Tag: Hospitals

KFF Health News’ ‘What the Health?’: Nursing Home Staffing Rules Prompt Pushback

The Host

It’s not surprising that the nursing home industry is filing lawsuits to block new Biden administration rules requiring minimum staffing at facilities that accept federal dollars. What is slightly surprising is the pushback against the rules from members of Congress. Lawmakers don’t appear to have the votes to disapprove the rule, but they might be able to force a floor vote, which could be embarrassing for the administration.

Meanwhile, Senate Democrats aim to force Republicans who proclaim support for contraceptive access to vote for a bill guaranteeing it, which all but a handful have refused to do.

This week’s panelists are Julie Rovner of KFF Health News, Rachel Cohrs Zhang of Stat, Alice Miranda Ollstein of Politico, and Sandhya Raman of CQ Roll Call.

Among the takeaways from this week’s episode:

  • In suing to block the Biden administration’s staffing rules, the nursing home industry is arguing that the Centers for Medicare & Medicaid Services lacks the authority to implement the requirements and that the rules, if enforced, could force many facilities to downsize or close.
  • Anthony Fauci, the retired director of the National Institute of Allergy and Infectious Diseases and the man who advised both Presidents Donald Trump and Joe Biden on the covid-19 pandemic, testified this week before the congressional committee charged with reviewing the government’s pandemic response. Fauci, the subject of many conspiracy theories, pushed back hard, particularly on the charge that he covered up evidence that the pandemic began because dangerous microbes escaped from a lab in China partly funded by the National Institutes of Health.
  • A giant inflatable intrauterine device was positioned near Union Station in Washington, D.C., marking what seemed to be “Contraceptive Week” on Capitol Hill. Republican senators blocked an effort by Senate Majority Leader Chuck Schumer to force a vote on consideration of legislation to codify the federal right to contraception. Immediately after, Schumer announced a vote for next week on codifying access to in vitro fertilization services.
  • Hospitals in London appear to be the latest, high-profile cyberattack victims, raising the question of whether it might be time for some sort of international cybercrime-fighting agency. In the United States, health systems and government officials are still in the very early stages of tackling the problem, and it is not clear whether Congress or the administration will take the lead.
  • An FDA advisory panel this week recommended against the formal approval of MDMA, a psychedelic also known as ecstasy, to treat post-traumatic stress disorder. Members of the panel said there was not enough evidence to recommend its use. But the discussion did provide more guidance about what companies need to present in terms of trials and evidence to make their argument for approval more feasible.

Also this week, Rovner interviews KFF Health News’ Bram Sable-Smith, who reported and wrote the latest KFF Health News-NPR “Bill of the Month” feature about a free cruise that turned out to be anything but. If you have an outrageous or baffling bill you’d like to send 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:


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Biden Wants Hospitals To Report Data on Gunshot Wounds

The Biden administration is enlisting America’s doctors to help combat gun violence.

About 160 health-care executives and officials have been invited to the White House today and Friday to promote public health solutions to the epidemic. A top priority, I’m told: The White House wants hospital emergency departments to collect more data about gunshot injuries their physicians treat, as well as routinely counsel patients about the safe use of firearms.

It’s part of the president’s strategy to build support for gun-safety measures outside the Capitol, where legislation to more strictly regulate firearms can’t overcome mainly Republican opposition. Biden’s already recruited educators to talk to parents about safe gun storage and community workers to help at-risk youth.

“The president has been clear: This is a public health crisis. So, to solve it, we need the leaders from the health-care sector,” Rob Wilcox, a deputy director of the White House Office of Gun Violence Prevention, told me in a phone interview. “Those are the leaders that run the health systems and hospitals that we go to for treatment, and it’s those doctors, nurses, practitioners on the front lines.”

Health experts have long described gun violence as a public health crisis, one that disproportionately affects Black and Hispanic residents in poor neighborhoods. Biden’s election opponent, former president Donald Trump, has assailed his gun policies and warned the National Rifle Association in May that “if the Biden regime gets four more years, they are coming for your guns.”

In 2022, more than 48,000 people were killed by guns in the United States, or about 132 people a day, according to the Centers for Disease Control and Prevention. An additional 200-plus Americans are injured each day, according to estimates.

Surveys show most Americans — across political affiliations and regardless of gun ownership — support policies that could reduce violence.

Biden’s initiative isn’t just about messaging. It’s also about money. Unlike America’s other deadly health threats — such as cancer, HIV and automobile crashes — limited federal dollars fund gun violence research, in part because of politics.

In 1996, a Republican-controlled Congress cut federal funding for gun safety research at the CDC, essentially shifting the burden to the private sector and academia — with a fraction of the previous budget. In 2019, Congress reversed course and has since agreed every year to allocate $25 million to the CDC and the National Institutes of Health for gun research.

Health researchers say more timely and comprehensive data about gun injuries and deaths would give them a better understanding of trends behind gun violence — and what policies might prevent it.

The White House is asking state and local health departments, health systems and hospitals to increase timely data collection on emergency department visits for firearm-related injuries to “support state and local jurisdictions in identifying and responding to emerging public health problems,” Wilcox said.

The goal is “to inform prevention efforts,” he said.

The data will cover fatal and nonfatal injuries. Existing CDC data focuses on deaths, while its data on injuries is limited. For instance, one person was killed in the Feb. 14 shooting at the Kansas City Chiefs Super Bowl victory parade, but the CDC data probably will not count the roughly two dozen other people who were injured.


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White House Enlists Doctors and Hospitals To Combat Gun Violence

The White House is calling on hospital executives, doctors, and other health care leaders to take bolder steps to prevent gun violence by gathering more data about gunshot injuries and routinely counseling patients about safe use of firearms.

Biden administration officials are hosting back-to-back events Thursday and Friday at the White House for about 160 health care officials, calling gun violence a “public health crisis” that requires them to act.

The strategy also reflects a stark political reality: Congress has been deadlocked on most gun-related legislation for years, with a deep divide between Republicans and Democrats. If Democratic President Joe Biden wants to get anything done quickly, he will need to look outside the Capitol. He has already enlisted educators to talk to parents about safe gun storage and community workers to help at-risk youth.

“The president has been clear: This is a public health crisis. So, to solve it, we need the leaders from the health care sector,” Rob Wilcox, a deputy director of the White House Office of Gun Violence Prevention, told KFF Health News. “Those are the leaders that run the health systems and hospitals that we go to for treatment, and it’s those doctors, nurses, practitioners on the front lines.”

Health experts have long described gun violence as a public health crisis, one that disproportionately affects Black and Hispanic residents in poor neighborhoods.

In 2022, more than 48,000 people were killed by guns in the U.S., or about 132 people a day, and suicides accounted for more than half of those deaths, according to the Centers for Disease Control and Prevention. An additional 200-plus Americans are injured each day, according to estimates from Johns Hopkins University research.

Guns are the leading cause of death for children and teens.

Gun violence prevention advocates applauded the Biden administration for attempting to depoliticize the issue by focusing on its health impacts. The health-centric message also resonates with the public, said Fatimah Loren Dreier, executive director of the Health Alliance for Violence Intervention, who planned to attend the June 6 event.

“The idea that there can be a bipartisan-driven, apolitical way to address the gun violence problem has created tremendous opportunity,” she said.

But the initiative isn’t just about messaging. It’s about numbers and statistics. Relative to America’s other deadly threats — such as cancer, HIV, and automobile crashes — fewer federal dollars fund gun violence research, mostly because of politics.

In 1996, Congress cut federal funding for gun control research by the CDC, essentially shifting the responsibility for funding and conducting the research to the private sector and academia — and with a fraction of the previous budget. In 2019, Congress reversed course and has since agreed every year to allocate $25 million to the CDC and the National Institutes of Health for gun research, but public health experts say it’s not nearly enough. By comparison, roughly three times that amount was earmarked for research on the prevention and treatment of underage drinking in fiscal year 2023, and 10 times as much to Parkinson’s disease research.

Slashing CDC research funding for firearms created decades-long gaps in data — and hamstrung efforts to respond to the crisis, researchers and health officials say. For instance, there’s little government data available to researchers on firearms, even basic statistics such as firearm ownership by city and which guns are used in shootings.

More timely and comprehensive data could give researchers a better understanding of the trends behind gun violence — and the steps to take to prevent it, said Bechara Choucair, a senior vice president and the chief health officer at Kaiser Permanente, who planned to attend the June 6 White House event.

“Anytime you want to address a problem with a public health lens, you have to understand the data,” he said. “You have to understand the data at a granular level so you can design interventions and test interventions and see if it works or if it doesn’t work.”

The White House is asking state and local health departments, health systems, and hospitals to boost timely data collection on emergency room visits for firearm-related injuries to “support state and local jurisdictions in identifying and responding to emerging public health problems,” Wilcox said.

The goal is “to inform prevention efforts,” he said.

The data will cover fatal and nonfatal injuries. Existing CDC data focuses on deaths, while its data on injuries is limited. For instance, one person was killed in the Feb. 14 shooting at the Kansas City Chiefs Super Bowl victory parade, but the CDC data likely will not count the roughly two dozen other people who were injured.

Collecting more detailed data could be costly for hospitals, whose ERs see most gunshot injuries, said Garen Wintemute, an ER physician and the head of a violence prevention program at the University of California-Davis. Right now, hospitals gather medical information about gunshot wounds and usually don’t get into other details, such as what type of gun or ammunition might have been used.

It’s not clear exactly what data hospitals will be asked to collect.

“It’s an intensive process,” Wintemute said. “The clinicians are going to gather the data that they need in order to treat the patient, and that may not include all the data that a researcher later would want to know about what happened.”

Some of this data is already being collected on a limited basis. The CDC collects near-real-time reporting of gunshot injuries from ERs in about a dozen states. The White House wants data from across the nation.

Wilcox added that federal grant dollars are available to health systems to conduct gun data collection through the Bipartisan Safer Communities Act, which Biden signed in 2022.

This year, Biden asked Congress to again boost funding for CDC firearm research in his proposed fiscal 2025 budget, but his previous efforts have failed in the GOP-controlled House of Representatives.

Lawmakers have yet to release a draft of their spending proposal for the Department of Health and Human Services.

“We should focus our CDC resources on infectious diseases, transmittable diseases, and certainly chronic diseases rather than controversial, political-charged activities,” Rep. Robert Aderholt (R-Ala.) said of Biden’s 2024 funding proposal.

Surveys show most Americans — across political affiliations and regardless of gun ownership — support policies that could reduce violence.

At this week’s meetings with health leaders, White House officials will also encourage doctors to talk with patients and the public about gun safety and securing guns.

When Wintemute talks with patients in the ER, he sits beside them and asks about their safety and the safety of others in their home, a practice he said many doctors already use to address an array of potential risks in a person’s life. The White House’s call for physicians to talk about gun violence legitimizes that, he said.

“A health professional can do what we do about tobacco and alcohol and other sorts of potentially risky behaviors, and talk with patients about how do we minimize the risk,” Wintemute said.

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

California Becomes Latest State To Try Capping Health Care Spending

California’s Office of Health Care Affordability faces a herculean task in its plan to slow runaway health care spending.

The goal of the agency, established in 2022, is to make care more affordable and accessible while improving health outcomes, especially for the most disadvantaged state residents. That will require a sustained wrestling match with a sprawling, often dysfunctional health system and powerful industry players who have lots of experience fighting one another and the state.

Can the new agency get insurers, hospitals, and medical groups to collaborate on containing costs even as they jockey for position in the state’s $405 billion health care economy? Can the system be transformed so that financial rewards are tied more to providing quality care than to charging, often exorbitantly, for a seemingly limitless number of services and procedures?

The jury is out, and it could be for many years.

California is the ninth state — after Connecticut, Delaware, Massachusetts, Nevada, New Jersey, Oregon, Rhode Island, and Washington — to set annual health spending targets.

Massachusetts, which started annual spending targets in 2013, was the first state to do so. It’s the only one old enough to have a substantial pre-pandemic track record, and its results are mixed: The annual health spending increases were below the target in three of the first five years and dropped beneath the national average. But more recently, health spending has greatly increased.

In 2022, growth in health care expenditures exceeded Massachusetts’ target by a wide margin. The Health Policy Commission, the state agency established to oversee the spending control efforts, warned that “there are many alarming trends which, if unaddressed, will result in a health care system that is unaffordable.”

Neighboring 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 pandemic. In 2022, the spending increase came in at half the state’s target rate. Connecticut and Delaware, by contrast, both overshot their 2022 targets.

It’s all a work in progress, and California’s agency will, to some extent, be playing it by ear in the face of state policies and demographic realities that require more spending on health care.

And it will inevitably face pushback from the industry as it confronts unreasonably high prices, unnecessary medical treatments, overuse of high-cost care, administrative waste, and the inflationary concentration of a growing number of hospitals in a small number of hands.

“If you’re telling an industry we need to slow down spending growth, you’re telling them we need to slow down your revenue growth,” says Michael Bailit, president of Bailit Health, a Massachusetts-based consulting group, who has consulted for various states, including California. “And maybe that’s going to be heard as ‘we have to restrain your margins.’ These are very difficult conversations.”

Some of California’s most significant health care sectors have voiced disagreement with the fledgling affordability agency, even as they avoid overtly opposing its goals.

In April, when the affordability office was considering an annual per capita spending growth target of 3%, the California Hospital Association sent it a letter saying hospitals “stand ready to work with” the agency. But the proposed number was far too low, the association argued, because it failed to account for California’s aging population, new investments in Medi-Cal, and other cost pressures.

The hospital group suggested a spending increase target averaging 5.3% over five years, 2025-29. That’s slightly higher than the 5.2% average annual increase in per capita health spending over the five years from 2015 to 2020.

Five days after the hospital association sent its letter, the affordability board approved a slightly less aggressive target that starts at 3.5% in 2025 and drops to 3% by 2029. Carmela Coyle, the association’s chief executive, said in a statement that the board’s decision still failed to account for an aging population, the growing need for mental health and addiction treatment, and a labor shortage.

The California Medical Association, which represents the state’s doctors, expressed similar concerns. The new phased-in target, it said, was “less unreasonable” than the original plan, but the group would “continue to advocate against an artificially low spending target that will have real-life negative impacts on patient access and quality of care.”

But let’s give the state some credit here. The mission on which it is embarking is very ambitious, and it’s hard to argue with the motivation behind it: to interject some financial reason and provide relief for millions of Californians who forgo needed medical care or nix other important household expenses to afford it.

Sushmita Morris, a 38-year-old Pasadena resident, was shocked by a bill she received for an outpatient procedure last July at the University of Southern California’s Keck Hospital, following a miscarriage. The procedure lasted all of 30 minutes, Morris says, and when she received a bill from the doctor for slightly over $700, she paid it. But then a bill from the hospital arrived, totaling nearly $9,000, and her share was over $4,600.

Morris called the Keck billing office multiple times asking for an itemization of the charges but got nowhere. “I got a robotic answer, ‘You have a high-deductible plan,’” she says. “But I should still receive a bill within reason for what was done.” She has refused to pay that bill and expects to hear soon from a collection agency.

The road to more affordable health care will be long and chock-full of big challenges and unforeseen events that could alter the landscape and require considerable flexibility.

Some flexibility is built in. For one thing, the state cap on spending increases may not apply to health care institutions, industry segments, or geographic regions that can show their circumstances justify higher spending — for example, older, sicker patients or sharp increases in the cost of labor.

For those that exceed the limit without such justification, the first step will be a performance improvement plan. If that doesn’t work, at some point — yet to be determined — the affordability office can levy financial penalties up to the full amount by which an organization exceeds the target. But that is unlikely to happen until at least 2030, given the time lag of data collection, followed by conversations with those who exceed the target, and potential improvement plans.

In California, officials, consumer advocates, and health care experts say engagement among all the players, informed by robust and institution-specific data on cost trends, will yield greater transparency and, ultimately, accountability.

Richard Kronick, a public health professor at the University of California-San Diego and a member of the affordability board, notes there is scant public data about cost trends at specific health care institutions. However, “we will know that in the future,” he says, “and I think that knowing it and having that information in the public will put some pressure on those organizations.”

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

Health Worker for a Nonprofit? The New Ban on Noncompete Contracts May Not Help You

Many physicians and nurses are happy about the Federal Trade Commission’s new rule banning the use of noncompete agreements in employment contracts. But they are disappointed that it may not protect those who work for nonprofit hospitals and health care facilities, which provide most of the nation’s care and employ the largest number of medical professionals.

In April, in a 3-2 vote, the FTC approved a final rule prohibiting contracts that prevent an employee from taking a job with a competitor. Calling the noncompete agreements “a widespread and often exploitative practice,” an agency announcement described them as an unfair method of competition that depresses wages and hinders new business formation.

The rule bars employers in most industries, including health care, from using contract clauses that block employees from leaving for other jobs or starting a competing business in the same geographic area for a fixed period of time.

But that doesn’t help many health professionals, because the FTC Act gives the agency authority over companies organized to operate for profit but not over nonprofit, charitable organizations, which are also tax-exempt.

Still, the agency noted some nonprofits could be bound by the rule if they do not operate as true charities. The rule establishes a two-part test to determine if the FTC has jurisdiction over a nonprofit — whether the organization is carrying on business for only charitable purposes, and whether its income goes to public rather than private interests.

“Our rulemaking record includes powerful stories from health care workers who are employed by nonprofits about how noncompetes hurt patients and providers,” said FTC Commissioner Rebecca Kelly Slaughter, one of three Democratic commissioners, in comments before the April 23 vote. “I do not think there is a good justification for them to be excluded from this rule.”

Noncompete contract terms have become increasingly common for physicians, nurse practitioners, and other medical professionals in hospitals and various health care facilities. Some providers say these agreements have forced them to leave their communities and patients behind if they wanted to exit unethical or unsafe workplace conditions.

Nearly 64% of U.S. community hospitals are nonprofits or government-owned, and they employ many of the nation’s medical professionals. As of 2022, nearly three-quarters of U.S. physicians were employed by hospital systems or other companies, both nonprofit and for-profit.

Based on their designation as charities that don’t have to pay income or property taxes, U.S. nonprofit hospitals received a total estimated tax exemption of $28 billion in 2020, according to KFF, a nonpartisan research organization.

That exceeded the estimated $16 billion they spent on charity care for patients unable to afford their medical bills, KFF said.

Physician and nursing groups say it makes no sense to treat nonprofit hospitals differently because they are just as money-driven as for-profit hospitals. Patients, they say, will benefit if providers are free to call out unsafe conditions and change jobs. “Giving physicians freedom of movement will force hospitals to compete to improve working conditions,” said Jonathan Jones, immediate past president of the American Academy of Emergency Medicine.

Chad Golder, general counsel and secretary of the American Hospital Association, which represents mostly nonprofit hospitals, said the rule would increase health care costs and reduce patient access by triggering hospital bidding wars for physicians. He predicted the FTC would try to apply the rule to both nonprofit and for-profit hospitals.

“They aren’t saying exactly what they’ll do, but it’s a pretty significant move for them to say we’ll apply our own test to determine if we can regulate a nonprofit,” Golder said. “Nonprofit entities now will need to be extra careful.”

In addition, some nonprofit hospitals have joint ventures with for-profit hospitals and medical groups. That could create complicated questions about whether their employee contracts come under the rule, said Chip Kahn, president and CEO of the Federation of American Hospitals, which represents for-profits.

The new rule arose from President Joe Biden’s 2021 executive order instructing the FTC to curb the unfair use of noncompete agreements, part of his broader mandate to boost U.S. economic competition and worker mobility.

The FTC argued that banning noncompetes, which it said cover 1 in 5 American workers, would lower health care costs by up to $194 billion over the next decade. It will ensure Americans “freedom to pursue a new job, start a new business, or bring a new idea to market,” FTC Chair Lina Khan said.

The rule also prohibits contract terms that function like noncompetes to stop employees from leaving to work for competing companies or start their own businesses. These might include overbroad nondisclosure agreements, training repayment provisions, and nonsolicitation clauses.

“No one should be trapped in an unsafe job by onerous contracts that prevent them from taking another job,” said Brynne O’Neal, a regulatory policy specialist at National Nurses United, the profession’s largest dedicated labor union in the U.S. Hospitals, she said, use training repayment agreement provisions that require nurses to pay as much as $30,000 in training costs if they leave, essentially locking them in their jobs.

California, Minnesota, North Dakota, and Oklahoma already ban enforcement of noncompete clauses for all employees of both nonprofits and for-profits, while about nine other states prohibit noncompetes for physicians. Even in states without bans, judges have invalidated noncompetes when they have found them to be overbroad or unreasonable.

Hospital executives argue that the noncompete rule will force them to compete against each other to hire physicians and other providers and ultimately cost them more, and that it advantages nonprofits over for-profits. “All it would do is increase the price of labor in a field that already has labor shortages and thin margins,” Golder said.

“The nonprofit hospital across the street could pursue our employees, while their employees would be protected, and that’s a basic fairness issue,” Kahn said.

But Clifford Atlas, an employment attorney with Jackson Lewis in New York, said that argument against the noncompete rule “won’t fly” in court because preventing competition for the services of physicians or other workers is not a business interest that’s protected by law or public policy.

The rule is set to take effect in September, though business groups have filed two federal lawsuits against it in Texas and one in Pennsylvania. Many legal experts predict that conservative judges will strike down the rule on the grounds that it exceeds the FTC’s statutory authority.

Physician and nurses’ groups hope the FTC rule, whatever its fate in the courts, helps persuade hospitals and other health care employers to stop using noncompetes and spurs more states to prohibit them.

“We’re telling our members it could be struck down, but we’re asking them to renegotiate their contracts,” said Jones of the American Academy of Emergency Medicine. “They should be asking their employers, ‘Wouldn’t you like to be on the right side and not to be seen as fighting against physicians and patients?’”

Readers Issue Rx for Clogged ERs and Outrageous Out-of-Pocket Costs

Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.


Lawmakers Must Protect Home Health To Alleviate Hospital Bottlenecks

The stark reality that countless seniors lie stranded in emergency rooms across the country waiting for care underscores the need for models of care that better support older Americans (“Stranded in the ER, Seniors Await Hospital Care and Suffer Avoidable Harm,” May 6). As KFF Health News reports, even if patients need to be admitted, at times, there are simply no rooms available.

As noted in the article, the backlog of patients waiting to be discharged to home health care has partly contributed to this problem in ERs. Medicare’s home health care program enables complex, disabled, and older patients to receive care and rehabilitation in their own homes after their hospitalization. Not only is this the preferred site of care by patients and their families, but it also helps open needed hospital beds and lessens the burden on emergency rooms and hospital staff.

Unfortunately, years of Medicare cuts are making it harder for home health providers to meet growing demand and provide vital care. The Centers for Medicare & Medicaid Services has repeatedly cut the Medicare home health program, and more cuts are expected in future years, already totaling $19 billion in cuts through 2029. Despite Medicare’s own data showing that home health saves taxpayers money, the cuts continue forcing home health providers to scale back the services they can provide, making it more difficult to recruit and retain staff, which ultimately harms patient access.

To protect home health and free up capacity in hospitals, Congress must pass the Preserving Access to Home Health Act (S 2137/HR 5159), which would prevent Medicare from implementing steep payment cuts to the Medicare Home Health Program in 2025 and beyond.

No patient should have to wait hours in an ER hallway while sick or injured. By stopping these cuts to the Medicare home health program, Congress can give patients access to high-quality care while also alleviating the burden on hospitals in crisis.

— Joanne Cunningham, CEO of the Partnership for Quality Home Healthcare, Washington, D.C.


Your recent article on seniors stranded in the ER was an interesting read. However, as a physician, I want to point out that you neglected an important issue. So many people use the emergency rooms as primary care facilities, with nonemergency visits: chronic issues such as headaches, earaches, coughs, and fatigue that have been going on for weeks and months. Sadly, because of a lack of knowledge of where to go for treatment, or lack of insurance, ERs must see these patients, which absolutely clogs up the ER. If you want to try and make a change, address these issues.

— Ira Shivitz, Nashville, Tennessee


On the social platform X, a reader weighed in on an article from KFF Health News-CBS News’ “When Medical Devices Malfunction” investigative series, which focused on a controversial dental appliance:

— Monica Raybon, Mobile, Alabama


Losing Rights in Oklahoma?

House Bill 3013 in Oklahoma would criminalize abortion-inducing drugs, which would punish a person who is intently trafficking these substances (“Anti-Abortion Hard-Liners Speak Up,” May 23). A person could get a fine of up to $100,000 or imprisonment for up to 10 years. Medication that is prescribed for other uses but can cause an abortion would not be considered an abortion-inducing drug. Plan B is not restricted in HB 3013, and there is no indication that the use or sale will be prohibited.

Abortion has been made illegal in many states, including Oklahoma. Since abortion is illegal, many women now look toward abortion pills. Women have unwanted pregnancies that can be caused by Plan B contraceptives not working or as a result of a sexual assault. As a result, women seek abortion pills since they cannot have a professional perform an abortion procedure.

The abortion pill has an 87%-98% effectiveness, whereas the abortion procedure is 98%-99% effective. The abortion pill can have side effects such as blood clots in the uterus, excessive bleeding, and increased infertility. Even though a medication abortion has these effects, women still decide to undergo it because many of them do not have access to a professional abortion procedure.

Taking away the only resource women have access to in Oklahoma would be detrimental. Women have already had their right to an abortion taken from them. Women should be able to decide what is best for them and if they want to end their pregnancy by taking the abortion pill. Although many argue that having an abortion leads to severe mental health issues, every woman has different results. Everyone should contact their representatives to vote no on bills like these. This bill would make decisions for many women when every woman should be able to make their own decisions.

— Lizbeth Hernandez, McLoud, Oklahoma


An Ohio reader hopped to a conclusion on the social platform X about an article on the difference between sunscreens available in the United States vs. other countries:

— Bob Schwartz, Cincinnati, Ohio


The Backdrop of Dietary Choices

When analyzing the impact of diet on health outcomes, it is essential to interpret the context of dietary choices. The intersection of socioeconomic status, access to nutritious food, and health disparities cannot be overlooked when investigating specific health conditions among racial groups (“Dietary Choices Are Linked to Higher Rates of Preeclampsia Among Latinas,” April 5).

The article pointed out the correlation between preeclampsia and conditions such as obesity, hypertension, and chronic kidney disease. While true, it is crucial to underscore that obesity rates are disproportionately higher among Black and Hispanic populations in the United States, according to the Centers for Disease Control and Prevention. This disparity is not merely a reflection of cultural dietary preferences but is deeply intertwined with the structural barriers that limit access to healthy, affordable food options for these communities.

Moreover, these health disparities are exacerbated by socioeconomic factors. Data from the U.S. Census Bureau indicates that 25.8% of Black Americans and 23.8% of Hispanic Americans lived below the poverty line in 2019, compared with 10.1% of non-Hispanic whites. This economic divide significantly impacts the ability of these communities to access fresh produce and nutritious food options, further entrenching health disparities.

Addressing this issue requires more than advising individuals to alter their eating habits. It necessitates systemic changes to make healthier food options more accessible and affordable. Initiatives like the “Sugar-Sweetened Beverages” tax, which has been implemented in several U.S. cities, demonstrate a proactive approach to discouraging unhealthy dietary choices by making sugary and overly refined foods more expensive. A study published just months after this was enacted in Berkeley, California, in 2015 found a significant decrease in SSB consumption coupled with increased water drinking. In a larger study done across multiple cities, it was found that tax implementation resulted in a 33% decline in SSB purchases. However, parallel efforts must be made to subsidize and lower the cost of nutritious foods, ensuring that healthy options are within reach for all, regardless of income or ZIP code. Other popular ideas in this space include increasing agricultural subsidies to lower the cost of produce. In conjunction with increasing the prices of sugary foods, this could serve as an effective strategy to promote healthier eating habits.

While cultural preferences indeed play a significant role in dietary habits, we must not overlook the structural barriers that prevent many from making healthier choices. By addressing these systemic issues, we can take a significant step toward reducing the prevalence of preeclampsia and other diet-related conditions, particularly among our most vulnerable populations.

— Lillian Levy, Berkeley, California


A New Yorker shared insights on the social platform X about an article in our series tracking the spending of opioid settlement funds:

— Lilo Stainton, Brooklyn, New York


Put an End to Picking Patients’ Pockets

In 2022, U.S. citizens spent $471.4 billion on out-of-pocket costs for health care and prescription drugs. This was a 6.6% increase from the previous year. Several strategies can be implemented to reduce Americans’ out-of-pocket costs (“A Battle Between Drugmakers and Insurers Hits Patients in the Wallet,” March 20). First, Congress must pass HR 830, the HELP (Help Ensure Lower Patient) Copays Act. The bill grants enrollees the opportunity to apply certain payments (coupons, vouchers, prescription assistance programs, etc.) toward cost-sharing requirements, allowing enrollees to reach their deductibles and out-of-pocket costs much sooner. There is a belief that coupon programs will increase the utilization of expensive drugs; this is incorrect. Drug manufacturers negotiate with pharmacy benefit managers to place their drugs on an insurer’s formulary. PBMs then list these medications as preferred or put them on a tier system; formulary drugs will cost an enrollee less than a non-formulary drug. Some PBMs permit insurers to formulate their formulary or have an open formulary. However, the insurer will incur additional costs for these methods.

Secondly, laws designed to regulate PBM operations are loosely enforced. This has to change. Some states (Arkansas, California, Louisiana, Maine, and New York) have passed legislation requiring transparency from PBMs; in those states, PBMs report drug pricing, fees charged, and the amounts of rebates received and retained. If PBMs do not adhere to the regulations, penalties will be enforced. The federal government should take the lead from these five states to enact a federal law requiring transparency of PBMs, and mandate flat-rate rebates for generic and brand-name drugs. The flat rates should reflect the market.

Thirdly, patent reform. Currently, drugmakers can extend their initial exclusivity period by filing additional patents on the same drugs in different forms and different administration routes, what’s known as a “patent thicket.” Manufacturers will patent the drugs’ generic versions as well. Patent thickets increase drug prices and delay generics from entering the market. Additionally, the federal government should cap drug prices. Manufacturers use research and development as an excuse to overcharge. In other developed countries, health technology assessments determine the price for innovation, keeping costs lower.

Now, some would say that’s too much government and it is affecting our capitalist society, but what’s more important than one’s health? These restrictions will not prevent the manufacturer from making a profit.

Lastly, the U.S. could leverage its bargaining power and negotiate directly with drugmakers. How? Turn over the negotiations to the Department of Health and Human Services. This regulatory body would represent U.S. citizens with commercial and federal insurance and negotiate cost-effective rates for prescription drugs.

— Tameka Houston, Baltimore, Maryland

In the House of Psychiatry, a Jarring Tale of Violence

At the American Psychiatric Association’s annual meeting, a patient described a restraint that haunts him, more than eight years later.