Ronnie Cohen
Mon, 13 May 2024 09:00:00 +0000

Raymond Llano carries a plastic bag with everything he owns in one hand, a cup of coffee in the other, and the flattened cardboard box he uses as a bed under his arm as he waits in line for lunch at Glide Memorial Church in San Francisco. At 55, he hasn't had a home for 15 years, since he lost a job at Target.

Llano once tried to get on public assistance but couldn't — something, he said, looking perplexed, about owing the state money — and he'd like to apply again.

But beginning next year, if he does, he'll face a new city requirement that single adults with no dependents who receive cash benefits be screened for illegal drug use and, if deemed necessary, enter treatment. San Francisco's voters approved the new mandate in March.

Llano has no objection to being screened. He said he uses cannabis, which is legal in California, though not federally, but does not use other drugs. Nonetheless, he said, “I suppose I would try recovery.”

Another man in the free-lunch line, Francis Farrell, 56, was far less agreeable. “You can screen me,” he said, raising his voice, “but I don't think you should force me into your idea of treatment.”

No one will be forced to undergo substance abuse treatment, nor will anyone be subject to drug testing, San Francisco officials insist. Rather, starting in January 2025, San Francisco's public assistance recipients who screen positive for addiction on a 10-question drug abuse test will be referred to treatment. Those who refuse or fail to show up for treatment will forfeit the $109 a month that the city grants to homeless adults who qualify for city shelters or supportive housing, or the $712 a month it grants to adults with home addresses.

The city famous for its tolerance is resorting to tough love.

Trent Rhorer, executive director of the San Francisco Human Services Agency, cited three reasons for the new measure, which was fashioned after similar policies in Los Angeles and New York: to incentivize people with a substance use disorder to enter treatment, to prevent taxpayer money from being used to buy illegal drugs, and to dissuade drug seekers from moving to San Francisco.

“We're giving them the opportunity to engage in something, without requiring sobriety, to hopefully get on a path to recovery,” Rhorer told KFF Health News.

When Mayor London Breed introduced the ballot initiative known as Measure F in a news conference last year, she called it an incentive to encourage drug-addicted recipients of public assistance to enter “into a program that will help save their life.” Accidental overdoses killed more than 800 people in San Francisco last year.

But in the eyes of many health care providers, researchers, and harm reduction advocates, the measure is neither an incentive nor an opportunity.

The policy was designed to have “a coercive, punitive effect” and could do more harm than good, said Vitka Eisen, president and chief executive of HealthRIGHT 360, San Francisco's largest drug treatment provider.

“It would have been an interesting project, much more in the spirit of San Francisco as a hub of innovation, to figure out if we can identify people with substance use disorder. And if they go into treatment and stay for a period of time, they'll get an increased benefit,” Eisen said.

About 5,800 people in the city currently receive benefits from the County Adult Assistance Programs, or CAAP. Under Measure F, those who acknowledge drug abuse on the screening test but refuse treatment and live in city-provided shelter will lose their cash benefits but can maintain their shelter, Rhorer said. However, CAAP recipients who refuse treatment and depend on public assistance to pay their rent in private housing could lose their homes.

The city will give recipients three chances to show up for treatment and will pay rent directly to a landlord for one month, Rhorer said. Measure F came in response to the grim conditions on some San Francisco streets, where men and women lie on sidewalks, often blocking passersby with their arms and legs splayed, or stand bent over, frozen like statues. Many use fentanyl, a synthetic opioid that has turned a long-standing homelessness problem into a public health emergency.

About 12% of people who fatally overdosed in San Francisco last year were CAAP recipients, Rhorer said.

Compassion fatigue seems to have settled over this city known for its kindheartedness. Measure F proponents raised $667,000 — more than 17 times as much as opponents — largely from business executives and tech investors, according to the San Francisco Ethics Commission. Then in March, 58% of voters approved the measure.

Since fentanyl began replacing heroin around 2019, Rhorer said, “drug tourists” have flocked to San Francisco, where the opioid has been cheap and plentiful. Lenient law enforcement and relatively generous cash public assistance grants also have drawn people with addiction, he said, although police activity has increased since last spring.

A recent city report found that only 53% of the 718 people whom police cited for substance use over a 10-month period that ended in February said they lived in the city.

“People who live in San Francisco, who really need the most help, don't get the help they need due to the influx of people coming from somewhere else,” said Cedric Akbar, who runs recovery programs and co-founded Positive Directions Equals Changes. “And should our tax dollars go to the ones in San Francisco, or are we going to take care of the whole country?”

Akbar began using heroin when he moved to San Francisco from Houston in the 1980s and has been in recovery for 31 years. He said he would have preferred even stricter requirements for eligibility for public assistance than those in Measure F but hopes the new mandate will at least help give people access to treatment.

The city's capacity for treatment is also a concern. Eisen and others describe a dire shortage of behavioral health workers to staff treatment facilities and residential step-down units, which are crucial for housing those in recovery from drug addiction.

New programs funded by the recently approved Proposition 1 in California, which authorizes the state to spend $6.38 billion to build mental health treatment facilities and provide housing for homeless people, are meant to address the shortages.

Leslie Suen, an addiction medicine physician and an assistant professor at the University of California-San Francisco, fears that pushing CAAP recipients into treatment could turn them off. When people “were stigmatized, or coerced, or told they would face consequences if they didn't do a certain thing,” she said, “that pushed them away from the health system even further.”

Though evidence suggests compulsory treatment can provide short-term benefits, it also can lead to long-term harm, the National Institute on Drug Abuse said in an email.

“To achieve the best outcomes,” the email said, treatment should be “delivered without stigma or penalty.”

Almost everyone with a substance use disorder enters treatment under some kind of pressure, whether from a parent, a spouse, an employer, or the criminal justice system, said Keith Humphreys, a Stanford University psychiatry professor.

Nonetheless, he questioned the morality of requiring welfare recipients, as opposed to criminals, to get drug treatment.

“I would never start with people who are poor but not committing crimes,” he said. “I would start with people who are harming others.”

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

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By: Ronnie Cohen
Title: San Francisco Tries Tough Love by Tying Welfare to Drug Rehab
Sourced From: kffhealthnews.org/news/article/san-francisco-welfare-drug-rehab/
Published Date: Mon, 13 May 2024 09:00:00 +0000

Did you miss our previous article…
https://www.biloxinewsevents.com/democrats-seek-to-make-gop-pay-for-threats-to-reproductive-rights/

Samantha Liss
Fri, 10 May 2024 09:00:00 +0000

ST. CHARLES, Mo. — Democrat Lucas Kunce is trying to pin reproductive care restrictions on Sen. Josh Hawley (R-Mo.), betting it will boost his chances of unseating the incumbent in November.

In a recent ad campaign, Kunce accuses Hawley of jeopardizing reproductive care, including in vitro fertilization. Staring straight into the camera, with tears in her eyes, a Missouri mom identified only as Jessica recounts how she struggled for years to conceive.

“Now there are efforts to ban IVF, and Josh Hawley got them started,” Jessica says. “I want Josh Hawley to look me in the eye and tell me that I can't have the child that I deserve.”

Never mind that IVF is legal in Missouri, or that Hawley has said he supports limited access to abortion as a “pro-life” Republican. In key races across the country, Democrats are branding their Republican rivals as threats to women's health after a broad erosion of reproductive rights since the Supreme Court struck down Roe v. Wade, including near-total state abortion bans, efforts to restrict medication abortion, and a court ruling that limited IVF in Alabama.

On top of the messaging campaigns, Democrats hope ballot measures to guarantee abortion rights in as many as 13 states — including Missouri, Arizona, and Florida — will help boost turnout in their favor.

The issue puts the GOP on the defensive, said J. Miles Coleman, an election analyst at the University of Virginia.

“I don't really think Republicans have found a great way to respond to it yet,” he said.

Abortion is such a salient issue in Arizona, for example, that election analysts say a U.S. House seat occupied by Republican Juan Ciscomani is now a toss-up.

Hawley appears in less peril, for now. He holds a wide lead in polls, though Kunce outraised him in the most recent quarter, raking in $2.25 million in donations compared with the incumbent's $846,000, according to campaign finance reports. Still, Hawley's war chest is more than twice the size of Kunce's.

Kunce, a Marine veteran and antitrust advocate, said he likes his odds.

“I just don't think we're gonna lose,” he told KFF Health News. “Missourians want freedom and the ability to control their own lives.”

Hawley's campaign declined to comment. He has backed a federal ban on abortion after 15 weeks and has said he supports exceptions for rape and incest and to protect the lives of pregnant women. Missouri's state ban is near total, with no exceptions for rape or incest.

“This is Josh Hawley's life's mission. It's his family's business,” Kunce said, a nod to Erin Morrow Hawley, the senator's wife, a lawyer who argued before the Supreme Court in March on behalf of activists who sought to limit access to the abortion pill mifepristone.

State abortion rights have won out everywhere they've been on the ballot since the end of Roe in 2022, including in Republican-led Kentucky and Ohio.

An abortion rights ballot initiative is also expected in Montana, where a Republican challenge to Democrat Jon Tester could decide control of the Senate.

On a late-April Saturday along historic Main Street in St. Charles, Missouri, people holding makeshift clipboards fashioned from yard signs from past elections invited locals strolling brick sidewalks to sign a petition to get the initiative on Missouri ballots. Nearby, diners enjoyed lunch on a patio tucked under a canopy of trees in this affluent St. Louis suburb.

Missouri was the first state to ban abortion after Roe fell; it is outlawed except in “cases of medical emergency.” The measure would add the right to abortion to the state constitution.

Larry Bax, 65, of St. Charles County, said he votes Republican most of the time but signed the ballot measure petition along with his wife, Debbie Bax, 66.

“We were never single-issue voters. Never in our life,” he said. “This has made us single-issue because this is so wrong.”

They won't vote for Hawley this fall, they said, but are unsure if they'll support the Democratic nominee.

Jim Seidel, 64, who lives in Wright City, 50 miles west of St. Louis, also signed the petition. He said he believes Missourians deserve the opportunity to vote on the issue.

“I've been a Republican all my life until just recently,” Seidel said. “It's just gone really wacky.”

He plans to vote for Kunce in November if he wins the Democratic primary in August, as seems likely. Seidel previously voted for a few Democrats, including Bill Clinton and Claire McCaskill, whom Hawley unseated as senator six years ago.

“Most of the time,” he added, Hawley is “strongly in the wrong camp.”

Over about two hours in conservative St. Charles, KFF Health News observed only one person actively declining to sign the petition. The woman told the volunteers she and her family opposed abortion rights and quickly walked away. The Catholic Church has discouraged voters from signing. At St. Joseph Parish in a nearby suburb, for example, a sign flashed: “Decline to Sign Reproductive Health Petition!”

The ballot measure organizers turned in more than twice the required number of signatures May 3, though, and now await certification from the secretary of state's office.

Larry Bax's concern goes beyond abortion and the ballot measure in Missouri. He worries about more governmental limits on reproductive care, such as on IVF or birth control. “How much further can that reach extend?” he said. Kunce is banking on enough voters feeling like Bax and Seidel to get an upset similar to the one that occurred in 2012 for the same seat — also over abortion. McCaskill defeated Republican Todd Akin that year, largely because of his infamous response when asked about abortion: “If it's a legitimate rape, the female body has ways to try to shut that whole thing down.”

——————————
By: Samantha Liss
Title: Democrats Seek To Make GOP Pay for Threats to Reproductive Rights
Sourced From: kffhealthnews.org/news/article/democrats-campaign-reproductive-rights-abortion/
Published Date: Fri, 10 May 2024 09:00:00 +0000

Did you miss our previous article…
https://www.biloxinewsevents.com/their-first-baby-came-with-medical-debt-these-illinois-parents-wont-have-another/

Noam N. Levey
Fri, 10 May 2024 09:00:00 +0000

JACKSONVILLE, Ill. — Heather Crivilare was a month from her due date when she was rushed to an operating room for an emergency cesarean section.

The first-time mother, a high school teacher in rural Illinois, had developed high blood pressure, a sometimes life-threatening condition in pregnancy that prompted doctors to hospitalize her. Then Crivilare's blood pressure spiked, and the baby's heart rate dropped. “It was terrifying,” Crivilare said.

She gave birth to a healthy daughter. What followed, though, was another ordeal: thousands of dollars in medical debt that sent Crivilare and her husband scrambling for nearly a year to keep collectors at bay.

The Crivilares would eventually get on nine payment plans as they juggled close to $5,000 in bills.

“It really felt like a full-time job some days,” Crivilare recalled. “Getting the baby down to sleep and then getting on the phone. I'd set up one payment plan, and then a new bill would come that afternoon. And I'd have to set up another one.”

Crivilare's pregnancy may have been more dramatic than most. But for millions of new parents, medical debt is now as much a hallmark of having children as long nights and dirty diapers.

About 12% of the 100 million U.S. adults with health care debt attribute at least some of it to pregnancy or childbirth, according to a KFF poll.

These people are more likely to report they've had to take on extra work, change their living situation, or make other sacrifices.

Overall, women between 18 and 35 who have had a baby in the past year and a half are twice as likely to have medical debt as women of the same age who haven't given birth recently, other KFF research conducted for this project found.

“You feel bad for the patient because you know that they want the best for their pregnancy,” said Eilean Attwood, a Rhode Island OB-GYN who said she routinely sees pregnant women anxious about going into debt.

“So often, they may be coming to the office or the hospital with preexisting debt from school, from other financial pressures of starting adult life,” Attwood said. “They are having to make real choices, and what those real choices may entail can include the choice to not get certain services or medications or what may be needed for the care of themselves or their fetus.”

Best-Laid Plans

Crivilare and her husband, Andrew, also a teacher, anticipated some of the costs.

The young couple settled in Jacksonville, in part because the farming community less than two hours north of St. Louis was the kind of place two public school teachers could afford a house. They saved aggressively. They bought life insurance.

And before Crivilare got pregnant in 2021, they enrolled in the most robust health insurance plan they could, paying higher premiums to minimize their deductible and out-of-pocket costs.

Then, two months before their baby was due, Crivilare learned she had developed preeclampsia. Her pregnancy would no longer be routine. Crivilare was put on blood pressure medication, and doctors at the local hospital recommended bed rest at a larger medical center in Springfield, about 35 miles away.

“I remember thinking when they insisted that I ride an ambulance from Jacksonville to Springfield … ‘I'm never going to financially recover from this,'” she said. “‘But I want my baby to be OK.'”

For weeks, Crivilare remained in the hospital alone as covid protocols limited visitors. Meanwhile, doctors steadily upped her medications while monitoring the fetus. It was, she said, “the scariest month of my life.”

Fear turned to relief after her daughter, Rita, was born. The baby was small and had to spend nearly two weeks in the neonatal intensive care unit. But there were no complications. “We were incredibly lucky,” Crivilare said.

When she and Rita finally came home, a stack of medical bills awaited. One was already past due.

Crivilare rushed to set up payment plans with the hospitals in Jacksonville and Springfield, as well as the anesthesiologist, the surgeon, and the labs. Some providers demanded hundreds of dollars a month. Some settled for monthly payments of $20 or $25. Some pushed Crivilare to apply for new credit cards to pay the bills.

“It was a blur of just being on the phone constantly with all the different people collecting money,” she recalled. “That was a nightmare.”

Big Bills, Big Consequences

The Crivilares' bills weren't unusual. Parents with private health coverage now face on average more than $3,000 in medical bills related to a pregnancy and childbirth that aren't covered by insurance, researchers at the University of Michigan found.

Out-of-pocket costs are even higher for families with a newborn who needs to stay in a neonatal ICU, averaging $5,000. And for 1 in 11 of these families, medical bills related to pregnancy and childbirth exceed $10,000, the researchers found.

“This forces very difficult trade-offs for families,” said Michelle Moniz, a University of Michigan OB-GYN who worked on the study. “Even though they have insurance, they still have these very high bills.”

Nationwide polls suggest millions of these families end up in debt, with sometimes devastating consequences.

About three-quarters of U.S. adults with debt related to pregnancy or childbirth have cut spending on food, clothing, or other essentials, KFF polling found.

About half have put off buying a home or delayed their own or their children's education.

These burdens have spurred calls to limit what families must pay out-of-pocket for medical care related to pregnancy and childbirth.

In Massachusetts, state Sen. Cindy Friedman has proposed legislation to exempt all these bills from copays, deductibles, and other cost sharing. This would parallel federal rules that require health plans to cover recommended preventive services like annual physicals without cost sharing for patients. “We want … healthy children, and that starts with healthy mothers,” Friedman said. Massachusetts health insurers have warned the proposal will raise costs, but an independent state analysis estimated the bill would add only $1.24 to monthly insurance premiums.

Tough Lessons

For her part, Crivilare said she wishes new parents could catch their breath before paying down medical debt.

“No one is in the right frame of mind to deal with that when they have a new baby,” she said, noting that college graduates get such a break. “When I graduated with my college degree, it was like: ‘Hey, new adult, it's going to take you six months to kind of figure out your life, so we'll give you this six-month grace period before your student loans kick in and you can get a job.'”

Rita is now 2. The family scraped by on their payment plans, retiring the medical debt within a year, with help from Crivilare's side job selling resources for teachers online.

But they are now back in debt, after Rita's recurrent ear infections required surgery last year, leaving the family with thousands of dollars in new medical bills.

Crivilare said the stress has made her think twice about seeing a doctor, even for Rita. And, she added, she and her husband have decided their family is complete.

“It's not for us to have another child,” she said. “I just hope that we can put some of these big bills behind us and give [Rita] the life that we want to give her.”

About This Project

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

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

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

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

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

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

——————————
By: Noam N. Levey
Title: Their First Baby Came With Medical Debt. These Illinois Parents Won't Have Another.
Sourced From: kffhealthnews.org/news/article/babies-come-with-medical-debt/
Published Date: Fri, 10 May 2024 09:00:00 +0000