Tag: Health IT

California Forges Ahead With Social Media Rules Despite Legal Barriers

California lawmakers are pursuing legislation aimed at protecting children from the dangers of social media, one of many efforts around the country to confront what U.S. Surgeon General Vivek Murthy and other public health experts say is a mental health emergency among young people.

But California’s efforts, like those in other states, will likely face the same legal challenges that have thwarted previous legislative attempts to regulate social media. The tech industry has argued successfully that imposing rules regulating how social media operate and how people can use the online services violates the free speech rights of the companies and their customers.

A previous effort at confronting the issue, the California Age-Appropriate Design Code Act in 2022, now rests with the U.S. Court of Appeals for the 9th Circuit. A tech trade association sued to block the law and won an injunction from a lower court, largely on First Amendment grounds. The appeals court heard oral arguments in the case on July 17.

“At the end of the day, unconstitutional law protects zero children,” said Carl Szabo, vice president and general counsel for NetChoice, which argued for the tech giants before the federal appellate court.

Like the design code act, the two proposals now working their way through the California Legislature would reshape the way social media users under 18 interact with the services.

The first bill, by state Sen. Nancy Skinner (D-Berkeley), prohibits sending push notifications to children at night and during school hours. Skinner’s measure also requires parental permission before platforms can send social media offerings via algorithms, which are designed to offer feeds that children didn’t ask for but might keep them looking at their phones longer, rather than the traditional chronological feeds of those they follow on the app.

The second measure, by Assemblymember Buffy Wicks (D-Oakland), would amend California’s privacy laws to prohibit businesses from collecting, using, selling, or sharing data on minors without their informed consent — or, for those under 13, without their parents’ approval.

Both bills have bipartisan support and are backed by state Attorney General Rob Bonta. “We need to act now to protect our children,” Bonta said earlier this year, by “strengthening data privacy protections for minors and safeguarding youth against social media addiction.”

California Gov. Gavin Newsom, a Democrat, has been vocal about youth and social media, too, and recently called for a statewide ban on cellphones in schools. His positions on the two social media proposals are not yet known. “But I think the governor, like most every other Californian, is concerned about the harms of social media on kids,” Skinner said.

California’s efforts are especially significant because its influence as the most populous state often results in its setting standards that are then adopted by other states. Also, some of the big tech companies that would be most affected by the laws, including Meta, Apple, Snap, and Alphabet, the parent company of Google, are headquartered in the state.

“Parents are demanding this. That’s why you see Democrats and Republicans working together,” said Wicks, who with a Republican colleague co-authored the design code act that is tied up in litigation. “Regulation is coming, and we won’t stop until we can keep our kids safe online.”

The fate of the design code act stands as a cautionary tale. Passed without a dissenting vote, the law would set strict limits on data collection from minors and order privacy settings for children to default to their highest levels.

NetChoice, which immediately sued to block the law, has prevailed in similar cases in Ohio, Arkansas, and Mississippi. It is challenging legislation in Utah that was rewritten after NetChoice sued over the original version. And NetChoice’s lawyers argued before the U.S. Supreme Court that efforts in Texas and Florida to regulate social media content were unconstitutional. Those cases were remanded to lower courts for further review.

Though the particulars differ in each state, the bottom line is the same: Each of the laws has been stifled by an injunction, and none has taken effect.

“When you look at these sweeping laws like the California laws, they’re ambitious and I applaud them,” said Nancy Costello, a clinical law professor at Michigan State University and the director of the school’s First Amendment Clinic. “But the bigger and broader the law is, the greater chance that there will be a First Amendment violation found by the courts.”

The harmful effects of social media on children are well established. An advisory from Surgeon General Murthy last year warned of a “profound risk of harm” to young people, noting that a study of adolescents from ages 12 to 15 found that those who spent more than three hours a day on social media were at twice the risk of depression and anxiety as nonusers. A Gallup survey in 2023 found that U.S. teenagers spent nearly five hours a day on social media.

In June, Murthy called for warnings on social media platforms like those on tobacco products. Later that month came Newsom’s call to severely restrict the use of smartphones during the school day in California. Legislation to codify Newsom’s proposal is working its way through the state Assembly.

Federal legislation has been slow to materialize. A bipartisan bill to limit algorithm-derived feeds and keep children under 13 off social media was introduced in May, but Congress has done little to meaningfully rein in tech platforms — despite Meta’s chief executive, Mark Zuckerberg, apologizing in a U.S. Senate hearing for “the types of things that your families have had to suffer” because of social media harms.

It remains unclear what kinds of regulation the courts will permit. NetChoice has argued that many proposed social media regulations amount to the government dictating how privately owned firms set their editorial rules, in violation of the First Amendment. The industry also leans on Section 230 of the 1996 Communications Decency Act, which shields tech companies from liability for harmful content produced by a third party.

“We’re hoping lawmakers will realize that as much as you may want to, you can’t end-around the Constitution,” said Szabo, the NetChoice attorney. “The government is not a substitute for parents.”

Skinner tried and failed last year to pass legislation holding tech companies accountable for targeting children with harmful content. This year’s measure, which was overwhelmingly passed by the California Senate and is pending in the state Assembly, would bar tech companies from sending social media notifications to children between midnight and 6 a.m. every day, and 8 a.m. to 3 p.m. on school days. The bill also calls for platforms to require minors to obtain parental consent to use their core offerings, and would limit their use to an hour to 90 minutes a day by default.

“If the private sector is not willing to modify their product in a way that makes it safe for Californians, then we have to require them to,” Skinner said, adding that parts of her proposal are standard practice in the European Union.

“Social media has already accommodated users in many parts of the world, but not the U.S.,” she said. “They can do it. They’ve chosen not to.”

Wicks, meanwhile, said she considers her data bill to be about consumer protection, not speech. The proposal would close a loophole in the California Electronic Communications Privacy Act to prevent social media platforms from collecting and sharing information on anyone under 18 unless they opt in. The Assembly approved Wicks’ measure without dissent, sending it to the state Senate for consideration.

Costello suggested that focusing the proposals more narrowly might give them a better chance of surviving court challenges. She is part of an effort coordinated by Harvard’s T.H. Chan School of Public Health to write model legislation that would require third-party assessments of the risks posed by the algorithms used by social media apps.

“It means that we’re not restricting content, we’re measuring harms,” Costello said. Once the harms are documented, the results would be publicly available and could lead state attorneys general to take legal action. Government agencies adopted a similar approach against tobacco companies in the 1990s, suing for deceptive advertising or business practices.

Szabo said NetChoice has worked with states to enact what he called “constitutional and commonsense laws,” citing measures in Virginia and Florida that would mandate digital education in school. “There is a role for government,” Szabo said. (The Florida measure failed.)

But with little momentum on actual regulation at the national level, state legislators continue to try to fill the vacuum. New York recently passed legislation similar to Skinner’s, which the state senator said was an encouraging sign.

Will NetChoice race for an injunction in New York? “We are having lots of conversations about it,” Szabo said.

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

Rescue From Above: How Drones May Narrow Emergency Response Times

The drones are coming.

Starting in September, if someone in Clemmons, North Carolina, calls 911 to report a cardiac arrest, the first responder on the scene may be a drone carrying an automated external defibrillator, or AED.

“The idea is for the drone to get there several minutes before first responders,” such as an emergency medical technician or an ambulance, said Daniel Crews, a spokesperson for the sheriff’s office in Forsyth County, where Clemmons is located. The sheriff’s office is partnering on the project with local emergency services, the Clinical Research Institute at Duke University, and the drone consulting firm Hovecon. “The ultimate goal is to save lives and improve life expectancy for someone experiencing a cardiac episode,” Crews said.

The Forsyth County program is one of a growing number of efforts by public safety and health care organizations across the country to use drones to speed up lifesaving treatment in situations in which every second counts.

More than 356,000 people have a cardiac arrest outside of a hospital setting every year in the United States, according to the American Heart Association. Most people are at home when it happens, and about 90% die because they don’t get immediate help from first responders or bystanders. Every minute that passes without medical intervention decreases the odds of survival by 10%.

“We’ve never been able to move the needle for cardiac arrest in private settings, and this technology could meet that need,” said Monique Anderson Starks, a cardiologist and associate professor of medicine at Duke University. Starks is leading pilot studies in Forsyth County and James City County, Virginia, to test whether drone AED delivery can improve treatment response times. The work is funded by a four-year grant from the American Heart Association.

A 2017 study found it takes an emergency medical services unit seven minutes, on average, to arrive on the scene following a 911 call, though response times vary considerably by region, and rural wait times can be much longer. Starks said she believes the drone-delivered AEDs in the pilot study could reduce the time to treatment by four minutes compared with first responders.

Unlike a heart attack, which occurs when blood flow to the heart is blocked, a cardiac arrest happens when a heart malfunction causes it to stop beating, typically because of an arrhythmia or an electrical problem. Eighty percent of cardiac arrests start as heart attacks. The only way to get the heart restarted is with CPR and a defibrillator.

In Forsyth County, a drone pilot from the sheriff’s department will listen in on 911 calls. If there’s a suspected cardiac arrest, the pilot can dispatch the drone even before emergency medical services are contacted. The drone, which weighs 22 pounds and can travel 60 mph, will fly to the location and hover 125 feet in the air before lowering an AED to the ground on a winch. The AED provides simple verbal instructions; the 911 dispatcher on the phone can also help a bystander use the AED.

Eventually there will be six drone bases in Forsyth and James City counties, Starks said.

While the technology is promising and research has often found that drones arrive faster than first responders, there’s little conclusive evidence that drones improve health outcomes.

A Swedish study published in The Lancet in 2023 compared the response times between drones and ambulances for suspected cardiac arrest in 58 deployments in an area of about 200,000 people. It found that drones beat the ambulance to the scene two-thirds of the time, by a median of three minutes and 14 seconds.

In the United States, most programs are just getting started, and they are exploring the use of drones to also provide remedies for drug overdoses and major trauma or potential drowning rescues.

In Florida, Tampa General Hospital, Manatee County, and Archer First Response Systems, or AFRS, began a program in May to deliver AEDs, a tourniquet, and Narcan, a nasal spray that can reverse an opioid overdose. The program initially covers a 7-square-mile area, and EMS dispatchers deploy the drones, which are monitored by drone pilots.

There were nearly 108,000 drug overdose deaths in the United States in 2022, according to the National Institute on Drug Abuse.

As of early July, the Tampa program hadn’t yet deployed any drones, said Gordon Folkes, the founder and chief executive of AFRS, which develops and deploys emergency drone logistics systems. One request in June to send a drone to an overdose couldn’t be fulfilled because of a violent thunderstorm, Folkes said. In the testing area, which covers about 7,000 residents, Folkes estimates that 10 to 15 drones might be deployed each year.

“The bread and butter for these systems is suburban areas” like Manatee County that are well-populated and where the drones have the advantage of being able to avoid traffic congestion, Folkes said.

There are other uses for drones in medical emergencies. The New York Police Department plans to drop emergency flotation devices to struggling swimmers at local beaches. In Chula Vista, California, a police drone was able to pinpoint the location of a burning car, and then officers pulled the driver out, said Sgt. Tony Molina.

Rescue personnel have used drones to locate people who wander away from nursing homes, said James Augustine, a spokesperson for the American College of Emergency Physicians who is the medical director for the International Association of Fire Chiefs.

In the United States, one hurdle for drone programs is that the Federal Aviation Administration typically requires that drones be operated within the operators’ visual line of sight. In May, when Congress passed the FAA reauthorization bill, it gave the FAA four months to issue a notice of proposed rulemaking on drone operations beyond the visual line of sight.

“The FAA is focused on developing standard rules to make [Beyond Visual Line of Sight] operations routine, scalable, and economically viable,” said Rick Breitenfeldt, an FAA spokesperson.

Some civil liberties groups are concerned that the FAA’s new rules may not provide enough protection from drone cameras for people on the ground.

Jay Stanley, a senior policy analyst at the American Civil Liberties Union, acknowledged the benefits of using drones in emergency situations but said there are issues that need to be addressed.

“The concern is that the FAA is going to significantly loosen the reins of drones without any significant privacy protections,” he said.

Rescate desde el cielo: cómo los drones pueden reducir el tiempo de respuesta a una emergencia

A partir de septiembre, si alguien en Clemmons, Carolina del Norte, llama al 911 para pedir ayuda porque una persona está sufriendo un paro cardíaco, el primero en intervenir en la escena podrá ser un dron que lleve un Desfibrilador Externo Automático, o DEA.

“La idea es que el dron llegue varios minutos antes que los primeros socorristas”, como un técnico en emergencias médicas o una ambulancia, dijo Daniel Crews, vocero de la oficina del sheriff en el condado de Forsyth, donde se encuentra Clemmons.

La oficina del sheriff está llevando adelante este proyecto en alianza con los servicios de emergencia locales, con el Instituto de Investigación Clínica de la Universidad de Duke y con Hovecon, una empresa de consultoría en drones. “El objetivo final es evitar muertes y aumentar la esperanza de vida de quienes sufren un episodio cardíaco”, dijo Crews.

Cada vez con más frecuencia, en todo el país, las organizaciones de emergencias médicas y  las de seguridad pública están utilizando drones para acelerar la intervención en situaciones en las que cada segundo es importante para salvar vidas. El Programa del Condado de Forsyth es una de esas iniciativas.

En Estados Unidos cada año más de 356,000 personas sufren un paro cardíaco fuera de un hospital, según la Asociación Americana del Corazón (AHA). La mayoría se descompensa estando en su casa y alrededor del 90% muere porque no recibe ayuda inmediata del personal de emergencias médicas o de los transeúntes. Cada minuto que pasa sin intervención médica disminuye las probabilidades de supervivencia en un 10%.

“Nunca hemos podido alcanzar una mejora significativa en el tiempo de atención de los accidentes cardiológicos cuando se producen en entornos privados, y esta tecnología podría ayudarnos a lograr ese objetivo”, dijo Monique Anderson Starks, cardióloga y profesora asociada de Medicina en la Universidad de Duke.

Starks lidera estudios piloto en los condados de Forsyth y James City, en Virginia, que están midiendo si efectivamente la entrega de DEA con drones puede mejorar los tiempos de respuesta al tratamiento. El trabajo está financiado por una subvención de cuatro años de la AHA.

Según un trabajo de 2017, después de una llamada al 911 una unidad de servicios médicos de emergencia necesita un promedio de siete minutos para llegar al lugar. Sin embargo, los tiempos de respuesta varían considerablemente según la región. Y en el caso de las áreas rurales pueden ser muchísimo más largos.

Starks dijo que cree que los DEA entregados por drones podrían reducir el tiempo de intervención en cuatro minutos respecto de lo que tardan los primeros socorristas.

A diferencia de un ataque cardíaco, que ocurre cuando está bloqueado el flujo sanguíneo al corazón, un paro cardíaco sucede cuando este órgano deja de latir, generalmente debido a una arritmia o a un problema eléctrico. El 80% de los paros cardíacos comienzan como ataques cardíacos. La única manera de reiniciar el corazón es con resucitación cardiopulmonar (RCP) y un desfibrilador.

En el condado de Forsyth, un piloto de drones de la oficina del sheriff escuchará las llamadas al 911. Si sospecha que se está ante un paro cardíaco, el piloto puede despachar el dron incluso antes de que se contacten los servicios de emergencia médica.

El dron, que pesa 22 libras y puede viajar a 60 mph, volará hasta el lugar y se mantendrá a 125 pies de altura antes de bajar un DEA al suelo, ayudado por un dispositivo mecánico.

El DEA imparte instrucciones verbales simples y, desde su puesto, también el operador de la línea 911 podrá ayudar a usar el desfibrilador a cualquier persona sin experiencia que esté cerca. Con el tiempo se espera que haya seis bases de drones en los condados de Forsyth y James City, dijo Starks.

Sin embargo, aunque la tecnología es prometedora y la investigación a menudo ha comprobado que los drones llegan más rápido que los primeros equipos de emergencia, existe poca evidencia concluyente de que mejoren los resultados de los socorristas.

Un estudio realizado en Suecia y publicado en 2023 por The Lancet comparó los tiempos de respuesta entre drones y ambulancias para casos sospechosos de paros cardíacos en 58 intervenciones que abarcaron una población de alrededor de 200,000 personas.

El estudio llegó a la conclusión de que en el 66,67% de las ocasiones analizadas, los drones llegaron antes que las ambulancias y que esto significó que, en promedio, se anticiparon 3 minutos y 14 segundos.

En Estados Unidos, la mayoría de los programas recién están comenzando. Se está explorando el uso de drones para intervenir en casos de sobredosis de drogas, de traumas mayores y en los rescates a personas que estuvieron en riesgo de ahogarse.

En Florida, el Hospital General de Tampa, el condado de Manatee y los Sistemas de Respuesta Inmediata Archer o AFRS, iniciaron un programa en mayo para entregar DEA, torniquetes y Narcan, un spray nasal que puede revertir la sobredosis de opioides.

El programa inicialmente cubre un área de 7 millas cuadradas y los operadores de los servicios médicos de emergencia (EMS) despliegan los drones, que son monitoreados por pilotos especializados. En 2022, hubo casi 108,000 muertes por sobredosis de drogas en el país, según el Instituto Nacional sobre el Abuso de Drogas.

Hasta principios de julio, el programa de Tampa aún no había enviado ningún dron, explicó Gordon Folkes, fundador y director ejecutivo de AFRS, que desarrolla y despliega sistemas de logística de drones de emergencia.

Una solicitud recibida en junio para que enviaran un dron en un caso por sobredosis no pudo cumplirse por razones climáticas, lo impidió una tormenta violenta, dijo Folkes. En el área de prueba, que cubre aproximadamente a 7,000 residentes, Folkes estima que se podrían desplegar de 10 a 15 drones cada año.

“El punto fuerte de estos sistemas son las áreas suburbanas muy pobladas, como el condado de Manatee, porque los drones tienen la ventaja de poder evitar las congestiones de tráfico”, agregó Folkes.

Hay otros usos para los drones en emergencias médicas. El Departamento de Policía de Nueva York planea lanzar dispositivos de flotación de emergencia a los nadadores que se encuentren en problemas en las playas locales. Además, en Chula Vista, California, un dron de la policía pudo identificar la ubicación de un auto en llamas, y eso permitió que los oficiales sacaran al conductor, dijo el sargento Tony Molina.

El personal de rescate ha utilizado drones para localizar a personas que se alejan de los hogares de adultos mayores, dijo James Augustine, vocero del Colegio Americano de Médicos de Emergencia, quien es el director médico de la Asociación Internacional de Jefes de Bomberos.

En Estados Unidos, un obstáculo para los programas de drones es que la Administración Federal de Aviación (FAA) generalmente requiere que los drones sean manejados dentro de la línea de visión de los operadores. En mayo, cuando el Congreso aprobó la ley de reautorización de la FAA, se le otorgó un plazo de cuatro meses para emitir una propuesta de reglamentación sobre las operaciones de drones más allá de la línea de visión.

“La FAA se está concentrando en desarrollar reglas estándar para hacer que las operaciones (más allá del campo visual) sean rutinarias, y económicamente viables”, dijo Rick Breitenfeldt, vocero de la FAA.

Por otro lado, algunos grupos de libertades civiles están preocupados porque las nuevas reglas de la FAA no proporcionen suficiente protección contra las cámaras de los drones para las personas en tierra.

Jay Stanley, analista de políticas senior de la Unión Americana de Libertades Civiles, reconoció los beneficios de usar drones en situaciones de emergencia pero consideró que aún hay problemas que deben abordarse.

“La preocupación es que la FAA va a flexibilizar significativamente las restricciones a los drones sin ninguna protección significativa de la privacidad”, expresó.

HealthSherpa and Insurers Team Up To Curb Unauthorized ACA Enrollment Schemes

The largest private company that brokers use to enroll people in Affordable Care Act health plans said it’s joining with insurers to thwart unauthorized Obamacare sign-ups and plan switches.

HealthSherpa, which has its own sales team, announced the new initiative — called “Member Defense Network” — July 16. It will cut off commissions for unscrupulous insurance brokers believed to be signing up thousands of Americans for health plans they don’t need or switching their coverage without express consent.

Federal regulators say at least 90,000 Obamacare customers have complained about unauthorized enrollments or plan switches in the first quarter of the year. The changes can leave consumers without access to their preferred doctors and increase their deductibles or saddle them with tax bills.

Amy Shepherd of Georgia said that while the carrier of her ACA plan has remained the same, the agent who collects the commission has been switched three times — all people she doesn’t know and without her consent. Even worse, she said, are the multiple calls she gets daily, at all hours, from other agents apparently trying to persuade her to switch plans.

“These spam calls are stressing me beyond words,” said Shepherd, who wants to remain in her current plan and has enlisted the help of a friend, who happens to be an insurance agent, to help.

Whether the network would help in situations like Shepherd’s remains to be seen. When duplicative enrollments are identified, it will use automation to check whether agents have filed written or recorded consent by the consumer, something they are supposed to do under federal rules. But agents say they are rarely asked to provide those documents by regulators.

If there’s no valid consent on file, or if an agent is caught submitting fake consents, they’re not going to get paid commissions while the situation is investigated, said George Kalogeropoulos, CEO of HealthSherpa. The firm has set up a website separate from its enrollment platform to run the network, and it may spin it off to another organization, he added.

HealthSherpa is one of more than a dozen private sector web brokers allowed by federal regulators to directly link to the federal health insurance marketplace, healthcare.gov, to sign people up for ACA coverage. Other web brokers can join the new program, Kalogeropoulos said.

But there are already doubts about HealthSherpa’s plan. Without all health insurers participating, some agents said, fraudulent enrollment may shift to those remaining outside HealthSherpa’s program. At its launch this week, the network included health insurers Ambetter, Molina Healthcare, and Highmark Blue Cross Blue Shield, representing about half the people who selected coverage during the ACA’s most recent open-enrollment period, said Kalogeropoulos, and more may follow.

Smaller brokerages worry that HealthSherpa’s algorithms may incorrectly flag transactions with their customers as suspicious.

“This could disrupt the market,” said Ronnell Nolan, president of Health Agents for America, a trade group. “This could put good agents out of business.”

Federal regulators say they are working on several regulatory and technical ways to address unauthorized sign-ups and switches but have released few details. Last week, the Centers for Medicare & Medicaid Services quietly put in place new rules requiring agents to log in to their own ACA enrollment accounts every 12 hours, instead of every 30 days, as a security measure.

CMS knows of the network initiative and said it will be required to conform to security and privacy standards.

“We expect and encourage all of our partners, including issuers, direct enrollment partners, and agents and brokers, to take steps to detect and prevent fraudulent actions against consumers,” said Jeff Wu, deputy director for policy at the Center for Consumer Information and Insurance Oversight, in a written statement.

Under HealthSherpa’s plan, participating Obamacare insurers will each day submit data on all plan changes and new enrollments. Then the network’s software will look for duplicate enrollments or other suspicious patterns across carriers — which can’t currently be done by the private sector — and automatically verify that agents have filed proof of consumer consent.

Most situations would be resolved without the need for human intervention, said Kalogeropoulos — unless the system discovers fake consent. Those cases would be reported to federal and state regulators.

Private sector enrollment sites like HealthSherpa help millions of people legitimately in ACA plans each year. Most brokers use such platforms as an alternative to what they consider the more clunky healthcare.gov site, yet they also complain that the private enrollment websites make fraud too easy. Armed with nothing more than a name, date of birth, and state of residence, unscrupulous insurance agents can switch healthcare.gov customers’ insurance plans or change the authorized agent on their policies to collect commissions from insurers.

“No other industry works this way,” said Arthur Barlow, CEO and president of Utah-based Compass Insurance Advisors. His firm, which includes 500 independent agents, supports the ideas behind HealthSherpa’s Member Defense Network, which he called “a step in the right direction to have a third party validate consent.”

More efforts to address the problem of easy access to healthcare.gov accounts are needed, said Aaron Arenbart, the ACA/Medicare director at DigitalBGA, an Austin, Texas-based firm that assists brokers.

He’s skeptical that HealthSherpa’s network is the answer, however. He’d rather see federal regulators require the private platforms use some form of two-factor authentication before agents can log in to consumers’ accounts.

“I can’t see it working at all,” Arenbart said of the network. “A lot of carriers are not even on board.” Rogue agents “will just move to those carriers,” he said.

Kalogeropoulos said that not all the unauthorized enrollments and plan switches are necessarily fraud. Some may be the result of confusion among agents as to whether they represent certain clients, he said — particularly when agents buy contact information from lead-generating firms that may sell the same names to multiple brokerages.

“In the most extreme example, we saw one member submitted 70 times by five different agents,” he said. HealthSherpa’s new system, he said, would determine which agent had the most valid consent.

It’s a multistep process that, in some cases, would be decided by which agent can first get a client to complete a third-party identity-proofing process using a driver’s license or other official documents.

One concern with HealthSherpa’s network, Barlow said, is the possibility that some cases won’t be resolved automatically, and consumers who are switched may have to remain in new plans while conflicts between agents are adjudicated.

Another problem, said Washington, D.C.-based attorney James Napoli, is that the network’s solution to check for consent “is one that occurs after the horse has left the barn.”

Napoli’s clients include Nelson’s group, Health Agents for America. “The fix ought to be much easier on the front end,” he said. “For example, two-factor authentication. There are ways to stop this fraud before it’s already occurred.”

911 Faces Its Own Emergency

The national 911 emergency response system is in the midst of its own code red.

The lack of federal funding to upgrade aging 911 systems has created significant disparities in state emergency response services, with older operations plagued by outages and longer response times.

Last month, for instance, Massachusetts was hit with a statewide 911 outage that lasted about two hours — making it at least the eighth state with a service interruption in the United States this year. The outage was blamed on a safety feature that was supposed to provide protection against cyberattacks and hacking. But it was just one more such episode in the headlines.

More than three-quarters of call centers experienced outages in the past year, based on the latest Pulse of 9-1-1 Survey by the National Emergency Number Association and Carbyne, which makes public safety technology products.

In Congress, lawmakers have looked at ways to pay to modernize 911 systems by using revenue from the Federal Communications Commission — specifically, revenue that comes from the FCC’s auctioning of the rights to transmit signals over specific bands of the electromagnetic spectrum. There’s a catch: The Senate in March 2023 let the FCC’s authority to auction spectrum bands lapse.

Lawmakers have floated proposals, but final plans are in limbo. For example, legislation sponsored by Rep. Cathy McMorris Rodgers (R-Wash.) would renew the auction authority until September 2026 and provide almost $15 billion in grants from auction proceeds for upgrading 911 systems. The bill unanimously passed the House Energy and Commerce Committee in May 2023.

With funding attempts in Congress stalled, states and localities are taking a piecemeal approach — tapping general funds or other resources to modernize operations. Florida, Illinois, Montana and Oklahoma passed legislation in 2023 to advance or fund next-generation 911 systems, according to the National Conference of State Legislatures.

Most of the country’s roughly 6,000 call centers were built using analog rather than digital technologies. Next-generation 911 systems are more resilient, with better backups in case of an outage, advocates say. They allow callers to share photos and videos or text messages, and they also improve location accuracy.

But upgrades by states, cities and counties are spotty — generally happening in jurisdictions with deeper pockets. Proponents say billions of dollars in federal funding is urgently needed to ease disparities and build a stronger national emergency response system.

“Now there are haves and have-nots,” said Jonathan Gilad, vice president of government affairs at NENA, which represents 911 first responders. “Next-generation 911 shouldn’t be for people who happen to have an emergency in a good location.”


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


KFF Health News’ ‘What the Health?’: Alabama’s IVF Ruling Still Making Waves

The Host

Reverberations from the Alabama Supreme Court’s first-in-the-nation ruling that embryos are legally children continued this week, both in the states and in Washington. As Alabama lawmakers scrambled to find a way to protect in vitro fertilization services without directly denying the “personhood” of embryos, lawmakers in Florida postponed a vote on the state’s own “personhood” law. And in Washington, Republicans worked to find a way to satisfy two factions of their base: those who support IVF and those who believe embryos deserve full legal rights.

Meanwhile, Congress may finally be nearing a funding deal for the fiscal year that began Oct. 1. And while a few bipartisan health bills may catch a ride on the overall spending bill, several other priorities, including an overhaul of the pharmacy benefit manager industry, failed to make the cut.

This week’s panelists are Julie Rovner of KFF Health News, Rachel Cohrs of Stat, Riley Griffin of Bloomberg News, and Joanne Kenen of Johns Hopkins University’s schools of nursing and public health and Politico Magazine.

Among the takeaways from this week’s episode:

  • Lawmakers are readying short-term deals to keep the government funded and running for at least a few more weeks, though some health priorities like preparing for a future pandemic and keeping down prescription drug prices may not make the cut.
  • After the Alabama Supreme Court’s decision that frozen embryos are people, Republicans find themselves divided over the future of IVF. The emotionally charged debate over the procedure — which many conservatives, including former Vice President Mike Pence, believe should remain available — is causing turmoil for the party. And Democrats will no doubt keep reminding voters about it, highlighting the repercussions of the conservative push into reproductive health care.
  • A significant number of physicians in Idaho are leaving the state or the field of reproductive care entirely because of its strict abortion ban. With many hospitals struggling with the cost of labor and delivery services, the ban is only making it harder for women in some areas to get care before, during, and after childbirth — whether they need abortion care or not.
  • A major cyberattack targeting the personal information of patients enrolled in a health plan owned by UnitedHealth Group is drawing attention to the heightened risks of consolidation in health care. Meanwhile, the Justice Department is separately investigating UnitedHealth for possible antitrust violations.
  • “This Week in Health misinformation”: Panelist Joanne Kenen explains how efforts to prevent wrong information about a new vaccine for RSV have been less than successful.

Also this week, Rovner interviews Greer Donley, an associate professor at the University of Pittsburgh School of Law, about how a 150-year-old anti-vice law that’s still on the books could be used to ban abortion nationwide.

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

Julie Rovner: ProPublica’s “Their States Banned Abortion. Doctors Now Say They Can’t Give Women Potential Lifesaving Care,” by Kavitha Surana.

Rachel Cohrs: The New York Times’ “$1 Billion Donation Will Provide Free Tuition at a Bronx Medical School,” by Joseph Goldstein.

Joanne Kenen: Axios’ “An Unexpected Finding Suggests Full Moons May Actually Be Tough on Hospitals,” by Tina Reed.

Riley Griffin: Bloomberg News’ “US Seeks to Limit China’s Access to Americans’ Personal Data,” by Riley Griffin and Mackenzie Hawkins.

Also mentioned on this week’s podcast:


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The Kids Are Not OK

The Host

Teen girls “are experiencing record high levels of violence, sadness, and suicide risk,” according to a new survey from the Centers for Disease Control and Prevention. In 2021, according to the survey, nearly 3 in 5 U.S. teen girls reported feeling “persistently sad or hopeless.”

Meanwhile, a conservative judge in Texas has delayed his ruling in a case that could ban a key drug used in medication abortion. A group of anti-abortion doctors is suing to challenge the FDA’s approval decades ago of the abortion pill mifepristone.

This week’s panelists are Julie Rovner of KHN, Alice Miranda Ollstein of Politico, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, and Sandhya Raman of CQ Roll Call.

Among the takeaways from this week’s episode:

  • American teenagers reported record rates of sadness in 2021, with especially high levels of depression in girls and teens identifying as LGBTQ+, according to a startling CDC report. Sexual violence, mass shootings, cyberbullying, and climate change are among the intensifying problems plaguing young people.
  • New polling shows more Americans are dissatisfied with abortion policy than ever before, as a U.S. district court judge in Texas makes a last call for arguments on the fate of mifepristone. The case is undermining confidence in continued access to the drug, and many providers are discussing using only misoprostol for medication abortions. Misoprostol is used with mifepristone in the current two-drug regimen but is safe and effective, though slightly less so, when used on its own.
  • There are big holes in federal health privacy protections, and some companies that provide health care, like mental health services, exploit those loopholes to sell personal, identifying information about their customers. And this week, Republican Gov. Glenn Youngkin of Virginia blocked a state law that would have banned search warrants for data collected by menstrual tracking apps.
  • California plans to manufacture insulin, directly taking on high prices for the diabetes drug. While other states have expressed interest in following suit, it will likely be up to wealthy, populous California to prove the concept.

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

Julie Rovner: NPR’s “Is the Deadly Fungi Pandemic in ‘The Last of Us’ Actually Possible?” by Michaeleen Doucleff

Alice Ollstein: The New York Times’ “Childbirth Is Deadlier for Black Families Even When They’re Rich, Expansive Study Finds,” by Claire Cain Miller, Sarah Kliff, and Larry Buchanan; interactive produced by Larry Buchanan and Shannon Lin

Joanne Kenen: NPR’s “In Tennessee, a Medicaid Mix-Up Could Land You on a ‘Most Wanted’ List,” by Blake Farmer

Sandhya Raman: Bloomberg Businessweek’s “Zantac’s Maker Kept Quiet About Cancer Risks for 40 Years,” by Anna Edney, Susan Berfield, and Jef Feeley

Also mentioned in this week’s podcast:


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