024 campaign national press secretary, May 13, 2024

KFF, “KFF Health Tracking Poll: The Public’s Views on the ACA,” May 15, 2024

KFF, “Recent Trends in Mental Health and Substance Use Concerns Among Adolescents,” Feb. 6, 2024

KFF Health News, “Drowning in a ‘High-Risk Insurance Pool’ — At $18,000 a Year,” Feb. 27, 2017

KFF Health News and PolitiFact, “Biden’s in the Ballpark on How Many People Have Preexisting Conditions,” Oct. 1, 2020

The New York Times, “Trump Leads in 5 Key States, as Young and Nonwhite Voters Express Discontent With Biden,” May 13, 2024

Phone interview and email exchanges with Theo Merkel, a senior fellow at the Manhattan Institute and the director of the Private Health Reform Initiative at the Paragon Health Institute, May 14-15, 2024

Phone interview with Edwin Park, a research professor at Georgetown University’s McCourt School of Public Policy, May 22, 2024

Phone interview with Sabrina Corlette, a co-director of the Center on Health Insurance Reforms at Georgetown University, May 14, 2024, post by @realDonaldTrump, Nov. 25, 2023

The Wall Street Journal, “ to Shut Down During Parts of Enrollment Period for Maintenance,” Sept. 23, 2017

Work, Aging and Retirement, “Job Lock, Work, and Psychological Well-Being in the United States,” Feb. 19, 2016, “First 2020 Presidential Debate between Donald Trump and Joe Biden,” Sept. 29, 2020, “Terminate” campaign advertisement, May 10, 2024

Phone interview with Joseph Antos, a senior fellow at the American Enterprise Institute, June 5, 2024

Health Affairs, What It Means To Cover Preexisting Conditions, Sept. 11, 2020

KFF, Pre-Existing Conditions and Medical Underwriting in the Individual Insurance Market Prior to the ACA, Dec. 12, 2016

PolitiFact, “Does Trump Want To Repeal the ACA, as Biden Says? Tracking His Changing Stance Over the Years,” June 3, 2024

Funding Instability Plagues Program That Brings Docs to Underserved Areas

For Diana Perez, a medical resident at the Family Health Center of Harlem, the handwritten thank-you note she received from a patient is all the evidence she needs that she has chosen the right training path.

Perez helped the patient, a homeless, West African immigrant who has HIV and other chronic conditions, get the medications and care he needed. She also did the paperwork that documented his medical needs for the nonprofit that helped him apply for asylum and secure housing.

“I really like whole-person care,” said Perez, 31, who has been based at this New York City health center for most of the past three years. “I wanted to learn and train, dealing with the everyday things I will be seeing as a primary care physician and really immersing myself in the community,” she said.

A selfie portrait of Diana Perez. She is outside on a balcony in New York City.
“I wanted to learn and train dealing with the everyday things I will be seeing as a primary care physician and really immersing myself in the community,” says Diana Perez, who is completing her primary care residency at the Family Health Center of Harlem.(Diana Perez)

Few primary care residents get such extensive community-based outpatient training. The vast majority spend most of their residencies in hospitals. But Perez, who is being trained through the Teaching Health Center Graduate Medical Education program, is among those treating patients in federally qualified health centers and community clinics in medically underserved rural and urban areas around the country. After graduating, these residents are more likely than hospital-trained graduates to stay on and practice locally where they are often desperately needed, research has found.

Amid the long-term shift from inpatient to outpatient medical care, training primary care doctors in outpatient clinics rather than hospitals is a no-brainer, according to Robert Schiller, chief academic officer at the Institute for Family Health, which runs the Harlem THC program and operates dozens of other health center sites in New York. “Care is moving out into the community,” he said, and the THC program is “creating a community-based training environment, and the community is the classroom.”

Yet because the program, established under the 2010 Affordable Care Act, relies on congressional appropriations for funding, it routinely faces financial uncertainty. Despite bipartisan support, it will run out of funds at the end of December unless lawmakers vote to replenish its coffers — no easy task in the current divided Congress in which gaining passage for any type of legislation has proved difficult. Faced with the prospect of not being able to cover three years of residency training, several of the 82 THC programs nationwide recently put their residency training programs on hold or are phasing them out.

That’s what the DePaul Family and Social Medicine Residency Program in New Orleans East, an area that has been slow to recover after Hurricane Katrina in 2005, has done. With a startup grant from the federal Health Resources and Services Administration, the community health center hired staff for the residency program and became accredited last fall. They interviewed more than 50 medical students for residency slots and hoped to enroll their first class of four first-year residents in July. But with funding uncertain, they put the new program on hold this spring, a few weeks before “Match Day,” when residency programs and students are paired.

“It was incredibly disappointing for many reasons,” said Coleman Pratt, the residency program’s director, who was hired two years ago to launch the initiative.

Until we know we’ve got funding, we’re “treading water,” Pratt said.

“In order to have eligible applications in-hand should Congress appropriate new multi-year funds, HRSA will issue a Notice of Funding Opportunity in late summer for both new and expanded programs to apply to be funded in FY 2025, subject to the availability of appropriations,” said Martin Kramer, an HRSA spokesperson, in an email.

For now, the Teaching Health Center program has $215 million to spend through 2024.

By contrast, the Centers for Medicare & Medicaid Services paid hospitals $18 billion to provide residency training for doctors in primary care and other specialties. Unlike THC funding, which must be appropriated by Congress, Medicare graduate medical education funding is guaranteed as a federal entitlement program.

Trying to keep THC’s three-year residency programs afloat when congressional funding comes through in fits and starts weighs heavily on the facilities trying to participate. These pressures are now coming to a head.

“Precariousness of funding is a theme,” said Schiller, noting that the Institute for Family Health put its own plans for a new THC in Brooklyn on hold this year.

The misalignment between the health care needs of the American population and the hospital-based medical training most doctors receive is a long-recognized problem. A 2014 report by the National Academies Press noted that “although the GME system has been producing more physicians, it has not produced an increasing proportion of physicians who choose to practice primary care, to provide care to underserved populations, or to locate in rural or other underserved areas.”

The Teaching Health Center program has demonstrated success in these areas, with program graduates more likely to practice in medically underserved areas after graduation. According to a study that analyzed the practice patterns of family medicine graduates from traditional GME training programs vs. those who participated in the THC program, nearly twice as many THC graduates were practicing in underserved areas three years after graduating, 35.2% vs. 18.6%. In addition, THC graduates were significantly more likely to practice in rural areas, 17.9% vs. 11.8%. They were also more likely to provide substance use treatment, behavioral health care, and outpatient gynecological care than graduates from regular GME programs.

But the lack of reliable, long-term funding is a hurdle to the THC training model’s potential, proponents say. For 2024, the Biden administration had proposed three years of mandatory funding, totaling $841 million, to support more than 2,000 residents.

“HRSA is eager to fund new programs and more residents, which is why the President’s Budget has proposed multi-year increased funding for the Teaching Health Center program,” Kramer said in an email.

The American Hospital Association supports expanding the THC program “to help address general workforce challenges,” said spokesperson Sharon Cohen in an email.

The program appeals to residents interested in pursuing primary and community care in underserved areas.

“There’s definitely a selection bias in who chooses these [THC] programs,” said Candice Chen, an associate professor of health policy and management at George Washington University.

Hospital primary care programs, for instance, typically fail to fill their primary care residency slots on Match Day. But in the THC program, “every single year, all of the slots match,” said Cristine Serrano, executive director of the American Association of Teaching Health Centers. On Match Day in March, more than 19,000 primary care positions were available; roughly 300 of those were THC positions.

Amanda Fernandez, 30, always wanted to work with medically underserved patients. She did her family medicine residency training at a THC in Hendersonville, North Carolina. She liked it so much that, after graduating last year, the Miami native took a job in Sylva, about 60 miles away.

Her mostly rural patients are accustomed to feeling like a way station for physicians, who often decamp to bigger metro areas after a few years. But she and her husband, a physician who works at the nearby Cherokee Indian Hospital, bought a house and plan to stay.

“That’s why I loved the THC model,” Fernandez said. “You end up practicing in a community similar to the one that you trained in.”

California Dabbles With Reining in Health Spending

California is now among the states trying to keep health-care costs down by setting spending caps — a task that pits public officials against a deeply entrenched and heavily lawyered set of players.

It’s uncertain whether the state can get insurers, hospitals and medical groups to collaborate on containing costs even as they jockey for their slice of California’s $400 billion-plus health-care pie.

The verdict could take years.

In late April, the state’s new Office of Health Care Affordability set a five-year target for spending growth that starts at 3.5 percent for 2025 and drops to 3 percent by 2029. The goal of the embryonic agency is to make care more affordable and accessible while improving health outcomes and reducing inequity.

To do so, California’s affordability office must confront high prices, unnecessary medical treatments, overuse of high-cost care like emergency rooms, and administrative waste. Not to mention state policies that favor greater investment in health care, which means more revenue for the industry.

This year, when the office was considering an annual per capita spending growth target of 3 percent, the California Hospital Association said the figure did not account for the state’s aging population, new investments in its Medicaid program and other cost pressures. Instead, the hospitals proposed a 5.3 percent average annual target over the five-year period.

The California Medical Association, which represents the state’s doctors, has expressed similar concerns.

For health-care organizations that miss the target, a long and messy process begins that could end with fines of as much as 100 percent of the overspending. But that probably wouldn’t happen until 2030 or beyond, if ever.

In 2013, Massachusetts was the first state to set annual spending targets. Connecticut, Delaware, Nevada, New Jersey, Oregon, Rhode Island and Washington are among other states that have set targets.

The results in Massachusetts have been mixed: The state beat its target in three of the first five years, falling below the average national spending increase.

But more recently, its health spending has increased. In 2022, it exceeded the target by nearly double, and the state’s Health Policy Commission, which oversees spending control efforts, warned of “many alarming trends.”

Proponents of California’s affordability agency hope that open dialogue — coupled with plans to make more detailed spending data public, including for specific health-care organizations — will foster greater industry accountability.

Rhode Island, despite a preexisting policy of limiting hospital price increases, exceeded its overall health-care spending growth target in 2019, the year it took effect. In 2020 and 2021, spending was largely skewed by the coronavirus pandemic. But in 2022, the spending increase came in at half the state’s target rate.

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‘I Try To Stay Strong’: Mom Struggles To Get Diagnosis for Son’s Developmental Problems

CASTRO VALLEY, Calif. — Four-year-old Ahmeir Diaz-Thornton couldn’t sit still in class and rarely ate his lunch. While his preschool classmates spoke in perfect sentences, Ahmeir had trouble pronouncing words.

Ahmeir’s preschool teacher relayed her concerns to his mother, Kanika Thornton, who was already worried about Ahmeir’s refusal to eat anything but yogurt, Chef Boyardee spaghetti, oatmeal, and applesauce. He also sometimes hit himself and others to cope with the frustration of not being able to communicate, she said.

Thornton took her son, who is on Medi-Cal, California’s Medicaid program, which covers low-income families, to his pediatrician. Then he was evaluated by a school district official, a speech therapist, and the pediatrician — again. Along the way, Thornton consulted teachers, case managers, and social service workers.

Ten months later, she still doesn’t have an accurate diagnosis for Ahmeir.

“I felt like I failed my child, and I don’t want to feel that,” said Thornton, 30, who has been juggling Ahmeir’s behavior and appointments on top of her pregnancy and caring for her two other children.

“Some days I don’t eat because he doesn’t eat,” said Thornton from her home in Alameda County in the San Francisco Bay Area. “I don’t want to hurt my unborn child. So I try to eat some crackers and cheese and stuff, but I don’t eat a meal because he doesn’t eat a meal.”

Seeking a diagnosis for a child’s behavioral problems can be challenging for any family as they navigate complicated medical and educational systems that don’t communicate effectively with parents, let alone each other.

A common obstacle families face is landing an appointment with one of a limited number of developmental specialists. It is particularly difficult for families with Medi-Cal, whose access to specialists is even more restricted than for patients with private insurance.

As they await their turn, they boomerang among counselors, therapists, and school officials who address isolated symptoms, often without making progress toward an overall diagnosis.

Obtaining a timely diagnosis for autism, anxiety, attention-deficit/hyperactivity disorder, or other behavioral disorders is important for children and their parents, said Christina Buysse, a clinical associate professor in developmental and behavioral pediatrics at Stanford University.

“Parent stress levels go down when a child is diagnosed early,” because they learn how to manage their child’s behaviors, she said.

Intervening early can also help retrain a child’s brain quickly and avoid lifelong consequences of developmental delays, said Adiaha Spinks-Franklin, president of the Society for Developmental and Behavioral Pediatrics.

“A speech and language delay at the age of 2 can put a child at risk of reading comprehension problems in the third grade,” she said.

Buysse is likely the right type of medical specialist for Ahmeir. As a developmental-behavioral pediatrician, she can often unify different symptoms into one diagnosis, and she knows what kind of therapy or medication patients need.

The Society for Developmental and Behavioral Pediatrics reports that there are only 706 actively certified developmental specialists in the nation.

“There just aren’t enough of us,” Buysse said, and some developmental specialists don’t accept Medicaid patients because they believe the reimbursement rates aren’t adequate.

A young boy rides a tricycle inside. He turns and tilts his head toward the camera and smiles.
Ahmeir Diaz-Thornton’s speech has improved with school-provided therapy. However, he is still waiting for a comprehensive medical evaluation and diagnosis. (Sejal Parekh for KFF Health News)

Thornton didn’t know her son needed to see a developmental specialist, and he had never been referred to one, despite his many medical appointments. Once she learned about this type of specialist in May, she asked his pediatrician for a referral.

Alameda Health System, which provides Ahmeir’s primary care, “does not have a developmental-behavioral pediatrician on staff at this time,” said Porshia Mack, the system’s associate chief medical officer of ambulatory services.

“We have made efforts to hire them, but recruiting and retaining pediatric subspecialists is difficult for all health systems, and public safety-net systems in particular,” she said.

Karina Rivera, a spokesperson for the Alameda Alliance for Health, Thornton’s Medi-Cal managed care plan, provided a list of nine developmental-behavioral pediatricians she said are in the plan’s network.

However, the only two in Alameda County work for Kaiser Permanente, which “is a closed system,” acknowledged Donna Carey, interim chief medical officer of the Alameda Alliance. In practice, that means “even if they have a developmental pediatrician, we don’t have access to that pediatrician,” she said.

The other seven specialists are in surrounding counties, which could pose transportation challenges for Thornton and other patients.

The Alameda Alliance for Health met state requirements for patient access to specialists in the most recent review of its network, in 2022, said Department of Health Care Services spokesperson Griselda Melgoza. The plan “was found compliant with all time or distance standards,” she said.

However, after learning from California Healthline that the plan considers Kaiser Permanente specialists part of its network, the department contacted the insurer to inquire, and will work with it “to ensure member-facing materials accurately represent their current network,” Melgoza said.

A month after starting preschool in fall 2023, Ahmeir was evaluated for speech delay through his school district. His pediatrician also began ordering tests to understand his eating habits.

But Thornton believes Ahmeir’s symptoms aren’t isolated problems that can be addressed in a piecemeal fashion. “It’s just something else. It’s his development,” she said. “I know a tantrum, but he doesn’t get tantrums. He will hit people. That’s a no-go.”

In addition to addressing medical concerns, a developmental specialist could help parents like Thornton understand what school districts offer and how to expedite school evaluations, Spinks-Franklin said. Ahmeir faces a six- to eight-month wait for a comprehensive evaluation through his school district for additional services, Thornton said.

It’s common for parents to get confused about what a school district can and can’t do for kids with developmental disabilities, said Corina Samaniego, who works at Family Resource Navigators, an organization that helps parents like Thornton in Alameda County. For instance, Samaniego said, school districts cannot provide medical diagnoses of autism, nor the therapy to address it.

Ahmeir has made significant improvement with speech therapy provided through the school district, Thornton said, and now speaks in full sentences more often. But she remains frustrated that she does not have a diagnosis that explains his persistent symptoms, especially his reluctance to eat and difficulty expressing emotions.

Thornton believes she has done everything she can to help him. She has even created elaborate food landscapes for Ahmeir with dinosaur-shaped chicken nuggets, mashed potato volcanoes, gravy lava, and broccoli trees — only to have him turn his head away.

As of late May, she continued to seek advice from teachers and counselors while she waited for an appointment with a specialist.

“I try to stay strong for my son and do the best I can and be there for him, talk to him, teach him things,” she said. “It’s been really tough.”

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

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

Many Young Adults Who Began Vaping as Teens Can’t Shake the Habit

G Kumar’s vaping addiction peaked in college at the University of Colorado, when flavored, disposable vapes were taking off.

“I’d go through, let’s say, 1,200 puffs in a week,” Kumar said.

Vaping became a crutch for them. Like losing a cellphone, losing a vape pen would set off a mad scramble.

“It needs to be right next to my head when I fall asleep at night, and then in the morning, I have to thrash through the sheets and pick it up and find it,” Kumar recalled.

They got sick often, including catching covid-19 — and vaping through all of it.

Kumar, now 24, eventually quit. But many of their generation can’t shake the habit.

“Everyone knows it’s not good for you and everyone wants to stop,” said Jacob Garza, a University of Colorado student who worked to raise awareness about substance use as part of the school’s health promotion program.

“But at this point, doing it all these years … it’s just second nature now,” he said.

Marketing by e-cigarette companies, touting the allure of fruity or candy-like flavors and names, led many teens to try vaping. As more high schoolers and younger kids experimented with e-cigarettes, physicians and researchers warned it could lead to widespread addiction, creating a “Generation Vape.”

Research has shown nicotine is highly rewarding to the brains of young people.

New data on substance use among adults ages 18-24 suggests that many former teen vapers remain e-cigarette users. National vaping rates for young adults increased from 7.6% in 2018 to 11% in 2021.

A photo of colorful vape juice products lined up on shelves in a store.
Rows of flavored tobacco vape juice on display at a store in Fresno, California, on Oct. 18.(Marek Warszawski/Fresno Bee/Tribune News Service via Getty Images)

It’s not surprising that many of them start in high school for social reasons, for all sorts of reasons,” said Delaney Ruston, a primary care physician and documentary filmmaker. “And many of them now — we’re seeing this — have continued to college and beyond.”

Her latest film is “Screenagers Under the Influence: Addressing Vaping, Drugs & Alcohol in the Digital Age.”

In Colorado, the share of those 18 to 24 who regularly vaped rose by about 61% from 2020 to 2022 — to nearly a quarter of that age group.

“That’s an astounding increase in just two years,” Ruston said.

Trends in that state are worth noting because, before the pandemic, Colorado led the nation in youth vaping among high school students, surpassing 36 other states surveyed.

Nationally, vaping rates among high schoolers dropped from 28% in 2019 to 10% in 2023, according to the Annual National Youth Tobacco Survey. But for many young people who started vaping at the height of the trend, a habit was set.

At Children’s Hospital Colorado, pediatric pulmonologist Heather De Keyser displayed on her screen a clouded X-ray of the lung of a young adult damaged by vaping.

For years, doctors like her and public health experts wondered about the potentially harmful impact of vaping on pre-adult bodies and brains — especially the big risk of addiction.

“I think, unfortunately, those lessons that we were worried we were going to be learning, we’re learning,” said De Keyser, an associate professor of pediatrics in the Breathing Institute at Children’s Hospital Colorado.

“We’re seeing increases in those young adults. They weren’t able to stop.”

A photo of a woman pointing to an X-ray.
Heather De Keyser, a pediatric pulmonologist at Children’s Hospital Colorado, points to the X-ray of a lung of a young adult damaged by vaping.(John Daley/Colorado Public Radio)

It’s no coincidence the vaping rates soared during the pandemic, according to several public health experts.

For the past couple of years, undergraduates have talked about the challenges of isolation and using more substances, said Alyssa Wright, who manages early intervention health promotion programs at CU-Boulder.

“Just being home, being bored, being a little bit anxious, not knowing what’s happening in the world,” Wright said. “We don’t have that social connection, and it feels like people are still even trying to catch up from that experience.”

Other factors driving addiction are the high nicotine levels in vaping devices, and “stealth culture,” said Chris Lord, CU-Boulder’s associate director of the Collegiate Recovery Center.

“The products they were using had five times more nicotine than previous vapes had,” he said. “So getting hooked on that was … almost impossible to avoid.”

By “stealth culture,” Lord means that vaping is exciting, something forbidden and secret. “As an adolescent, our brains are kind of wired that way, a lot of us,” Lord said.

All over the U.S., state and local governments have filed suits against Juul Labs, alleging the company misrepresented the health risks of its products.

The lawsuits argued that Juul became a top e-cigarette company by aggressively marketing directly to kids, who then spread the word themselves by posting to social media sites like YouTube, Instagram, and TikTok.

“What vaping has done, getting high schoolers, in some cases even middle schoolers, hooked on vaping, is now playing out,” said Colorado Attorney General Phil Weiser.

Juul agreed to pay hundreds of millions in settlements. The company did not respond to requests for comment on this article.

R.J. Reynolds, which makes another popular vape brand, Vuse, sent this statement: “We steer clear of youth enticing flavors, such as bubble gum and cotton candy, providing a stark juxtaposition to illicit disposable vapor products.”

Other big vape companies, like Esco Bar, Elf Bar, Breeze Smoke, and Puff Bar, didn’t respond to requests for comment.

“If we lived in an ideal world, adults would reach the age of 24 without ever having experimented with adult substances. In reality, young adults experiment,” said Greg Conley, director of legislative and external affairs with American Vapor Manufacturers. “This predates the advent of nicotine vaping.”

A photo of colorful disposable vapes shown inside a convenience store.
Disposable vapes are displayed in a convenience store on June 23, 2022, in El Segundo, California.(Patrick T. Fallon/AFP via Getty Images)

The FDA banned flavored vape cartridges in 2020 to crack down on marketing to minors, but the products are still easy to find.

Joe Miklosi, a consultant to the Rocky Mountain Smoke-Free Alliance, a trade group for vape shops, contends the shops are not driving vaping rates among young adults in Colorado. “We keep demographic data in our 125 stores. Our average age [of customers] is 42,” he said.

He has spoken with thousands of consumers who say vaping helped them quit smoking cigarettes, he said. Vape shops sell products to help adult smokers quit, Miklosi said.

Colorado statistics belie that claim, according to longtime tobacco researcher Stanton Glantz. The data is “completely inconsistent with the argument that most e-cigarette use is adult smokers trying to use them to quit,” said Glantz, the former director of the Center for Tobacco Control Research and Education at the University of California-San Francisco.

For recent college graduate G Kumar, now a rock climber, the impetus to quit vaping was more ecological than health-related. They said they were turned off by the amount of trash generated from used vape devices and the amount of money they were spending.

Kumar got help from cessation literature and quitting aids from the university’s health promotion program, including boxes of eucalyptus-flavored toothpicks, which tasted awful but provided a distraction and helped with oral cravings.

It took a while and a lot of willpower to overcome the intense psychological cravings.

“The fact that I could just gnaw on toothpicks for weeks on end was, I think, what kept me sane,” Kumar said.

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

Biden Administration Advances Plan To Remove Medical Debt From Credit Scores

Americans would no longer have to worry about medical debts dragging down their credit scores under federal regulations proposed Tuesday by the Consumer Financial Protection Bureau.

If enacted, the rules would dramatically expand protections for tens of millions of Americans burdened by medical bills they can’t afford.

The regulations would also fulfill a pledge by the Biden administration to address the scourge of health care debt, a uniquely American problem that touches an estimated 100 million people, forcing many to make sacrifices such as limiting food, clothing, and other essentials.

“No one should be denied access to economic opportunity simply because they experienced a medical emergency,” Vice President Kamala Harris said Tuesday.

The administration further called on states to expand efforts to restrict debt collection by hospitals and to make hospitals provide more charity care to low-income patients, a step that could prevent more Americans from ending up with medical debt.

And Harris urged state and local governments to continue to buy up medical debt and retire it, a strategy that has become increasingly popular nationwide.

Credit reporting, a threat traditionally used by medical providers and debt collectors to induce patients to pay their bills, is the most common collection tactic used by hospitals, a KFF Health News analysis has shown.

Although a single unpaid bill on a credit report may not hugely affect some people, the impact can be devastating for those with large health care debts.

There is growing evidence, for example, that credit scores depressed by medical debt can threaten people’s access to housing and fuel homelessness. People with low credit scores can also have problems getting a loan or can be forced to borrow at higher interest rates.

“We’ve heard stories of individuals who couldn’t get jobs because their medical debt was impacting their credit score and they had low credit,” said Mona Shah, a senior director at Community Catalyst, a nonprofit that’s pushed for expanded medical debt protections for patients.

Shah said the proposed regulations would have a major impact on patients’ financial security and health. “This is a really big deal,” she said.

Administration officials said they plan to review public comments about their proposal through the rest of this year and hope to issue a final rule early next year.

CFPB researchers have found that medical debt — unlike other kinds of debt — does not accurately predict a consumer’s creditworthiness, calling into question how useful it is on a credit report.

The three largest credit agencies — Equifax, Experian, and TransUnion — said they would stop including some medical debt on credit reports as of last year. The excluded debts included paid-off bills and those less than $500.

Those moves have substantially reduced the number of people with medical debt on their credit reports, government data shows. But the agencies’ voluntary actions left out many patients with bigger medical bills on their credit reports.

A recent CFPB report found that 15 million people still have such bills on their credit reports, despite the voluntary changes. Many of these people live in low-income communities in the South, according to the report.

The proposed rules would not only bar future medical bills from appearing on credit reports; they would also remove current medical debts, according to administration officials.

Officials said the banned debt would include not only medical bills but also dental bills, a major source of Americans’ health care debt.

Even though the debts would not appear on credit scores, patients will still owe them. That means that hospitals, physicians, and other providers could still use other collection tactics to try to get patients to pay, including using the courts.

Patients who used credit cards to pay medical bills — including medical credit cards such as CareCredit — will also continue to see those debts on their credit scores as they would not be covered by the proposed regulation.

Hospital leaders and representatives of the debt collection industry have warned that restricting credit reporting may have unintended consequences, such as prompting more hospitals and physicians to require upfront payment before delivering care.

But consumer and patient advocates continue to call for more action. The National Consumer Law Center, Community Catalyst, and about 50 other groups last year sent letters to the CFPB and IRS urging stronger federal action to rein in hospital debt collection.

State leaders also have taken steps to expand consumer protections. In recent months, a growing number of states, led by Colorado and New York, have enacted legislation prohibiting medical debt from being included on residents’ credit reports or factored into their credit scores. Other states, including California, are considering similar measures.

Many groups are also urging the federal government to bar tax-exempt hospitals from selling patient debt to debt-buying companies or denying medical care to people with past-due bills, practices that remain widespread across the U.S., KFF Health News found.

About This Project

“Diagnosis: Debt” is a reporting partnership between KFF Health News and NPR exploring the scale, impact, and causes of medical debt in America.

The series draws on original polling by KFF, court records, federal data on hospital finances, contracts obtained through public records requests, data on international health systems, and a yearlong investigation into the financial assistance and collection policies of more than 500 hospitals across the country. 

Additional research was conducted by the Urban Institute, which analyzed credit bureau and other demographic data on poverty, race, and health status for KFF Health News to explore where medical debt is concentrated in the U.S. and what factors are associated with high debt levels.

The JPMorgan Chase Institute analyzed records from a sampling of Chase credit card holders to look at how customers’ balances may be affected by major medical expenses. And the CED Project, a Denver nonprofit, worked with KFF Health News on a survey of its clients to explore links between medical debt and housing instability. 

KFF Health News journalists worked with KFF public opinion researchers to design and analyze the “KFF Health Care Debt Survey.” The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current health care debt and 382 adults who had health care debt in the past five years. The margin of sampling error is plus or minus 3 percentage points for the full sample and 3 percentage points for those with current debt. For results based on subgroups, the margin of sampling error may be higher.

Reporters from KFF Health News and NPR also conducted hundreds of interviews with patients across the country; spoke with physicians, health industry leaders, consumer advocates, debt lawyers, and researchers; and reviewed scores of studies and surveys about medical debt.

Listen to the Latest ‘KFF Health News Minute’

June 6

This week on the KFF Health News Minute: Dairy farm workers weigh the risks of testing positive for bird flu and potentially losing a paycheck, and cruise-goers could face costly medical bills if they get sick at sea.

May 30

This week on the KFF Health News Minute: High demand and high prices keep drugs like Ozempic out of reach for diabetes patients on a fixed income, and why changing the kind of respiratory inhaler you use could be a better choice for the planet.

May 23

This week on the KFF Health News Minute: A 1930s law is keeping cutting-edge sunscreen off the shelf in the United States, and survivors of gun violence often have to decide what to do with the bullets still in their bodies.

May 16

This week on the KFF Health News Minute: DIY gel manicures could give you an allergic reaction and some aspiring specialist physicians are avoiding states with strict abortion laws.

May 9

This week on the KFF Health News Minute: Beware fine print on a doctor’s agreement that might get in the way of a health insurance reimbursement, and health risks from climate change have Oregon looking to send Medicaid recipients air conditioners and purifiers.

May 2

This week on the KFF Health News Minute: Young adults who got hooked on vaping struggle to kick the habit and vehicle tires emerge as a major source of air pollution.

April 25

This week on the KFF Health News Minute: Some homeless people who are eligible for Medicaid are losing it as states rush to purge their rolls, and a wave of communities have stopped adding cavity-preventing fluoride to their drinking water.

April 18

This week on the KFF Health News Minute: A shortage of dentists has more primary care doctors taking care of teeth, and providers risk jail time in states that continue to outlaw needle exchanges.

April 11

This week on the KFF Health News Minute: Rising attacks on emergency room staffers have nurses demanding harsher penalties, and a loophole in the No Surprises Act left a mom with an air-ambulance bill of more than $97,000.

April 4

This week on the KFF Health News Minute: A tech-powered, faster way to diagnose the disease that causes diabetes-related blindness, and emerging research on alcohol consumption and women’s risks.  

March 28

This week on the KFF Health News Minute: Questions around abortion rights could be on the ballot in more than a dozen states this November, and a new report points to rising rates of alcohol-related deaths among women.

March 21

This week on the KFF Health News Minute: Public health experts worry the anti-vaccine movement pits parental rights against public health, and a Michigan widower joins the fight for minimum staffing levels for hospital nurses.

March 14

This week on the KFF Health News Minute: Medicaid expansion could help some rural hospitals stay open, and upcoming rules from the Consumer Financial Protection Bureau would keep all medical debt off credit reports.

March 6

This week on the KFF Health News Minute: Some providers are saving penicillin for pregnant patients amid a shortage of the drug, which is used to treat syphilis, and why bigger hearing aids might be better.

Feb. 28

This week on the KFF Health News Minute: Calls for confidential mental health treatment rise as some medical providers put off care for fear of losing their jobs, and lawmakers grapple with how to regulate artificial intelligence in medicine.

Feb. 22

This week on the KFF Health News Minute: Pain specialists say injections for kids don’t have to hurt so much, and states overwhelmed by the housing crisis are using Medicaid funds to curb homelessness.

Feb. 15

This week on the KFF Health News Minute: Some cities rethink the role of police in responding to someone in a mental health crisis, and the FDA takes aim at a carcinogen commonly found in hair-straightening products.

Feb. 08

This week on the KFF Health News Minute: The Federal Trade Commission says drugmakers are misusing patents to keep prices high on medication delivery devices like inhalers and injectors, and some providers are using a loophole in the Affordable Care Act to charge patients for preventive care that’s supposed to be free.

Feb. 01

This week on the KFF Health News Minute: Americans struggle to find a primary care provider, and some experts on aging are calling on older drivers to sign an advance directive to determine when they should stop driving.

Jan. 25

This week on the KFF Health News Minute: The federal government will force some insurers to review prior authorization requests more quickly, and it’s still worth it to get vaccinated for the flu, covid, and RSV in the middle of respiratory virus season.

Jan. 18

This week on the KFF Health News Minute: Workers in smoky casinos say they shouldn’t have to gamble with their health on the job, and some Medicare Advantage enrollees feel trapped in their plans as they get older and sicker.

Jan. 11

This week on the KFF Health News Minute: A national shortage of Adderall leaves people with narcolepsy struggling to live normal lives. and researchers find little evidence that mental health courts are keeping those who need them most out of lockup.

Jan. 4

This week on the KFF Health News Minute: In some states, anglers have little guidance about the “forever chemicals” in freshwater fish, and California once again expands access to its Medicaid program, opening the door wider for immigrants regardless of age or legal status.

The KFF Health News Minute is available every Thursday on CBS News Radio.

End of Internet Subsidy Leaves Millions Facing Telehealth Disconnect

When the clock struck midnight on May 31, more than 23 million low-income households were dropped from a federal internet subsidy program that for years had helped them get connected.

The Affordable Connectivity Program was created in 2021, in the midst of the covid-19 pandemic, to help people plug into jobs, schools and health care by reducing their internet costs by up to $75 a month.

Helping connect households was particularly important in rural America, where telehealth services are often leaned on to fill health care gaps and address provider shortages.

But that aid evaporated last month when Congress didn’t move to keep it funded.

“Internet bills for millions of Americans are increasing because Congressional Republicans failed to act,” White House spokesperson Robyn Patterson emailed me.

Some lawmakers have argued that too much of the subsidy money went to people who don’t need it. Last month, Republicans and Democrats introduced proposals to address those concerns. The ACP debate continues, with a funding measure expected to be part of the Spectrum and National Security Act of 2024, under consideration Wednesday by the Senate’s Commerce, Science and Transportation Committee.

The day before the subsidies expired, White House officials offered a consolation prize, announcing they had worked out a deal with 15 internet providers that agreed to keep offering low-cost plans. The announcement isn’t really new, though, nor as robust as a previous deal.

In 2022, the Biden administration announced that 20 companies would offer plans for $30 a month or less. AT&TVerizon and Comcast are among the players continuing to sell low-cost plans the administration says will benefit an estimated 10 million households.

Of course, low-cost plans still come with bills consumers must pay. And without the connectivity program’s monthly assistance, 77 percent of households that benefited from it will have to change plans or drop their internet connections, Jessica Rosenworcel, chair of the Federal Communications Commission, wrote in a letter to lawmakers.

“A consistent theme is that many ACP recipients are seniors on fixed incomes struggling to pay competing bills and make ends meet,” she wrote.

Those affected are people like Myrna Broncho, 69, a Shoshone-Bannock tribal member who talked with me at the Fort Hall Reservation in southeastern Idaho. She had qualified for a $75 subsidy, enough to eliminate her internet bill after she signed on last year.

Without the subsidy, she’ll have to “go back on my tight budget.” Retired and ranching, Broncho said she uses the internet for shopping, paying bills and keeping track of her health care.

Rosenworcel’s letter arguing for renewed funding for the ACP was sent to a handful of lawmakers, including Sens. Maria Cantwell (D-Wash.), who chairs the commerce committee, and Ted Cruz (R-Tex.), who has proposed greatly narrowing eligibility for the program.

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