Tag: Biden Administration

En la convención republicana de Trump se escuchó poco y nada sobre atención de salud

Ni una palabra sobre el Obamacare o el aborto.

En la Convención Nacional Republicana en Milwaukee esta semana, donde los delegados nominaron oficialmente a Donald Trump como candidato presidencial del partido para 2024, los oradores principales le dieron poco lugar a los temas de atención médica.

Este silencio es sorprendente, dado que la atención médica constituye la mayor parte del presupuesto federal, casi $2 mil millones, así como el 17% de la producción económica del país.

También muestra un contraste marcado con las prioridades del Partido Republicano cuando nominó a Trump por primera vez.

En 2016, la última vez que los republicanos se reunieron en masa para una convención presidencial, derogar la Ley de Cuidado de Salud a Bajo Precio (ACA) fue un tema favorito. También anular Roe vs. Wade y sus protecciones constitucionales para el aborto.

El cambio de tono refleja las sensibilidades políticas de Trump. En 2017, el intento fallido del ex presidente de derogar Obamacare contribuyó a una aplastante derrota del partido en las elecciones congresionales de medio término de 2018, y la ley ahora tiene un amplio apoyo.

El aborto también se ha convertido en un tema peligroso para los republicanos desde que Roe fuera anulado en 2022, con la mayoría de los estadounidenses oponiéndose a una prohibición nacional.

En una de las pocas piezas de política de salud en la plataforma del Partido Republicano para 2024, el ex presidente promete no recortar el Seguro Social ni Medicare, el programa de salud para estadounidenses mayores y que viven con discapacitados, ni cambiar la edad federal para jubilarse.

En su discurso de aceptación el jueves 18, Trump prometió proteger Medicare y encontrar curas para el Alzheimer y el cáncer. Pero no delineó ninguna propuesta de atención médica para un segundo mandato. “Los demócratas van a destruir el Seguro Social y Medicare”, dijo.

La atención médica no es un tema ganador para los republicanos, dijo Charles Coughlin, CEO de una firma de asuntos públicos de Phoenix que fue un órgano político republicano durante mucho tiempo antes de convertirse en independiente en 2017.

Los oradores en la convención se han centrado en cambios en la inflación, el crimen y la inmigración. “Tienen los datos de encuestas probados y verdaderos que muestran que, para ellos, esos son temas ganadores, y ahí es donde quieren mantener el foco narrativo”, dijo.

La inmigración se ha mezclado con algunos problemas de salud, incluida la crisis de opioides nacional y la cobertura de seguro público.

Algunos republicanos, incluida la representante por Georgia Marjorie Taylor Greene, quien se dirigió a la convención el 15 de julio, han afirmado que un aumento en las personas que cruzan la frontera sur ha causado más sobredosis de drogas y más muertes.

Sin embargo, la mayor parte del fentanilo incautado en la frontera con México entra por puertos de entrada legales, según el Instituto Cato, un grupo de expertos libertarios, y la mayoría de las personas sentenciadas en el país por tráfico de fentanilo son ciudadanos estadounidenses, según la Comisión de Sentencias de Estados Unidos.

Hablando el 17 de julio, la representante por Texas, Monica De La Cruz, afirmó que las políticas demócratas permiten que las personas que ingresan al país sin autorización reciban beneficios gubernamentales, aunque en gran medida no son elegibles para programas de salud federales.

De La Cruz también dijo que la administración Biden había recortado Medicare Advantage para los adultos mayores. Si bien la administración Biden este año recortó modestamente el gasto en planes privados, el gobierno federal aún gasta más dinero por beneficiario en Medicare Advantage que en los del programa tradicional de Medicare.

La escasez de oradores de la convención enfocados en la atención médica refleja la nueva plataforma del Partido Republicano, un documento que se ajusta estrechamente tanto al contenido como al tono de las opiniones de Trump.

Junto con su promesa de proteger Medicare, el documento de 28 páginas promete que los republicanos expandirán las opciones de atención médica para veteranos, así como el acceso a “nuevas opciones asequibles de atención médica y medicamentos recetados” de manera más amplia, sin dar más detalles.

Sobre el aborto, el partido eliminó de la plataforma su llamado de décadas a límites federales, incluyendo en cambio un lenguaje que sugiere que la Enmienda 14ª prohíbe el aborto. La plataforma también dice que el partido apoya elecciones a nivel estatal sobre la política de aborto y se opone al “Aborto tardío”.

Solo alrededor del 1% de los abortos en el país ocurren después de las 21 semanas de embarazo, según KFF, una organización sin fines de lucro de información sobre salud que incluye a KFF Health News.

En contraste, la plataforma de 2016 —un documento de 66 páginas— pedía convertir la financiación federal abierta de Medicaid en subvenciones en bloque e introducir un “modelo de apoyo premium” para Medicare para limitar el gasto. También pedía limitar los pagos de demandas por negligencia médica y combatir el abuso de drogas.

La palabra “aborto” aparece 32 veces en la plataforma de 2016, en comparación con una sola vez en el documento de 2024.

“El Partido Republicano está huyendo a toda velocidad de ese tema”, dijo Coughlin.

Durante la semana de la convención, apareció en internet el video de una llamada entre el candidato presidencial independiente Robert F. Kennedy Jr. y Trump. En el video, se escucha a Trump compartiendo afirmaciones refutadas sobre las vacunas infantiles, diciendo falsamente que las inyecciones pueden hacer que un bebé “cambie radicalmente” y descartando sus beneficios para la salud.

Como candidato, Kennedy ha hecho repetidamente afirmaciones falsas sobre la seguridad y eficacia de las vacunas. Trump le ha seguido la corriente durante mucho tiempo a los escépticos de las vacunas. Pero como presidente, en 2020, ordenó la creación del programa “Operación Warp Speed” que ayudó a impulsar el desarrollo de vacunas contra covid-19.

Desde el inicio de la pandemia, sin embargo, el escepticismo sobre las vacunas ha explotado en el Partido Republicano. Solo el 36% dicen tener confianza en que las vacunas contra covid son seguras, y el 44% de los republicanos e independientes inclinados hacia los republicanos dicen que los padres deberían poder decidir no vacunar a sus hijos contra el sarampión, las paperas y la rubéola “incluso si eso puede crear riesgos de salud para otros niños y adultos”, según encuestas de KFF.

At Trump’s GOP Convention, There’s Little To Be Heard on Health Care

No talk of Obamacare. Or abortion.

At the Republican National Convention in Milwaukee this week, where delegates officially nominated Donald Trump as the party’s 2024 presidential candidate, health care issues received little attention from prime-time speakers.

The silence is surprising, given health care makes up the largest chunk of the federal budget, nearly $2 trillion, as well as 17% of U.S. economic output.

It also stands in stark contrast to the GOP’s priorities when it first nominated Trump.

In 2016, the last time Republicans gathered en masse for a presidential convention, repealing the Affordable Care Act was a favorite topic. So was overturning Roe v. Wade and its constitutional protections for abortion.

The change in tone reflects Trump’s political sensitivities. The failed attempt under the former president to repeal Obamacare in 2017 contributed to a crushing GOP defeat in the 2018 congressional elections, and the law now enjoys broad support. Abortion, too, has become a treacherous topic for Republicans since Roe was overturned in 2022, with most Americans opposed to a national ban.

In one of the only pieces of health policy in the GOP’s 2024 platform, the former president vows not to cut Social Security or Medicare, the health program for older and disabled Americans, or change the federal retirement age.

In his speech accepting the nomination Thursday night, Trump promised to protect Medicare and find cures for Alzheimer’s disease and cancer. But he did not outline any health care proposals for a second term. “Democrats are going to destroy Social Security and Medicare,” he said.

Health care isn’t a winning subject for Republicans, said Charles Coughlin, CEO of a Phoenix public affairs firm who was a longtime GOP political operative before he became an independent in 2017.

Speakers at the convention have instead focused on inflation, crime, and immigration. “They have the tried-and-true polling data to show those are winning issues for them, and that’s where they want to keep the narrative focused,” he said.

Immigration has bled into a few health issues, including the U.S. opioid crisis and public insurance coverage. Some Republicans — including Georgia U.S. House Rep. Marjorie Taylor Greene, who addressed the convention on July 15 — have claimed an increase in people crossing the southern border has caused a surge of drug overdoses and deaths.

However, most fentanyl seized at the border with Mexico enters through legal ports of entry, according to the Cato Institute, a libertarian think tank, and most people sentenced in the U.S. for fentanyl trafficking are American citizens, according to the U.S. Sentencing Commission.

Speaking on July 17, U.S. House Rep. Monica De La Cruz of Texas claimed Democratic policies allow people who come into the country without authorization to receive government benefits, even though they are largely not eligible for federal health programs.

De La Cruz also said the Biden administration had cut Medicare Advantage for seniors. While the Biden administration this year modestly cut spending on the private plans, the federal government still spends more money per beneficiary on Medicare Advantage than for those in the traditional Medicare program.

The paucity of convention speakers focused on health care reflects the new GOP platform, a document hewing closely to both the substance and tone of Trump’s views. Along with its promise to protect Medicare, the 28-page document vows that Republicans will expand veterans’ health care choices, as well as access to “new Affordable Healthcare and prescription drug options” more broadly, without elaboration.

On abortion, the party stripped from the platform its decades-old call for federal limits, including instead language suggesting the 14th Amendment prohibits abortion. The platform also says the party supports state-level elections on abortion policy and opposes “Late Term Abortion.” Only about 1% of abortions in the U.S. occur after 21 weeks of pregnancy, according to KFF, a health information nonprofit that includes KFF Health News.

In contrast, the 2016 platform — a 66-page document — also called for shifting open-ended federal Medicaid funding into block grants and introducing a Medicare “premium-support model” to cap spending. It also called for limiting payouts from medical malpractice lawsuits and combating drug abuse.

The word “abortion” appears 32 times in the 2016 platform, compared with once in the 2024 document.

“The GOP is in a headlong sprint away from that issue,” Coughlin said.

During the week of the convention, video of a call between independent presidential candidate Robert F. Kennedy Jr. and Trump appeared online. In the video, Trump is heard sharing disproven claims about childhood vaccines, saying falsely that the shots can cause a baby to “change radically” and dismissing their health benefits.

As a candidate, Kennedy has repeatedly made false claims about the safety and efficacy of vaccines. Trump has long entertained vaccine skeptics. (Before Trump took the oath of office in 2017, Kennedy told reporters Trump had invited him to chair a presidential commission on vaccines, though the commission never materialized.) But as president, Trump ordered the creation of the “Operation Warp Speed” program in 2020 that helped drive development of covid-19 vaccines.

Since the start of the pandemic, however, vaccine skepticism has blossomed in the Republican Party. Just 36% of Republicans say they’re confident covid vaccines are safe, and 44% of Republicans and Republican-leaning independents say parents should be able to decide not to vaccinate their children against measles, mumps, and rubella “even if that may create health risks for other children and adults,” according to KFF polling.

KFF Health News’ ‘What the Health?’: At GOP Convention, Health Policy Is Mostly MIA

The Host

The Republican National Convention highlighted a number of policy issues this week, but health care was not among them. That was not much of a surprise, as it is not a top priority for former President Donald Trump or most GOP voters. The nomination of Sen. J.D. Vance of Ohio adds an outspoken abortion opponent to the Republican ticket, though he brings no particular background or expertise in health care.

Meanwhile, abortion opponents are busy trying to block state ballot questions from reaching voters in November. Legal battles over potential proposals continue in several states, including Florida, Arkansas, and Arizona.

This week’s panelists are Julie Rovner of KFF Health News, Alice Miranda Ollstein of Politico, Sarah Karlin-Smith of the Pink Sheet, and Joanne Kenen of the Johns Hopkins schools of public health and nursing and Politico Magazine.

Among the takeaways from this week’s episode:

  • Sen. J.D. Vance of Ohio has cast few votes on health policy since joining Congress last year. He has taken a doctrinaire approach to abortion restrictions, though, including expressing support for prohibiting abortion-related interstate travel and invoking the Comstock Act to block use of the mail for abortion medications. He also speaks openly about his mother’s struggles with addiction, framing it as a health rather than criminal issue in a way that resonates with many Americans.
  • Although Republicans have largely abandoned calls to repeal and replace the Affordable Care Act, it would be easy for former President Donald Trump to undermine the program in a second term; expanded subsidies for coverage are due to expire next year, and there’s always the option to cut spending on marketing the program, as Trump did during his first term.
  • Trump’s recent comments to Robert F. Kennedy Jr. about childhood vaccinations echoed tropes linked to the anti-vaccination movement — particularly the false claim that while one vaccine may be safe, it is perhaps dangerous to receive several at once. The federal vaccination schedule has been rigorously evaluated and found to be safe and effective.
  • Covid is surging once again, with President Joe Biden among those testing positive this week. The virus is proving a year-round concern and has peaked regularly in summertime; covid spreads best indoors, and lately millions of Americans have taken refuge inside from extremely high temperatures. Meanwhile, the virology community is concerned that the nation isn’t testing enough animals or humans to understand the risk posed by bird flu.

Also this week, Rovner interviews KFF Health News’ Renuka Rayasam, who wrote the June installment of KFF Health News-NPR’s “Bill of the Month,” about a patient who walked into what he thought was an urgent care center and walked out with an emergency room bill. If you have an exorbitant or baffling medical bill, you can send it to us here.

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

Julie Rovner: Time magazine’s “‘We’re Living in a Nightmare:’ Inside the Health Crisis of a Texas Bitcoin Town,” by Andrew R Chow.

Joanne Kenen: The Washington Post’s “A Mom Struggles To Feed Her Kids After GOP States Reject Federal Funds,” by Annie Gowen.

Alice Miranda Ollstein: ProPublica’s “Texas Sends Millions to Crisis Pregnancy Centers. It’s Meant To Help Needy Families, but No One Knows if It Works,” by Cassandra Jaramillo, Jeremy Kohler, and Sophie Chou, ProPublica, and Jessica Kegu, CBS News.

Sarah Karlin-Smith: The New York Times’ “Promised Cures, Tainted Cells: How Cord Blood Banks Mislead Patients,” by Sarah Kliff and Azeen Ghorayshi.

Also mentioned on this week’s podcast:

The Wall Street Journal’s “Mail-Order Drugs Were Supposed To Keep Costs Down. It’s Doing the Opposite,” by Jared S. Hopkins.


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.

Trump Is Wrong in Claiming Full Credit for Lowering Insulin Prices

“Low INSULIN PRICING was gotten for millions of Americans by me, and the Trump Administration, not by Crooked Joe Biden. He had NOTHING to do with it.”

Former President Donald Trump in a Truth Social post, June 8

Former President Donald Trump has repeatedly claimed that he — and not President Joe Biden — deserves credit for lowering older Americans’ prescription drug prices, specifically for insulin.

In a June 8 post on Truth Social, the former president’s social platform, Trump wrote: “Low INSULIN PRICING was gotten for millions of Americans by me, and the Trump Administration, not by Crooked Joe Biden. He had NOTHING to do with it.”

Trump again claimed sole credit for lowering insulin prices during the June 27 presidential debate in Atlanta. After Biden touted the $35 monthly out-of-pocket cap for Medicare patients mandated by the Inflation Reduction Act, Trump responded: “I’m the one that got the insulin down for the seniors. I took care of the seniors.”

It’s not just the former president making such claims. Fox News anchor John Roberts and former Arkansas Gov. Mike Huckabee, a Republican, both have said the Biden administration is wrong to take credit for lowering insulin costs.

Because drug prices and Medicare will likely be issues in the presidential campaign, we dug into the facts surrounding those claims.

The Trump Administration’s Program

Trump is correct that his administration enacted a program to lower insulin costs for some patients on Medicare.

In July 2020, Trump signed an executive order establishing the “Part D Senior Savings Model,” a temporary, voluntary program run by the Centers for Medicare & Medicaid Services that let some Medicare Part D prescription drug plans cap monthly out-of-pocket insulin copay costs at $35 or less. It covered at least one insulin product of each dosage and type.

The program began Jan. 1, 2021, and ran through Dec. 31, 2023. In 2022, the Trump-era program included a total of 2,159 Medicare drug plans, and CMS estimated that more than 800,000 Medicare beneficiaries who use insulin could have benefited from it that year.

The Department of Health and Human Services has estimated that more than 1.5 million Medicare beneficiaries paid more than $35 a month for insulin in 2020, before Trump’s program took effect. An analysis by the Rand Corp., a nonpartisan think tank, showed the program reduced participants’ out-of-pocket insulin costs by $198 to $441 per year on average, depending on their Medicare plan.

The Inflation Reduction Act Provisions

The Inflation Reduction Act, which Congress passed and Biden signed into law in August 2022, included an insulin provision that went further than Trump’s voluntary initiative.

The act did cap out-of-pocket costs of insulin for Medicare patients at $35 per month. But whereas the Trump program applied only to certain Medicare Part D plans, the act mandated that all Medicare drug programs cap out-of-pocket insulin costs — including those in what’s known as Medicare Part B, which pays for medical equipment such as insulin pumps. The act’s insulin provisions took effect Jan. 1, 2023, for Part D plans and July 1 of that year for Part B.

The act also mandated that the out-of-pocket price cap apply to all insulin products a given Medicare plan covers, not just a subset.

Taken together, those provisions mean a far greater number of Medicare beneficiaries stand to benefit from the act’s insulin provisions — including people receiving insulin via a pump, who were left out of the Trump-era program.

CMS estimates that more than 3.3 million Medicare beneficiaries use one or more of the common forms of insulin. Although some of those people were likely already paying less than $35 per month for their medications, the Inflation Reduction Act benefited far more than the 800,000 patients affected by Trump’s program.

“It’s likely a larger population than under the Trump administration’s model,” said Juliette Cubanski, deputy director of the Program on Medicare Policy at KFF, a health information nonprofit that includes KFF Health News.

“The Trump administration did establish this voluntary model, and one perhaps could view that as some precedent for what we saw in the Inflation Reduction Act,” Cubanski added. “But I think it’s inaccurate to state that President Biden had nothing to do with enabling millions of Americans to benefit from lower insulin copayments.”

Preliminary research shows the Inflation Reduction Act’s insulin provisions had a greater average financial benefit than those in Trump’s program. Insulin-using older Americans were estimated to save an annual average of $501 per person, HHS figures show.

The Inflation Reduction Act has also had an impact beyond Medicare. After the law passed, some pharmaceutical companies — including Eli Lilly and Co., Novo Nordisk, Sanofi, and Civica Rx — self-imposed price caps for all insured insulin users, not just Medicare patients. During his 2023 State of the Union address, Biden proposed expanding this benefit to all insulin patients, and he’s made that point a staple of his campaign appearances.

“I’m determined to make that apply to every American, not just seniors, in the second term,” he said at a campaign event in May in Philadelphia.

The Stakes for the 2024 Election

Beyond insulin products, the Inflation Reduction Act caps total out-of-pocket prescription costs at $2,000 annually for people with Medicare drug plans starting in 2025, down from $3,300 this year for most Medicare beneficiaries.

But every congressional Republican opposed the Inflation Reduction Act, including its insulin savings provisions, in 2022, and the law is vulnerable to repeal should Trump take the White House. Trump has repeatedly criticized the law and called for overturning some of its provisions. He has not specified how he would address its health measures.

In an email exchange with KFF Health News, Trump campaign spokesperson Karoline Leavitt highlighted drug savings programs the former president instituted during his term in office, but repeatedly declined to extrapolate on, or defend, Trump’s claim that Biden deserves no credit for lowering insulin costs.

Asked whether Trump intended to maintain the Inflation Reduction Act’s insulin provisions should he win a second term in office, Leavitt wrote, “President Trump will do everything possible to lower drug costs for Americans when he’s back in the White House, just like he accomplished in his first term.”

Our Ruling

Trump can claim some credit for lowering insulin costs for seniors, as his administration advanced a voluntary program to do so.

But his claim that Biden had “NOTHING to do with it” is patently false. The Inflation Reduction Act, which Biden signed into law, imposed a mandatory Medicare insulin price cap that applied across the program, benefiting a significantly larger number of insulin users — including people not enrolled in Medicare. 

We rate Trump’s claim False.

Sources:

Civica Rx, “Civica to Manufacture and Distribute Affordable Insulin,” March 3, 2022

Centers for Medicare & Medicaid Services, “Part D Senior Savings Model,” accessed July 2, 2024

CMS, “President Trump Announces Lower Out of Pocket Insulin Costs for Medicare’s Seniors,” May 26, 2020

CNN, “READ: Biden-Trump Debate Transcript,” June 28, 2024

Eli Lilly and Co., “Lilly Cuts Insulin Prices by 70% and Caps Patient Insulin Out-of-Pocket Costs at $35 Per Month,” March 1, 2023

Email exchange with Karoline Leavitt, Donald J. Trump 2024 campaign national press secretary, July 1, 2024

Facebook.com, post by @MikeHuckabee, June 10, 2024

Federal Registrar, “Access to Affordable Life-Saving Medications,” July 24, 2020

Department on Health and Human Services, “Insulin Affordability and the Inflation Reduction Act: Medicare Beneficiary Savings by State and Demographics,” Jan. 24, 2023

KFF, “Changes to Medicare Part D in 2024 and 2025 Under the Inflation Reduction Act and How Enrollees Will Benefit,” April 20, 2023

Novo Nordisk, “Novo Nordisk To Lower U.S. Prices of Several Pre-Filled Insulin Pens and Vials up to 75% for People Living With Diabetes in January 2024,” March 14, 2023

Phone interview with Juliette Cubanski, deputy director of KFF’s Program on Medicare Policy, June 16, 2024

Rand Corp., “Evaluation of the Part D Senior Savings Model,” May 2023

Republican Study Committee, “Fiscal Sanity to Save America,” March 20, 2024

Sanofi, “Sanofi Capping Its Insulin to a $35 Out-of-Pocket Costs in the U.S.,” June 1, 2023

Stat, “Biden and Trump Are Fighting To Claim Credit for $35 Insulin. It Was Actually a Pharma Giant’s Idea,” June 13, 2024

The White House, “FACT SHEET: President Biden’s Cap on the Cost of Insulin Could Benefit Millions of Americans in All 50 States,” March 2, 2023

The White House, “Remarks by President Biden and Vice President Harris at a Campaign Event | Philadelphia, PA,” May 29, 2024

The White House, “Remarks of President Joe Biden — State of the Union Address as Prepared for Delivery,” Feb. 7, 2023

Truthsocial.com, post by @realDonaldTrump, June 8, 2024

X.com, post by @justinbaragona, June 3, 2024

A Little-Recognized Public Health Crisis

About every 12 minutes, someone is killed on America’s roads and countless others are injured.

More than 42,500 people died in car crashes in 2022, a death toll that rivals or surpasses those of other major public health threats, such as the flu and gun violence.

“We have not recognized that traffic violence is a preventable public health crisis,” said Amy Cohen, a co-founder of Families for Safe Streets.

Traffic-related injuries and deaths cost the health-care system more than $55 billion in 2022, according to the Centers for Disease Control and Prevention. And pedestrian deaths have spiked, reaching 7,522in 2022, the highest level in more than four decades, according to the federal government.

“The transportation system shouldn’t hurt us, and it shouldn’t harm the environment,” said Johnathon Ehsani, an associate professor at the Johns Hopkins Bloomberg School of Public Health who uses policy and behavioral research to try to prevent car crashes.

Transportation experts blame traffic deaths on more reckless driving and less traffic enforcement than before the coronavirus pandemic, combined with larger and deadlier SUVs and trucks. But they primarily fault a transportation system that was designed for efficient movement and economic development — not safety.

To reverse that, the Biden administration is looking to the “safe system approach,” a transportation strategy that has achieved piecemeal adoption across the country.

The approach puts safety at the core of road and vehicle design and transportation policies, forcing traffic to move more slowly through communities, Ehsani said.

This translates into lowering speed limits, narrowing roads and creating separate lanes for bicyclists, and more buffers for pedestrians. He said the approach also de-emphasizes cars — which make people more sedentary and cause air pollution — and boosts public transportation.

The Biden administration in 2021 injected more than $20 billion in funding for transportation safety programs through the Infrastructure Investment and Jobs Act.

Some states and localities are also taking steps.

New York and Michigan adopted laws this spring allowing local jurisdictions to lower speed limits, and voters in Los Angeles approved a resident-sponsored ballot initiative to redesign streets, invest more in public transportation, add bike lanes and widen sidewalks to protect pedestrians.

But in a country where cars are inextricably linked to the culture and economy, political resistance remains entrenched.

Stuck in the middle are people whose lives and health have been devastated. I visited a Latino working-class neighborhood in Los Angeles where I met María Rivas Cruz, who in February 2023 was struck along with her fiancé, Raymond Olivares, by a driver going 70 in a 40-mph zone.

Rivas Cruz was severely injured. Olivares died at the scene.

Residents had pleaded for years for lower speed limits, safety islands and more marked crosswalks. After the crash, the county installed protective steel posts midway across the street, which Rivas Cruz called a “band-aid.”

“There’s so much death going on,” said Rivas Cruz, who now at age 28 walks with a cane and lives with chronic pain. “The representatives have failed us.”

A portrait of María Rivas Cruz, looking through a scrapbook in her home.
María Rivas Cruz looks through a scrapbook of memories from her more than a decade-long relationship with Raymond Olivares, who died last year after the two were struck by a speeding car outside their home in southeastern Los Angeles. Rivas Cruz survived but now lives with chronic pain and walks with a cane.(Lauren Justice for KFF Health News)

This article is not available for syndication due to republishing restrictions. If you have questions about the availability of this or other content for republication, please contact NewsWeb@kff.org.


J.D. Vance, Trump’s VP Pick, Says Media Twisted His Remarks on Abortion and Domestic Violence

During the Republican National Convention’s opening night, Sen. J.D. Vance (R-Ohio) spoke to Fox News for his first interview as former President Donald Trump’s vice presidential nominee.

Sitting in the Fiserv Forum, the convention’s Milwaukee venue, Vance took questions from host Sean Hannity and addressed criticism about his previous comments on domestic violence, abortion, and his 2016 disapproval of Trump.

A couple of times, Vance accused the media of twisting controversial comments about violent marriages and abortion exemptions. We took a closer look at four of his claims.

Vance Mischaracterizes Biden’s Stance on Abortion

Vance addressed his own and Trump’s position on abortion. He described Trump’s position “to let voters in states” decide abortion laws as “reasonable,” contrasting it with Biden’s. 

“Donald Trump is running against a Joe Biden president who wants taxpayer-funded abortions up until the moment of birth,” Vance said.

This is False and misleads about how rarely abortions are performed late in pregnancy. 

The vast majority of abortions in the U.S. — about 91% — occur in the first trimester. About 1% take place after 21 weeks, and far fewer than 1% occur in the third trimester and typically involve emergencies such as fatal fetal anomalies or life-threatening medical emergencies affecting the pregnant woman.

Biden has said he supported Roe v. Wade, the landmark 1973 U.S. Supreme Court ruling that legalized abortion and was overturned in June 2022, and wants federally protected abortion access. 

Roe didn’t provide unrestricted access to abortion. It legalized abortion federally but also enabled the states to restrict or ban abortions once a fetus is viable, typically around 24 weeks into pregnancy. Exceptions to that time frame typically were allowed when the pregnant woman’s life or health was at risk.

The Democratic-led Women’s Health Protection Act of 2021, which failed to pass the Senate, would have effectively codified a right to abortion while allowing for post-viability restrictions similar to Roe‘s.

During the 2020 presidential campaign, Biden promised to repeal the Hyde Amendment, which says federal funds can’t be used to pay for abortions, except in cases of rape or incest or to save the woman’s life. However, the amendment has continued to be included in congressional spending bills. 

Vance’s Comments About Women in Violent Marriages

Hannity asked Vance to explain controversial 2021 comments about women staying in violent marriages. 

“Both me and my mom actually were victims of domestic violence,” Vance told Hannity. “So, to say ‘Vance has supported women staying in violent marriages,’ I think it’s shameful for them to take a guy with my history and my background and say that that’s what I believe. It’s not what I believe. It’s not what I said.” 

The comments in question came from a 2021 event Vance participated in at Pacifica Christian High School in California. In a conversation about his 2016 memoir “Hillbilly Elegy,” the event moderator asked Vance about his experience being raised by his grandparents, following his mother’s divorces and struggles with drug addiction. 

“What is causing one generation to give up on fatherhood when the other one was so doggedly determined to stick it out even in tough times?” the moderator asked. 

Vance talked about the economic effect of men losing manufacturing jobs then discussed his grandparents’ marriage. 

In his memoirs, Vance detailed his grandparents’ relationship and told a story about Vance’s grandmother pouring lighter fluid on his grandfather and striking a match after he came home drunk. She had previously threatened to kill her husband if he came home drunk again, according to a 2016 book review published by The Washington Post. 

Vance commended his grandparents for staying together, comparing it with younger generations. 

“This is one of the great tricks that I think the sexual revolution pulled on the American populace, which is the idea that, like, ‘Well, OK, these marriages were fundamentally, you know, they were maybe even violent, but certainly they were unhappy. And so getting rid of them and making it easier for people to shift spouses like they change their underwear, that’s going to make people happier in the long term.’ 

“And maybe it worked out for the moms and dads, though I’m skeptical. But it really didn’t work out for the kids of those marriages.”

In response to a 2022 Vice News story highlighting the comments, Jai Chabria, a strategist for Vance, said the media missed Vance’s point.

“This is a comment that he made where he’s talking about how it’s important that couples stay together for the kids, that we actually have good kids first,” he said. “All he is saying is that it is far too often the case where couples get divorced, they split up, and they don’t take the kids’ needs into consideration.”

Vance’s Comments About Rape, Abortion, and ‘Inconvenience’

Hannity asked Vance to discuss his position on abortion, allowing the senator to address his past comments that have been criticized. 

“Let me go back to the issue of abortion,” Hannity said. “And there was this article that said, ‘Oh, J.D. Vance said it’s inconvenient.’”

Vance told Hannity, “The Democrats have completely twisted my words. What I did say is that we sometimes in this society see babies as inconveniences, and I absolutely want us to change that.”

We looked into comments Vance made on abortion while he was running for Senate in 2022. His opponent claimed Vance had said that rape was inconvenient, but we found that’s not directly what Vance said. 

In a 2021 interview, Vance was asked whether laws should allow women to get abortions if they were victims of rape or incest. He said society should not view a pregnancy or birth resulting from rape or incest as “inconvenient.” 

“My view on this has been very clear, and I think the question betrays a certain presumption that is wrong,” Vance said in 2021. “It’s not whether a woman should be forced to bring a child to term, it’s whether a child should be allowed to live, even though the circumstances of that child’s birth are somehow inconvenient or a problem to the society. The question really, to me, is about the baby.”

Editor’s note: This is excerpted from PolitiFact’s full coverage. You can read the full story here.

Abortion and the 2024 Election: A Video Primer

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More than a dozen states are weighing abortion-related ballot measures to be decided this fall, most of which would protect abortion rights if passed. KFF Health News’ Julie Rovner and Rachana Pradhan explain what’s at stake in the 2024 election, both at the national and state levels.

Find more of our abortion coverage here.

Biden Budget Touches All the Bases

The Host

President Joe Biden’s fiscal 2024 budget proposal includes new policies and funding boosts for many of the Democratic Party’s important constituencies, including advocates for people with disabilities and reproductive rights. It also proposes ways to shore up Medicare’s dwindling Hospital Insurance Trust Fund without cutting benefits, basically daring Republicans to match him on the politically potent issue.

Meanwhile, five women in Texas who were denied abortions when their pregnancies threatened their lives or the viability of the fetuses they were carrying are suing the state. They charge that the language of Texas’ abortion ban makes it impossible for doctors to provide needed care without fear of enormous fines or prison sentences.

This week’s panelists are Julie Rovner of KHN, Shefali Luthra of The 19th, Victoria Knight of Axios, and Margot Sanger-Katz of The New York Times.

Among the takeaways from this week’s episode:

  • Biden’s budget manages to toe the line between preserving Medicare and keeping the Medicare trust fund solvent while advancing progressive policies. Republicans have yet to propose a budget, but it seems likely any GOP plan would lean heavily on cuts to Medicaid and subsidies provided under the Affordable Care Act. Democrats will fight both of those.
  • Even though the president’s budget includes something of a Democratic “wish list” of social policy priorities, the proposals are less sweeping than those made last year. Rather, many — such as extending to private insurance the $35 monthly Medicare cost cap for insulin — build on achievements already realized. That puts new focus on things the president has accomplished.
  • Walgreens, the nation’s second-largest pharmacy chain, is caught up in the abortion wars. In January, the chain said it would apply for certification from the FDA to sell the abortion pill mifepristone in states where abortion is legal. However, last week, under threats from Republican attorneys general in states where abortion is still legal, the chain wavered on whether it would seek to sell the pill there or not, which caused a backlash from both abortion rights proponents and opponents.
  • The five women suing Texas after being denied abortions amid dangerous pregnancy complications are not asking for the state’s ban to be lifted. Rather, they’re seeking clarification about who qualifies for exceptions to the ban, so doctors and hospitals can provide needed care without fear of prosecution.
  • Although anti-abortion groups have for decades insisted that those who have abortions should not be prosecuted, bills introduced in several state legislatures would do exactly that. In South Carolina, those who have abortions could even be subject to the death penalty. So far none of these bills have passed, but the wave of measures could herald a major policy change.

Also this week, Rovner interviews Harris Meyer, who reported and wrote the two latest KHN-NPR “Bill of the Month” features. Both were about families facing unexpected bills after childbirth. If you have an outrageous or exorbitant medical bill you want to share with us, you can do that here.

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

Julie Rovner: KHN’s “Girls in Texas Could Get Birth Control at Federal Clinics, Until a Christian Father Objected,” by Sarah Varney

Shefali Luthra: The 19th’s “Language for Treating Childhood Obesity Carries Its Own Health Risks to Kids, Experts Say,” by Jennifer Gerson

Victoria Knight: KHN’s “After People on Medicaid Die, Some States Aggressively Seek Repayment From Their Estates,” by Tony Leys

Margot Sanger-Katz: ProPublica’s “How Obamacare Enabled a Multibillion-Dollar Christian Health Care Grab,” by J. David McSwane and Ryan Gabrielson

Also mentioned in this week’s podcast:


To hear all our podcasts, click here.

And subscribe to KHN’s What the Health? on SpotifyApple PodcastsStitcherPocket Casts, or wherever you listen to podcasts.

March Medicaid Madness

The Host

With Medicare and Social Security apparently off the table for federal budget cuts, the focus has turned to Medicaid, the federal-state health program for those with low incomes. President Joe Biden has made it clear he wants to protect the program, along with the Affordable Care Act, but Republicans will likely propose cuts to both when they present a proposed budget in the next several weeks.

Meanwhile, confusion over abortion restrictions continues, particularly at the FDA. One lawsuit in Texas calls for a federal judge to temporarily halt distribution of the abortion pill mifepristone. A separate suit, though, asks a different federal judge to temporarily make the drug easier to get, by removing some of the FDA’s safety restrictions.

This week’s panelists are Julie Rovner of Kaiser Health News, Alice Miranda Ollstein of Politico, Rachel Cohrs of STAT News, and Lauren Weber of The Washington Post.

Among the takeaways from this week’s episode:

  • States are working to review Medicaid eligibility for millions of people as pandemic-era coverage rules lapse at the end of March, amid fears that many Americans kicked off Medicaid who are eligible for free or near-free coverage under the ACA won’t know their options and will go uninsured.
  • Biden promised this week to stop Republicans from “gutting” Medicaid and the ACA. But not all Republicans are on board with cuts to Medicaid. Between the party’s narrow majority in the House and the fact that Medicaid pays for nursing homes for many seniors, cutting the program is a politically dicey move.
  • A national group that pushed the use of ivermectin to treat covid-19 is now hyping the drug as a treatment for flu and RSV — despite a lack of clinical evidence to support their claims that it is effective against any of those illnesses. Nonetheless, there is a movement of people, many of them doctors, who believe ivermectin works.
  • In reproductive health news, a federal judge recently ruled that a Texas law cannot be used to prosecute groups that help women travel out of state to obtain abortions. And the abortion issue has highlighted the role of attorneys general around the country — politicizing a formerly nonpartisan state post. –And Eli Lilly announced plans to cut the price of some insulin products and cap out-of-pocket costs, though their reasons may not be completely altruistic: An expert pointed out that a change to Medicaid rebates next year means drugmakers soon will have to pay the government every time a patient fills a prescription for insulin, meaning Eli Lilly’s plan could save the company money.

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

Julie Rovner: The New York Times’ “A Drug Company Exploited a Safety Requirement to Make Money,” by Rebecca Robbins.

Alice Miranda Ollstein: The New York Times’ “Alone and Exploited, Migrant Children Work Brutal Jobs Across the U.S.,” by Hannah Dreier.

Rachel Cohrs: STAT News’ “Nonprofit Hospitals Are Failing Americans. Their Boards May Be a Reason Why,” by Sanjay Kishore and Suhas Gondi.

Lauren Weber: KHN and CBS News’ “This Dental Device Was Sold to Fix Patients’ Jaws. Lawsuits Claim It Wrecked Their Teeth,” by Brett Kelman and Anna Werner.

Also mentioned in this week’s podcast:


To hear all our podcasts, click here.

And subscribe to KHN’s What the Health? on SpotifyApple PodcastsStitcherPocket Casts, or wherever you listen to podcasts.

A Health-Heavy State of the Union

The Host

Health care was a recurring theme throughout President Joe Biden’s 2023 State of the Union address on Capitol Hill this week. He took a victory lap on recent accomplishments like capping prescription drug costs for seniors on Medicare. He urged Congress to do more, including making permanent the boosted insurance premium subsidies added to the Affordable Care Act during the pandemic. And he sparred with Republicans in the audience — who jeered and called him a liar — over GOP proposals that would cut Medicare and Social Security.

Meanwhile, abortion rights advocates and opponents are anxiously awaiting a federal court decision out of Texas that could result in a nationwide ban on mifepristone, one of two drugs used in medication abortion.

This week’s panelists are Julie Rovner of KHN, Alice Miranda Ollstein of Politico, Rachel Cohrs of Stat, and Sarah Karlin-Smith of the Pink Sheet.

Among the takeaways from this week’s episode:

  • President Joe Biden’s State of the Union address emphasized recent victories against high health care costs, like Medicare coverage caps on insulin and out-of-pocket caps on prescription drug spending. Biden’s lively, informal exchange with lawmakers over potential cuts to Medicare and Social Security seemed to steal the show, though the political fight over cutting costs in those entitlement programs is rooted in a key question: What constitutes a “cut”?
  • Biden’s calls for bipartisanship to extend health programs like pandemic-era subsidies for Affordable Care Act health plans are expected to clash with conservative demands to slash federal government spending. And last year’s Senate fights demonstrate that sometimes the opposition comes from within the Democratic Party.
  • While some abortion advocates praised Biden for vowing to veto a federal abortion ban, others felt he did not talk enough about the looming challenges to abortion access in the courts. A decision is expected soon in a Texas court case challenging the future use of mifepristone. The Trump-appointed judge’s decision could ban the drug nationwide, meaning it would be barred even in states where abortion continues to be legal.
  • The FDA is at the center of the abortion pill case, which challenges its approval of the drug decades ago and could set a precedent for legal challenges to the approval of other drugs. In other FDA news, the agency recently changed policy to allow gay men to donate blood; announced new food safety leadership in response to the baby formula crisis; and kicked back to Congress a question of how to regulate CBD, or cannabidiol, products.
  • In drug pricing, the top-selling pharmaceutical, Humira, will soon reach the end of its patent, which will offer a telling look at how competition influences the price of biosimilars — and the problems that remain for lawmakers to resolve.

Also this week, Rovner interviews Kate Baicker of the University of Chicago about a new paper providing a possible middle ground in the effort to establish universal health insurance coverage in the U.S.

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

Julie Rovner: The New York Times’ “Don’t Let Republican ‘Judge Shoppers’ Thwart the Will of Voters,” by Stephen I. Vladeck

Alice Miranda Ollstein: Politico’s “Mpox Is Simmering South of the Border, Threatening a Resurgence,” by Carmen Paun

Sarah Karlin-Smith: KHN’s “Decisions by CVS and Optum Panicked Thousands of Their Sickest Patients,” by Arthur Allen

Rachel Cohrs: ProPublica’s “UnitedHealthcare Tried to Deny Coverage to a Chronically Ill Patient. He Fought Back, Exposing the Insurer’s Inner Workings,” by David Armstrong, Patrick Rucker, and Maya Miller

Also mentioned in this week’s podcast:


To hear all our podcasts, click here.

And subscribe to KHN’s What the Health? on SpotifyApple PodcastsStitcherPocket Casts, or wherever you listen to podcasts.