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1 in 3 People Dropped by Utah Medicaid Left Uninsured, a ‘Concerning’ Sign for Nation

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Phil Galewitz, KFF
Wed, 22 Nov 2023 20:33:00 +0000

About 30% of Utah residents who were cut from Medicaid this year say they became uninsured, according to state who conducted a first-of-its-kind survey of people disenrolled from the program.

Utah has dropped more than 130,000 out of about 500,000 Medicaid beneficiaries since April, after the federal government lifted a pandemic-era requirement that states keep people enrolled in the insurance program for low-income people. Since then, every state has started what's called an “unwinding” to reassess whether people in Medicaid are still eligible and drop those no longer qualified — people who fail to respond to government inquiries.

Utah's survey sheds light on the fate of the 11 million people cut from the program nationwide so far. While officials predicted some of them would wind up uninsured, little information is yet available about how many obtained coverage elsewhere. States have renewed Medicaid coverage for more than 20 million people, according to KFF's unwinding tracker.

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The Utah survey, said Arielle Kane, director of Medicaid initiatives at the advocacy group Families USA, “does, unfortunately, give us a window, in a bad way, as Utah is a state with very low unemployment — so in a state with higher unemployment it may be worse.”

On top of the pandemic throwing millions of Americans out of work and onto Medicaid rolls, in 2020 Utah began expanding its program under the Affordable Care Act, raising eligibility to cover more working people with low incomes. As a result, tens of thousands who enrolled three years ago had never been through the of renewing their coverage.

Utah's Medicaid director, Jennifer Strohecker, announced the results of the survey of disenrolled people on Nov. 14. “This is really challenging for us and concerning to us as we consider what this means on the population,” she said.

Advocates for expanded U.S. insurance coverage fear many people left uninsured by the unwinding are , as they make up more than 40% of Medicaid enrollees.

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The survey had 1,003 respondents and a margin of error of plus or minus 3%, said Kolbi Young, a spokesperson for the Medicaid agency. The agency declined to make the full survey results available, saying they're still under review.

Nationwide, there are other signs that many people dropped from Medicaid are winding up uninsured. Epic Research, a division of the electronic medical company, published a study Nov. 17 showing that uninsured emergency room visits increased substantially this summer, after the unwinding began.

The researchers examined ER records from nearly 1,300 hospitals. They found that the self-pay rate among increased from 6.1% in March to 8.5% in August — the highest rate observed since the first weeks of the pandemic.

Even before the pandemic, it was typical for many people who lost Medicaid coverage to go without insurance for a time, said Robin Rudowitz, a Medicaid policy researcher and vice president at KFF. “We do know from earlier research that following a disenrollment from Medicaid, two-thirds of people had a period of uninsurance over the course of the following year,” she said.

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So Utah's survey results — showing about a third of disenrolled people lack insurance — is “not outlandish, but it is very concerning,” said Emily Zheutlin, a health policy analyst with the Utah Health Policy and a member of the state's Medicaid advisory board.

She said people in the state have had difficulty renewing their Medicaid coverage, with long wait times on calls to the state Medicaid agency. Many people also don't know they need to reverify their eligibility, she said.

Without health coverage, people may delay seeking needed care or be left with unaffordable bills when they get it.

Rachel Craig, government affairs manager for the Association for Utah Community Health, which represents community health centers, had feared up to half of those disenrolled from Medicaid would be uninsured.

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“This is better than expected, though it's still a big number,” she said.

But she said the state's survey could be skewed because people with insurance may be more likely to respond than people who are uninsured.

KFF Health News data journalist Hannah Recht contributed to this .

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By: Phil Galewitz, KFF Health News
Title: 1 in 3 People Dropped by Utah Medicaid Left Uninsured, a ‘Concerning' Sign for Nation
Sourced From: kffhealthnews.org/news/article/utah-medicaid-disenrollment-uninsured-increase/
Published Date: Wed, 22 Nov 2023 20:33:00 +0000

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Pregnancy Care Was Always Lacking in Jails. It Could Get Worse.

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Renuka Rayasam
Fri, 23 Feb 2024 10:00:00 +0000

It was about midnight in June 2022 when police officers showed up at Angela Collier's door and told her that someone anonymously requested a welfare check because they thought she might have had a miscarriage.

Standing in front of the concrete steps of her home in Midway, Texas, Collier, initially barefoot and wearing a baggy gray T-shirt, told officers she planned to see a doctor in the morning because she had been bleeding.

Police body camera footage obtained by KFF Health News through an open request shows that the officers then told Collier — who was 29 at the time and enrolled in online classes to study psychology — to turn around.

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Instead of taking her to get medical care, they handcuffed and her because she had outstanding warrants in a neighboring county for failing to appear in court to face misdemeanor drug charges three weeks earlier. She had missed that court date, medical records show, because she was at a hospital receiving treatment for pregnancy complications.

Despite her symptoms and being about 13 weeks pregnant, Collier spent the next day and a half in the Walker County Jail, about 80 miles north of Houston. She said her bleeding worsened there and she begged repeatedly for medical attention that she didn't , according to a formal complaint she filed with the Texas Commission on Jail Standards.

“There wasn't anything I could do,” she said, but “just lay there and be scared and not know what was going to happen.”

Collier's experience highlights the limited oversight and absence of federal standards for reproductive care for pregnant women in the criminal justice system. Incarcerated people have a constitutional right to , yet only a half-dozen states have passed laws guaranteeing access to prenatal or postpartum medical care for people in custody, according to a review of reproductive health care legislation for incarcerated people by a research group at Johns Hopkins School of Medicine. And now abortion restrictions might be putting care further out of reach.

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Collier's arrest was “shocking and disturbing” because officers “blithely” took her to jail despite her miscarriage concerns, said Wanda Bertram, a spokesperson for the Prison Policy Initiative, a nonprofit organization that studies incarceration. Bertram reviewed the body cam footage and Collier's complaint.

“Police arrest people who are in medical emergencies all the time,” she said. “And they do that regardless of the fact that the jail is often not equipped to care for those people in the way an emergency room might be.”

After a decline during the first year of the pandemic, the number of women in U.S. jails is once again rising, hitting nearly 93,000 in June 2022, a 33% increase over 2020, according to the Department of Justice. Tens of thousands of pregnant women enter U.S. jails each year, according to estimates by Carolyn Sufrin, an associate professor of gynecology and obstetrics at Johns Hopkins School of Medicine, who researches pregnancy care in jails and prisons.

The health care needs of incarcerated women have “always been an afterthought,” said Dana Sussman, deputy executive director at Pregnancy Justice, an organization that defends women who have been charged with crimes related to their pregnancy, such as substance use. For example, about half of states don't provide free menstrual products in jails and prisons. “And then the needs of pregnant women are an afterthought beyond that,” Sussman said.

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Researchers and advocates worry that confusion over recent abortion restrictions may further complicate the situation. A nurse cited Texas' abortion laws as one reason Collier didn't need care, according to her statement to the standards commission.

Texas allows treatment of miscarriage and ectopic pregnancies, a life-threatening condition in which a fertilized egg implants outside the uterus. However, different interpretations of the law can create confusion.

A nurse told Collier that “hospitals no longer did dilation and curettage,” Collier told the commission. “Since I wasn't hemorrhaging to the point of completely soaking my pants, there wasn't anything that could be done for me,” she said.

Collier testified that she saw a nurse only once during her stay in jail, even after she repeatedly asked jail staffers for help. The nurse checked her temperature and blood pressure and told her to put in a formal request for Tylenol. Collier said she completed her miscarriage shortly after being released.

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Collier's case is a “canary in a coal mine” for what is in jails; abortion restrictions are “going to have a huge ripple effect on a system already unequipped to handle obstetric emergencies,” Sufrin said.

‘There Are No Consequences'

Jail and prison health policies vary widely around the country and often fall far short of the American College of Obstetricians and Gynecologists' guidelines for reproductive health care for incarcerated people. ACOG and other groups recommend that incarcerated women have access to unscheduled or emergency obstetric visits on a 24-hour basis and that on-site health care providers should be better trained to recognize pregnancy problems.

In Alabama, where women have been jailed for substance use during pregnancy, the state offers pregnancy tests in jail. But it doesn't guarantee a minimum standard of prenatal care, such as access to extra food and medical visits, according to Johns Hopkins' review.

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Policies for pregnant women at federal facilities also don't align with national standards for nutrition, safe housing, and access to medical care, according to a 2021 report from the Government Accountability Office.

Even when laws exist to ensure that incarcerated pregnant women have access to care, the language is often vague, leaving discretion to jail personnel.

Since 2020, Tennessee law has required that jails and prisons provide pregnant women “regular prenatal and postpartum care, as necessary.” But last August a woman gave birth in a jail cell after seeking medical attention for more than an hour, according to the Montgomery County Sheriff's Office.

Pregnancy complications can quickly escalate into life-threatening situations, requiring more timely and specialized care than jails can often provide, said Sufrin. And when jails fail to comply with laws on the books, little oversight or enforcement may exist.

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In , many jails didn't consistently follow laws that aimed to improve access to reproductive health care, such as providing free menstrual items, according to a May 2023 report commissioned by state lawmakers. The report also said jails weren't transparent about whether they followed other laws, such as prohibiting the use of solitary confinement for pregnant women.

Krishnaveni Gundu, as co-founder of the Texas Jail Project, which advocates for people held in county jails, has lobbied for more than a decade to strengthen state protections for pregnant incarcerated people.

In 2019, Texas became one of the few states to require that jails' health policies include obstetrical and gynecological care. The law requires jails to promptly transport a pregnant person in labor to a hospital, and additional regulations mandate access to medical and mental health care for miscarriages and other pregnancy complications.

But Gundu said lack of oversight and meaningful enforcement mechanisms, along with “apathy” among jail employees, have undermined regulatory protections.

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“All those reforms feel futile,” said Gundu, who helped Collier prepare for her testimony. “There are no consequences.”

Before her arrest, Collier had been to the hospital twice that month experiencing pregnancy complications, a bladder infection, her medical records show. Yet the commission found that Walker County Jail didn't violate minimum standards. The commission did not consider the police body cam footage or Collier's personal medical records, which support her assertions of pregnancy complications, according to investigation documents obtained by KFF Health News via an open records request.

In making its determination, the commission relied mainly on the jail's medical records, which note that Collier asked for medical attention for a miscarriage once, in the morning on the day she was released, and refused Tylenol.

“Your complaint of no medical care is unfounded,” the commission concluded, “and no further action will be taken.”

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Collier's miscarriage had ended before she entered the jail, argued Lt. Keith DeHart, jail lieutenant for the Walker County Sheriff's Office. “I believe there was some misunderstanding,” he said.

Brandon Wood, executive director of the commission, wouldn't comment on Collier's case but defends the group's investigation as thorough. Jails “have a duty to ensure that those records are accurate and truthful,” he said. And most Texas jails are complying with heightened standards, he said.

Bertram disagrees, saying the fact that care was denied to someone who was begging for it speaks volumes. “That should tell you something about what these standards are worth,” she said.

Last year, Chiree Harley spent six weeks in a Comal County, Texas, jail shortly after discovering she was pregnant and before she could get prenatal care, she said.

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I was “thinking that I was going to be well taken care of,” said Harley, 37, who also struggled with substance use.

Jail officials put her in the infirmary, Harley said, but she saw only a jail doctor and never visited an OB-GYN, even though she had previous pregnancy complications including losing multiple pregnancies at around 21 weeks. This time she had no idea how far along she was.

She said that she started leaking amniotic fluid and contractions on Nov. 1, but that jail officials waited nearly two days to take her to a hospital. Harley said officers forced her to sign papers releasing her from jail custody while she was having contractions in the hospital. Harley delivered at 23 weeks; the baby boy died less than a day later in her arms.

The whole experience was “very scary,” Harley said. “Afterwards we were all very, very devastated.”

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Comal County declined to send Harley's medical and other records in response to an open records request. Michael Shaunessy, a partner at McGinnis Lochridge who represents Comal County, said in a statement that, “at all times, the Comal County Jail provided Chiree Harley with all appropriate and necessary medical treatment for her and her unborn child.” He did not respond to questions about whether Harley was provided specialized obstetric care.

‘I Trusted Those People'

In states like Idaho, Mississippi, and Louisiana that installed near-total abortion bans after the Supreme Court eliminated the constitutional right to abortion in 2022, some might have to wait until no fetal cardiac activity is detected before they can get care, said Kari White, the executive and scientific director of Resound Research for Reproductive Health.

White co-authored a recent study that documented 50 cases in which pregnancy care deviated from the standard because of abortion restrictions even outside of jails and prisons. Health care providers who worry about running afoul of strict laws might tell patients to go home and wait until their situations worsen.

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“Obviously, it's much trickier for people who are in jail or in prison, because they are not going to necessarily be able to leave again,” she said.

Advocates argue that boosting oversight and standards is a start, but that states need to find other ways to manage pregnant women who get caught in the justice system.

For many pregnant people, even a short stay in jail can cause lasting trauma and interrupt crucial prenatal care.

Collier remembers being in “disbelief” when she was first arrested but said she was not “distraught.”

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“I figured I would be taken care of, that nothing bad was gonna happen to me,” she said. As it became clear that she wouldn't get care, she grew distressed.

After her miscarriage, Collier saw a mental health specialist and started medication to treat depression. She hasn't returned to her studies, she said.

“I trusted those people,” Collier said about the jail staff. “The whole experience really messed my head up.”

——————————
By: Renuka Rayasam
Title: Pregnancy Care Was Always Lacking in Jails. It Could Get Worse.
Sourced From: kffhealthnews.org/news/article/pregnancy-care-jails-prisons-incarcerated-women/
Published Date: Fri, 23 Feb 2024 10:00:00 +0000

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Florida Defies CDC in Measles Outbreak, Telling Parents It’s Fine to Send Unvaccinated Kids to School

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Amy Maxmen
Fri, 23 Feb 2024 10:00:00 +0000

With a brief memo, Florida Surgeon General Joseph Ladapo has subverted a public standard that's long kept measles outbreaks under control.

On Feb. 20, as measles spread through Manatee Bay Elementary in South Florida, Ladapo sent parents a letter granting them permission to send unvaccinated children to school amid the outbreak.

The Department of Health “is deferring to parents or guardians to make decisions about school attendance,” wrote Ladapo, who was appointed to head the agency by Florida Gov. Ron DeSantis, whose name is listed above Ladapo's in the letterhead.

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Ladapo's move contradicts advice from the Centers for Disease Control and Prevention.

“This is not a parental rights issue,” said Scott Rivkees, Florida's former surgeon general who is now a professor at Brown University. “It's about protecting fellow classmates, teachers, and members of the community against measles, which is a very serious and very transmissible illness.”

Most people who aren't protected by a vaccine will get measles if they're exposed to the virus. This vulnerable group includes children whose parents don't get them vaccinated, infants too young for the vaccine, those who can't be vaccinated for medical reasons, and others who don't mount a strong, lasting immune response to it. Rivkees estimates that about a tenth of people in a community fall into the vulnerable category.

The CDC advises that unvaccinated students stay home from school for three weeks after exposure. Because the highly contagious measles virus spreads on tiny droplets through the and on surfaces, students are considered exposed simply by sitting in the same cafeteria or classroom as someone infected. And a person with measles can pass along an infection before they develop a fever, cough, rash, or other signs of the illness. About 1 in 5 people with measles end up hospitalized, 1 in 10 develop ear infections that can lead to permanent hearing loss, and about 1 in 1,000 die from respiratory and neurological complications.

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“I don't know why the health department wouldn't follow the CDC recommendations,” said Thresia Gambon, president of the Florida chapter of the American Academy of Pediatrics and a pediatrician who practices in Miami and Broward, the county affected by the current measles outbreak. “Measles is so contagious. It is very worrisome.”

Considering the dangers of the disease, the vaccine is incredibly safe. A person is about four times as likely to die from being struck by lightning during their lifetime in the United States as to have a potentially -threatening allergic reaction to the measles, mumps, and rubella vaccine.

Nonetheless, last year a record number of parents filed for exemptions from school vaccine requirements on religious or philosophical grounds across the United States. The CDC reported that childhood immunization rates hit a 10-year low.

In addition to Florida, measles cases have been reported in 11 other states this year, Arizona, Georgia, Minnesota, and Virginia.

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Only about a quarter of Florida's counties had reached the 95% threshold at which communities are considered well protected against measles outbreaks, according to the most recent data posted by the Florida Department of Health in 2022. In Broward County, where six cases of measles have been reported over the past , about 92% of children in kindergarten had received routine immunizations against measles, chickenpox, polio, and other diseases. The remaining 8% included more than 1,500 kids who had vaccine exemptions, as of 2022.

Broward's local health department has been offering measles vaccines at Manatee Bay Elementary since the outbreak began, according to the county school superintendent. If an unvaccinated person gets a dose within three days of exposure to the virus, they're far less likely to get measles and spread it to others.

For this reason, government have occasionally mandated vaccines in emergencies in the past. For example, Philadelphia's deputy health commissioner in 1991 ordered children to get vaccinated against their parents' wishes during outbreaks traced to their faith-healing churches. And during a large measles outbreak among Orthodox Jewish communities in Brooklyn in 2019, the New York health commissioner mandated that anyone who lived, worked, or went to school in hard-hit neighborhoods get vaccinated or face a fine of $1,000. In that ordinance, the commissioner wrote that the presence of anyone lacking the vaccine in those , unless it was medically contraindicated, “creates an unnecessary and avoidable risk of continuing the outbreak.”

Ladapo moved in the opposite direction with his letter, deferring to parents because of the “high immunity rate in the community,” which data contradicts, and because of the “burden on families and educational cost of healthy children missing school.”

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Yet the burden of an outbreak only grows larger as cases of measles spread, requiring more emergency care, more testing, and broader quarantines as illness and hospitalizations mount. Curbing a 2018 outbreak in southern Washington with 72 cases cost about $2.3 million, in addition to $76,000 in medical costs, and an estimated $1 million in economic losses due to illness, quarantine, and caregiving. If numbers soar, death becomes a burden, too. An outbreak among a largely unvaccinated population in Samoa caused more than 5,700 cases and 83 deaths, mainly among children.

Ladapo's letter to parents also marks a departure from the norm because local health departments tend to take the lead on containing measles outbreaks, rather than state or federal authorities. In response to queries from KFF Health News, Broward County's health department deferred to Florida's state health department, which Ladapo oversees.

“The county doesn't have the power to disagree with the state health department,” said Rebekah Jones, a data scientist who was from her post at the Florida health department in 2020, over a rift regarding coronavirus data.

DeSantis, a Republican, appointed Ladapo as head of the state health department in late 2021, as DeSantis integrated skepticism about covid vaccines into his political platform. In the months that followed, Florida's health department removed information on covid vaccines from its homepage, and reprimanded a county health director for encouraging his staff to get the vaccines, leading to his resignation. In January, the health department website posted Ladapo's call to halt vaccination with covid mRNA vaccines entirely, based on notions that scientists call implausible.

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Jones was not surprised to see Ladapo pivot to measles. “I think this is the predictable outcome of turning fringe, anti-vaccine rhetoric into a defining trait of the Florida government,” she said. Although his latest decision runs contrary to CDC advice, the federal agency rarely intervenes in measles outbreaks, entrusting the task to states.

In an email to KFF Health News, the Florida health department said it was working with others to identify the contacts of people with measles, but that details on cases and places of exposure were confidential. It repeated Ladapo's decision, adding, “The surgeon general's recommendation may change as epidemiological investigations continue.”

For Gambon, the outbreak is already disconcerting. “I would like to see the surgeon general promote what is safest for children and for school staff,” she said, “since I am sure there are many who might not have as strong immunity as we would hope.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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By: Amy Maxmen
Title: Florida Defies CDC in Measles Outbreak, Telling Parents It's Fine to Send Unvaccinated Kids to School
Sourced From: kffhealthnews.org/news/article/florida-defies-cdc-measles-outbreak/
Published Date: Fri, 23 Feb 2024 10:00:00 +0000

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KFF Health News’ ‘What the Health?’: Alabama Court Rules Embryos Are Children. What Now?

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Thu, 22 Feb 2024 20:00:00 +0000

The Host

Julie Rovner
KFF Health


@jrovner


Read Julie's stories.

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Julie Rovner is chief Washington correspondent and host of KFF Health News' weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “ and Policy A to Z,” now in its third edition.

The Alabama Supreme Court's groundbreaking ruling last week that frozen embryos have legal rights as people has touched off a national debate about the potential fallout of the “personhood” movement. Already the of Alabama-Birmingham has paused its in vitro fertilization program while it determines the ongoing legality of a process that has become increasingly common for those wishing to start a

Meanwhile, former is reportedly leaning toward endorsing a national, 16-week abortion ban. At the same time, former aides are planning a long agenda of reproductive health restrictions should Trump win a second term.

This week's panelists are Julie Rovner of KFF Health News, Lauren Weber of The Washington Post, Rachana Pradhan of KFF Health News, and Victoria Knight of Axios.

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Panelists

Victoria Knight
Axios


@victoriaregisk


Read Victoria's stories.

Rachana Pradhan
KFF Health News

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@rachanadpradhan


Read Rachana's stories.

Lauren Weber
The Washington Post


@LaurenWeberHP

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Read Lauren's stories.

Among the takeaways from this week's episode:

  • The Alabama Supreme Court's decision on embryonic personhood could have wide-ranging implications beyond reproductive health care, with potential implications for tax deductions, child support payments, criminal law, and much more.
  • Donald Trump is considering a national abortion ban at 16 weeks of gestation, according to recent reports. It is unclear whether such a ban would go far enough to please his conservative supporters, but it would be far enough to give Democrats ammunition to campaign on it. And some are looking into using a 19th-century anti-smut law, the Comstock Act, to implement a national ban under a new Trump presidency — no action from Congress necessary.
  • New reporting from KFF Health News draws on many interviews with clinicians at Catholic hospitals about how the Roman Catholic Church's directives dictate the care they may offer patients, especially in reproductive health. It also draws attention to the vast number of religiously affiliated hospitals and the fact that, for many women, a Catholic hospital may be their only option.
  • Questions about 's cognitive health are drawing attention to ageism in politics — as well as in American life, with fewer people taking precautions against the virus even as it remains a serious threat to vulnerable people, especially the elderly. The mental of the nation's leaders is a valid, relevant question for many voters, though the questions are also fueled by frustration with a political system in which many offices are held by older people who have been around a long time.

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

Julie Rovner: Stat's “New CMS Rules Will Throttle Access Researchers Need to Medicare, Medicaid Data,” by Rachel M. Werner.

Lauren Weber: The Washington Post's “They Take Kratom to Ease Pain or Anxiety. Sometimes, Death Follows,” by David Ovalle.

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Rachana Pradhan: Politico's “Red States Hopeful for a 2nd Trump Term Prepare to Curtail Medicaid,” by Megan Messerly.

Victoria Knight: ProPublica's “The Year After a Denied Abortion,” by Stacy Kranitz and Kavitha Surana.

Also mentioned on this week's podcast:

Credits

Francis Ying
Audio producer

Emmarie Huetteman
Editor

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To hear all our click here.

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

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Title: KFF Health News' ‘What the Health?': Alabama Court Rules Embryos Are Children. What Now?
Sourced From: kffhealthnews.org/news/podcast/what-the-health-335-alabama-ruling-embryos-children-february-22-2024/
Published Date: Thu, 22 Feb 2024 20:00:00 +0000

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