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A Physician Travels to South Asia Seeking Enduring Lessons From the Eradication of Smallpox

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Céline Gounder
Fri, 29 Mar 2024 10:00:00 +0000

Smallpox was certified eradicated in 1980, but I first learned about the disease's twisty, storied history in 1996 while interning at the World Health Organization. As a college student in the 1990s, I was fascinated by the sheer magnitude of what it took to wipe a human disease from the earth for the first time.

Over the years, I've turned to that history over and over, looking for inspiration and direction on how to be more ambitious when confronting public health threats of my day.

In the late 1990s, I had the opportunity to meet some of the health care professionals and other eradication campaign workers who helped stop the disease. I came to see that the history of this remarkable achievement had been told through the eyes mostly of white from the United States, what was then the Soviet Union, and other parts of Europe.

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But I knew that there was more to tell, and I worried that the stories of legions of local public health workers in South Asia could be lost forever. With its dense urban slums, sparse rural villages, complicated geopolitics, corrupt governance in some corners, and punishing terrain, South Asia had been the hardest battlefield the smallpox eradicators had to conquer.

I decided to capture some of that history. That work became a , an eight-episode, limited- audio documentary, called “Epidemic: Eradicating Smallpox.”

My field began in summer 2022, when I traveled to India and Bangladesh — which had been the site of a grueling battle in the war on the disease. I tracked down aging smallpox workers, some now in their 80s and 90s, who had done the painstaking work of hunting down every last case of smallpox in the region and vaccinating everyone who had been exposed. Many of the smallpox campaign veterans had fallen out of touch with one another. Their friendships had been forged at a time when long-distance calls were expensive and telegrams were still used for urgent messages.

How did they defeat smallpox? And what lessons does that victory hold for us today?

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I also documented the stories of people who contracted smallpox and lived. What can we learn from them? The survivors I met are not unlike my father, who grew up in a rural village in southern India where his childhood was shaped by family finances that limited access to opportunity. The stories he shared with me about the big social and economic divides in India fueled my decision to choose a career in public health and to work for equity. As we emerge from the covid pandemic, that connection is a big part of why I wanted to go back in time in search of answers to the challenges we face today.

Unwarranted Optimism

I sought out Indian and Bangladeshi public health workers, as well as the WHO epidemiologists — largely from the U.S. and Europe — who had designed and orchestrated the eradication campaigns across South Asia. Those smallpox leaders of the 1960s and '70s showed moral imagination: While many and scientists thought it would be impossible to stop a disease that had lasted for millennia, the eradication champions had a wider vision for the world — not just less smallpox or fewer deaths but elimination of the disease completely. They did not limit themselves to obvious or incremental improvements.

Bill Foege, a campaign leader in the 1970s, said by contrast today's policymakers can be very reluctant to programs that don't already have data to back them up. They typically want proof of sustainability before investing in novel programs, he said, but real-world sustainability often only becomes clear when new ideas are put into practice and at scale.

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The smallpox eradication visionaries were different from these cautious current leaders. “They had ‘unwarranted optimism,'” Foege said. They had faith that they could make “something happen that could not have been foreseen.”

In India, in particular, many leaders hoped their nation could compete with other superpowers on the world stage. That idealism, in part, stoked their belief that smallpox could be stopped.

During the smallpox program in South Asia, Mahendra Dutta was one the biggest risk-takers — willing to look beyond the pragmatic and politically palatable. He was a physician and public health leader who used his political savvy to help usher in a transformative smallpox vaccination strategy across India.

The eradication campaign had been grinding in India for over a decade. India had invested time and resources — and no small amount of publicity — into a mass vaccination approach. But the virus was still spreading out of control. At a time when India's leaders were eager to project strength as a superpower and protective of the nation's image on the world stage, Dutta's was one of the voices that proclaimed to India's policymakers that mass vaccination wasn't working.

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Dutta told them it was past time for India to adopt a new, more targeted vaccine strategy called “search and containment.” Teams of eradication workers visited communities across India to track down active cases of smallpox. Whenever they found a case, health workers would isolate the infected person, then vaccinate anyone that individual might have come in contact with.

To smooth the way for the new strategy, Dutta called in favors and even threatened to resign from his job.

He died in 2020, but I spoke with his son Yogesh Parashar, who said Dutta straddled two worlds: the in-the-trenches realities of smallpox eradication — and India's bureaucracy. “My father did all the dirty work. He got enemies also in the process, I'm sure he did, but that is what he did,” Parashar said.

A Failure to Meet Basic Needs

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Smallpox workers understood the need to build trust through partnerships: The WHO's global smallpox eradication program paired its epidemiologists with Indian and Bangladeshi community health workers, who included laypeople with and eager and idealistic medical students. Those local smallpox eradication workers were trusted messengers of the public health program. They leveraged the region's myriad cultures and traditions to pave the way for people to accept the smallpox campaign and overcome vaccine hesitation. While encouraging vaccine acceptance, they embraced cultural practices: using folk songs to spread public health messages, for example, and honoring the way locals used the leaves of the neem tree to alert others to stay away from the home of someone infected with smallpox.

Smallpox eradication in South Asia unfolded against a backdrop of natural disaster, civil war, sectarian violence, and famine — crises that created many pressing needs. By many, many measures, the program was a success. Indeed, smallpox was stopped. Still, in the all-consuming push to end the virus, public health writ large often failed to meet people's basic needs, such as housing or food.

The smallpox workers I interviewed said they were sometimes confronted by locals who made it clear they had concerns that, even in the midst of a raging epidemic, felt more immediate and important than smallpox.

Eradication worker Shahidul Haq Khan, whom podcast listeners meet in Episode 4, heard that sentiment as he traveled from community to community in southern Bangladesh. People asked him: “There's no rice in people's stomachs, so what is a vaccine going to do?” he said.

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But the eradication mission largely did not include meeting immediate needs, so often the health workers' hands were tied.

When a community's immediate concerns aren't addressed by public health, it can feel like disregard — and it's a mistake, one that hurts public health's reputation and future effectiveness. When public health representatives return to a community years or decades later, the memory of disregard can make it much harder to enlist the cooperation needed to respond to the next public health crises.

Rahima Banu Left Behind

The eradication of smallpox was one of humankind's greatest triumphs, but many people — even the grandest example of that victory — did not share in the win. That realization hit me hard when I met Rahima Banu. As a toddler, she was the last person in the world known to have contracted a naturally occurring case of variola major smallpox. As a little girl, she and her family had — for a time — unprecedented access to care and attention from public health workers hustling to contain smallpox.

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But that attention did not stabilize the family long-term or lift them from poverty.

Banu became a symbol of the eradication effort, but she did not share in the prestige or rewards that came after. Nearly 50 years later, Banu, her husband, their three daughters, and a son share a one-room bamboo-and-corrugated-metal home with a mud floor. Their finances are precarious. The family cannot afford good health care or to send their daughter to college. In recent years when Banu has had health problems or troubles with her eyesight, there have been no public health workers bustling around, ready to help.

“I cannot thread a needle because I cannot see clearly. I cannot examine the lice on my son's head. I cannot read the Quran well because of my vision,” Banu said in Bengali, speaking through a translator. “No one wants to know how I am living my with my husband and children, whether I am in a good condition or not, whether I am settled in my life or not.”

Missed Opportunities

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I believe some of our public health efforts today are repeating mistakes of the smallpox eradication campaign, failing to meet people's basic needs and missing opportunities to use the current crisis or epidemic to make sustained improvements in overall health.

The 2022 fight against mpox is one example. The highly contagious virus spiked around the world and spread quickly, predominantly among men who have sex with men. In New York , for example, in part because some Black and Hispanic people had a historical mistrust for city officials, those groups ended up with lower rates of Mpox vaccination. And that failure to vaccinate became a missed opportunity to education and other health care treatments, including access to HIV testing and prevention.

And so has it gone with the covid pandemic, too. Health care providers, the clergy, and leaders from communities of color were enlisted to promote immunization. These trusted messengers were successful in narrowing race-related disparities in vaccination coverage, not only protecting their own but also shielding hospitals from crushing patient loads. Many weren't paid to do this work. They stepped up despite having good reason to mistrust the health care system. In some ways, government officials upheld their end of the social contract, providing social and economic support to help these communities weather the pandemic.

But now we're back to business as usual, with financial, housing, food, health care, and caregiving insecurity all on the rise in the U.S. What trust was built with these communities is again eroding. Insecurity, a form of worry over unmet basic needs, robs us of our ability to imagine big and better. Our insecurity about immediate needs like health care and caregiving is corroding trust in government, other institutions, and one another, leaving us less prepared for the next public health crisis.

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By: Céline Gounder
Title: A Physician Travels to South Asia Seeking Enduring Lessons From the Eradication of Smallpox
Sourced From: kffhealthnews.org/news/article/smallpox-eradication-lessons-insecurity-public-health-gounder/
Published Date: Fri, 29 Mar 2024 10:00:00 +0000

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Kaiser Health News

Millions Were Booted From Medicaid. The Insurers That Run It Gained Medicaid Revenue Anyway.

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Phil Galewitz, KFF News
Fri, 26 Apr 2024 13:55:00 +0000

Private Medicaid health plans lost millions of members in the past year as pandemic protections that prohibited states from dropping anyone from the government program expired.

But despite Medicaid's unwinding, as it's known, at least two of the five largest publicly traded companies selling plans have continued to increase revenue from the program, according to their latest earnings reports.

“It's a very interesting paradox,” said Andy Schneider, a research professor at Georgetown 's McCourt School of Public Policy, of plans' Medicaid revenue increasing despite enrollment drops.

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Medicaid, the state-federal health program for low-income and disabled people, is administered by states. But most people enrolled in the program get their through insurers contracted by states, UnitedHealthcare, Centene, and Molina.

The companies persuaded states to pay them more money per Medicaid enrollee under the assumption that younger and healthier people were dropping out — presumably for Obamacare coverage or employer-based health insurance, or because they didn't see the need to get coverage — leaving behind an older and sicker population to , their executives have told investors.

Several of the companies reported that states have made midyear and retrospective changes in their payments to plans to account for the worsening health status of members.

In an earnings call with analysts on April 25, Molina Healthcare CEO Joe Zubretsky said 19 states increased their payment rates this year to adjust for sicker Medicaid enrollees. “States have been very responsive,” Zubretsky said. “We couldn't be more pleased with the way our state customers have responded to rates be commensurate with normal cost trends and trends that have been influenced by the acuity shift.”

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Health plans have much uncertainty during the Medicaid unwinding, as states began reassessing enrollees' eligibility and dropping those deemed no longer qualified or who lost coverage because of procedural errors. Before the unwinding, plans said they expected the overall risk profile of their members to go up because those remaining in the program would be sicker.

UnitedHealthcare, Centene, and Molina had Medicaid revenue increases ranging from 3% to 18% in 2023, according to KFF. The two other large Medicaid insurers, Elevance and CVS Health, do not break out Medicaid-specific revenue.

The Medicaid enrollment of the five companies collectively declined by about 10% from the end of March 2023 through the end of December 2023, from 44.2 million people to 39.9 million, KFF data shows.

In the first quarter of 2024, UnitedHealth's Medicaid revenue rose to $20.5 billion, up from $18.8 in the same quarter of 2023.

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Molina on April 24 reported nearly $7.5 billion in Medicaid revenue in the first quarter of 2024, up from $6.3 billion in the same quarter a year earlier.

On April 26, Centene reported that its Medicaid enrollment fell 18.5% to 13.3 million in the first quarter of 2024 with the same period a year ago. The company's Medicaid revenue dipped 3% to $22.2 billion.

Unlike UnitedHealthcare, whose Medicaid enrollment fell to 7.7 million in March 2024 from 8.4 million a year prior, Molina's Medicaid enrollment rose in the first quarter of 2024 to 5.1 million from 4.8 million in March 2023. Molina's enrollment jump last year was partly a result of its having bought a Medicaid plan in Wisconsin and gained a new Medicaid contract in Iowa, the company said in its earnings news release.

Molina added 1 million members because states were prohibited from terminating Medicaid coverage during the pandemic. The company has lost 550,000 of those people during the unwinding and expects to lose an additional 50,000 by June.

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About 90% of Molina Medicaid members have gone through the redetermination , Zubretsky said.

The corporate giants also offset the enrollment losses by getting more Medicaid money from states, which they use to pass on higher payments to certain facilities or providers, Schneider said. By holding the money temporarily, the companies can count these “directed payments” as revenue.

Medicaid health plans were big winners during the pandemic after the federal government prohibited states from dropping people from the program, leading to a surge in enrollment to about 93 million Americans.

States made efforts to limit health plans' profits by clawing back some payments above certain thresholds, said Elizabeth Hinton, an associate director at KFF.

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But once the prohibition on dropping Medicaid enrollees was lifted last spring, the plans faced uncertainty. It was unclear how many people would lose coverage or when it would happen. Since the unwinding began, more than 20 million people have been dropped from the rolls.

Medicaid enrollees' health care costs were lower during the pandemic, and some states decided to exclude pandemic-era cost data as they considered how to set payment rates for 2024. That provided yet another win for the Medicaid health plans.

Most states are expected to complete their Medicaid unwinding processes this year.

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By: Phil Galewitz, KFF Health News
Title: Millions Were Booted From Medicaid. The Insurers That Run It Gained Medicaid Revenue Anyway.
Sourced From: kffhealthnews.org/news/article/medicaid-unwinding-insurer-revenue/
Published Date: Fri, 26 Apr 2024 13:55:00 +0000

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California Is Investing $500M in Therapy Apps for Youth. Advocates Fear It Won’t Pay Off.

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Molly Castle Work
Fri, 26 Apr 2024 09:00:00 +0000

With little pomp, California launched two apps at the start of the year offering free behavioral health services to youths to them cope with everything from living with anxiety to body acceptance.

Through their phones, young people and some caregivers can meet BrightLife Kids and Soluna coaches, some who specialize in peer support or substance use disorders, for roughly 30-minute virtual counseling sessions that are best suited to those with more mild needs, typically those without a clinical diagnosis. The apps also feature self-directed activities, such as white noise sessions, guided breathing, and of ocean waves to help users relax.

“We believe they're going to have not just great impact, but wide impact across California, especially in places where maybe it's not so easy to find an in-person behavioral health visit or the kind of coaching and supports that and young people need,” said Gov. Gavin Newsom's health secretary, Mark Ghaly, during the Jan. 16 announcement.

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The apps represent one of the Democratic governor's major forays into health technology and come with four-year contracts valued at $498 million. California is believed to be the first state to offer a mental health app with free coaching to all young , according to the Department of Health Care Services, which operates the program.

However, the rollout has been slow. So slow that one of the companies has missed a deadline to make its app available on Android phones. Only about 15,000 of the state's 12.6 million and young adults have signed up for the apps, and school counselors say they've never heard of them.

Advocates for youth question the wisdom of investing taxpayer dollars in two private companies. Social workers are concerned the companies' coaches won't properly identify youths who need referrals for clinical care. And the spending is drawing lawmaker scrutiny amid a state deficit pegged at as much as $73 billion.

An App for That

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Newsom's administration says the apps fill a need for young Californians and their families to access professional telehealth for free, in multiple languages, and outside of standard 9-to-5 hours. It's part of Newsom's sweeping $4.7 billion master plan for kids' mental health, which was introduced in 2022 to increase access to mental health and substance use support services. In addition to launching virtual tools such as the teletherapy apps, the initiative is working to expand workforce capacity, especially in underserved .

“The reality is that we are rarely 6 feet away from our devices,” said Sohil Sud, director of Newsom's Children and Youth Behavioral Health Initiative. “The question is how we can leverage technology as a resource for all California youth and families, not in place of, but in addition to, other behavioral health services that are being developed and expanded.”

The virtual platforms come amid rising depression and suicide rates among youth and a shortage of mental health providers. Nearly half of California youths from the ages of 12 to 17 report having recently struggled with mental health issues, with nearly a third experiencing serious psychological distress, according to a 2021 study by the UCLA Center for Health Policy Research. These rates are even higher for multiracial youths and those from low-income families.

But those supporting youth mental health at the local level question whether the apps will move the needle on climbing depression and suicide rates.

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“It's fair to applaud the state of California for aggressively seeking new tools,” said Alex Briscoe of California Children's Trust, a statewide initiative that, along with more than 100 local partners, works to improve the social and emotional health of children. “We just don't see it as fundamental. And we don't believe the youth mental health crisis will be solved by technology projects built by a professional class who don't share the lived experience of marginalized communities.”

The apps, BrightLife Kids and Soluna, are operated by two companies: Brightline, a 5-year-old venture capital-backed startup; and Kooth, a London-based publicly traded company that has experience in the U.K. and has also signed on some schools in Kentucky and Pennsylvania and a health plan in Illinois. In the first five months of Kooth's Pennsylvania pilot, 6% of students who had access to the app signed up.

Brightline and Kooth represent a growing number of health tech firms seeking to profit in this space. They beat out dozens of other bidders including international consulting companies and other youth telehealth platforms that had already snapped up contracts in California.

Although the service is intended to be free with no insurance requirement, Brightline's app, BrightLife Kids, is folded into and only accessible through the company's main app, which asks for insurance information and directs users to paid licensed counseling options alongside the free coaching. After KFF Health questioned why the free coaching was advertised below paid options, Brightline reordered the page so that, even if a child has high-acuity needs, free coaching shows up first.

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The apps take an expansive view of behavioral health, making the tools available to all California youth under age 26 as well as caregivers of babies, toddlers, and children 12 and under. When KFF Health News asked to speak with an app user, Brightline connected a reporter with a mother whose 3-year-old daughter was learning to sleep on her own.

‘It's Like Crickets'

Despite being months into the launch and having millions in marketing funds, the companies don't have a definitive rollout timeline. Brightline said it hopes to have deployed teams across the state to present the tools in person by midyear. Kooth said developing a strategy to hit every school would be “the main focus for this calendar year.”

“It's a big state — 58 counties,” Bob McCullough of Kooth said. “It'll take us a while to get to all of them.”

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Brightline's contract states that the company was required to launch downloadable apps for iOS and Android phones by January, but so far BrightLife Kids is available only on Apple phones. Brightline said it's aiming to launch the Android version over the summer.

“Nobody's really done anything like this at this magnitude, I think, in the U.S. before,” said Naomi Allen, a co-founder and the of Brightline. “We're very much in the early innings. We're already learning a lot.”

The contracts, obtained by KFF Health News through a request, show the companies operating the two apps could earn as much as $498 million through the contract term, which ends in June 2027, months after Newsom is set to leave office. And the state is spending hundreds of millions more on Newsom's virtual behavioral health strategy. The state said it aims to make the apps available long-term, depending on usage.

The state said 15,000 people signed up in the first three months. When KFF Health News asked how many of those users actively engaged with the app, it declined to say, noting that data would be released this summer.

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KFF Health News reached out to nearly a dozen California mental health professionals and youths. None of them were aware of the apps.

“I'm not hearing anything,” said Loretta Whitson, executive director of the California Association of School Counselors. “It's like crickets.”

Whitson said she doesn't think the apps are on “anyone's” radar in schools, and she doesn't know of any schools that are actively advertising them. Brightline will be presenting its tool to the counselor association in May, but Whitson said the company didn't reach out to plan the meeting; she did.

Concern Over Referrals

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Whitson isn't comfortable promoting the apps just yet. Although both companies said they have a clinical team on staff to assist, Whitson said she's concerned that the coaches, who aren't all licensed therapists, won't have the training to detect when users need more help and refer them to clinical care.

This sentiment was echoed by other school-based social workers, who also noted the apps' duplicative nature — in some counties, like Los Angeles, youths can access free virtual counseling sessions through Hazel Health, a for-profit company. Nonprofits, too, have entered this space. For example, Teen Line, a peer-to-peer hotline operated by Southern California-based Didi Hirsch Mental Health Services, is free nationwide.

While the state is also funneling money to the schools as part of Newsom's master plan, students and school-based mental health professionals voiced confusion at the large app investment when, in many school districts, few in-person counseling roles exist, and in some cases are dwindling.

Merchant, a student at College of the Desert in Palm Desert, noted that it can be hard to access in-person therapy at her school. She believes the community college, which has about 15,000 students, has only one full-time counselor and one part-time bilingual counselor. She and several students interviewed by KFF Health News said they appreciated having engaging content on their phone and the ability to speak to a coach, but all said they'd prefer in-person therapy.

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“There are a lot of people who are seeking therapy, and people close to me that I know. But their insurances are taking forever, and they're on the waitlist,” Merchant said. “And, like, you're seeing all these people struggle.”

Fiscal conservatives question whether the money could be spent more effectively, like to bolster county efforts and existing youth behavioral health programs.

Republican state Sen. Roger Niello, vice chair of the Senate Budget and Fiscal Review Committee, noted that California is forecasted to face deficits for the next three years, and taxpayer watchdogs worry the apps might cost even more in the long run.

“What starts as a small financial commitment can become uncontrollable expenses down the road,” said Susan Shelley of the Howard Jarvis Taxpayers Association.

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

——————————
By: Molly Castle Work
Title: California Is Investing $500M in Therapy Apps for Youth. Advocates Fear It Won't Pay Off.
Sourced From: kffhealthnews.org/news/article/california-youth-teletherapy-apps-rollout-slow/
Published Date: Fri, 26 Apr 2024 09:00:00 +0000

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KFF Health News’ ‘What the Health?’: Abortion — Again — At the Supreme Court

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Wed, 24 Apr 2024 20:30:00 +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 , “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care and Policy A to Z,” now in its third edition.

Some justices suggested the Supreme Court had said its piece on when it overturned Roe v. Wade in 2022. This term, however, the court has agreed to review another abortion case. At issue is whether a federal law requiring emergency care in hospitals overrides Idaho's near-total abortion ban. A decision is expected by summer.

Meanwhile, the Centers for Medicare & Medicaid finalized the first-ever minimum staffing requirements for nursing homes participating in the programs. But the industry argues that there are not enough workers to hire to meet the standards.

This week's panelists are Julie Rovner of KFF Health News, Joanne Kenen of the Johns Hopkins 's nursing and public health schools and Politico Magazine, Tami Luhby of CNN, and Alice Miranda Ollstein of Politico.

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Panelists

Joanne Kenen
Johns Hopkins University and Politico


@JoanneKenen


Read Joanne's articles.

Tami Luhby
CNN

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@Luhby


Read Tami's stories.

Alice Miranda Ollstein
Politico


@AliceOllstein

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Read Alice's stories.

Among the takeaways from this week's episode:

  • This week's Supreme Court hearing on emergency abortion care in Idaho was the first challenge to a state's abortion ban since the overturn of the constitutional right to an abortion. Unlike previous abortion cases, this one focused on the everyday impacts of bans on abortion care — cases in which pregnant experienced medical emergencies.
  • Establishment medical groups and themselves are getting more vocal and active as states set laws on abortion access. In a departure from earlier political moments, some major medical groups are campaigning on state ballot measures.
  • Medicaid officials this week finalized new rules intended to more closely regulate managed-care plans that enroll Medicaid patients. The rules are intended to ensure, among other things, that patients have prompt access to needed primary care doctors and specialists.
  • Also this week, the Federal Trade Commission voted to ban most “noncompete” clauses in employment contracts. Such language has become common in health care and prevents not just doctors but other health workers from changing jobs — often forcing those workers to move or commute to leave a position. Business interests are already suing to block the new rules, they would be too expensive and risk the loss of proprietary information to competitors.
  • The fallout from the cyberattack of Change continues, as yet another group is demanding ransom from UnitedHealth Group, Change's owner. UnitedHealth said in a statement this week that the records of “a substantial portion of America” may be involved in the breach.

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

Julie Rovner: NBC News' “Women Are Less Likely To Die When Treated by Female Doctors, Study Suggests,” by Liz Szabo.  

Alice Miranda Ollstein: States Newsroom's “Loss of Federal Protection in Idaho Spurs Pregnant Patients To Plan for Emergency Air Transport,” by Kelcie Moseley-Morris.  

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Tami Luhby: The Associated Press' “Mississippi Lawmakers Haggle Over Possible Medicaid Expansion as Their Legislative Session Nears End,” by Emily Wagster Pettus.  

Joanne Kenen: States Newsroom's “Missouri Prison Agency To Pay $60K for Sunshine Law Violations Over Inmate Death Records,” by Rudi Keller.  

Also mentioned on this week's podcast:

Credits

Francis Ying
Audio producer

Emmarie Huetteman
Editor

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To hear all our podcasts, click here.

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

——————————
Title: KFF Health News' ‘What the Health?': Abortion — Again — At the Supreme Court
Sourced From: kffhealthnews.org/news/podcast/what-the-health-344-abortion-supreme-court-april-25-2024/
Published Date: Wed, 24 Apr 2024 20:30:00 +0000

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