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Cities Know the Way Police Respond to Mental Crisis Calls Needs to Change. But How?

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Nicole Leonard, WHYY and Kate Wolffe, CapRadio and Simone Popperl
Thu, 08 Feb 2024 10:00:00 +0000

If you or someone you know may be experiencing a mental crisis, contact the 988 Suicide & Crisis Lifeline by dialing “988,” or the Crisis Text Line by texting “HOME” to 741741.

Philadelphia police officers Kenneth Harper and Jennifer Torres were in their patrol car sitting at a red light when a call came in over the 911 radio dispatch.

“This job says ‘female complaint in reference to dispute with daughter, suffers from bipolar, infant on location,'” Harper read off the computer near the front seat.

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The officers got a little more information from the dispatcher: A mother needed help with her adult daughter who had become combative after drinking alcohol.

It was a Friday morning. Harper and Torres quickly drove off in the direction of the address they were given just a few miles away. They traveled in a white SUV, absent of any police markings, with a third team member in the back seat, Krystian Gardner. Gardner is not a police officer. She's a mental health clinician and social worker.

“Do we know the age of the daughter?” Gardner asked the officers. She was preparing a list of possible services and treatment options.

As the team pulled up to a row house in North Philadelphia, the mother was waiting for them outside, on the front stoop. They spent 40 minutes with the , working to de-escalate the immediate tension, the mom with support, and connect her daughter to treatment services.

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The trio returned to the patrol car and got to work documenting what had happened and recording the visit in an electronic database.

Officer Torres commented on the adult daughter: “In regards to her mental health, she is taking care of herself, she's taking her medication, and she's going to therapy, so we don't need to help her too much on that aspect.”

“She's actually sleeping right now, so I gave her my card and she'll call us whenever she wakes up,” Torres added.

Soon, the radio crackled with their next call, to a home across town where an older woman with a history of mental disorders had wandered outside naked.

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This visit took longer, over an hour, but had a similar outcome — help with the immediate mental health crisis, a connection to follow-up services with a case , and no arrest or use of force by police.

New Ways to Respond to Behavioral Health Needs

Emergency dispatchers in Philadelphia are increasingly assigning 911 calls involving people in mental health crises to the city's Crisis Intervention Response Team, which pairs police officers with civilian mental health professionals. This model is called a “co-responder program.”

Cities are experimenting with new ways to meet the rapidly increasing demand for behavioral health crisis intervention, at a time when incidents of police shooting and killing people in mental health crisis have become painfully familiar.

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Big questions persist: What role should law enforcement play in mental crisis response, if any? How can make sure the right kind of response is dispatched to meet the needs of a person in crisis? And what kind of ongoing support is necessary after a crisis response call?

City officials and behavioral health professionals often don't have easy answers, in part because the programs are new and hard data on their effectiveness is scarce. Without a single, definitive model for how to improve crisis response, cities are trying to learn from one another's successes and mistakes as they build and adjust their programs.

The Philadelphia Police Department established its Behavioral Health Unit in November 2022 and officially launched the co-responder crisis teams as a main feature.

The department said its goal is to meet people's immediate behavioral health needs, avoiding arrests or use of force, if possible. Philadelphia's program has answered about 600 calls since December 2022 — and only one case resulted in an arrest as of November 2023, according to city data.

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In about 85% of cases, people experienced one of four major outcomes: They were connected to outpatient mental health and social services, voluntarily entered psychiatric treatment, were involuntarily committed to treatment, or were taken to a hospital for medical care.

“I think the practical experiences that people have had has really opened up a lot of people's eyes to what the work does, how it's actually reducing harm to the community,” said Kurt August, director of Philadelphia's Office of Criminal Justice.

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City officials in Philadelphia looked to such cities as Los Angeles, Houston, and Denver, which have developed their own models over the years. They contacted people like Chris Richardson.

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Richardson in 2016 helped found Denver's co-responder program, which pairs police officers with mental health professionals, like Philadelphia's CIRT program.

Denver had been unhappy with the status quo, Richardson recalled. At the time, rank-and-file police officers were the only ones responding to 911 calls involving people in crisis.

“We just heard a lot of those communities saying, ‘We wish there was something better,'” he said. “That's what kind of gave us that ability to start those conversations and start a partnership.”

Getting buy-in from law enforcement and other emergency response teams took time, Richardson said. Eventually, the co-responder program grew to include all police precincts and several fire departments.

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Then, Denver city and county park rangers began requesting the aid of mental health professionals to accompany them while on patrol in public spaces, and during emergency calls.

“And then, somewhere in the middle there, we were like, you know, give a social worker a radio. We're like, why are we sending police to this, in general?” he said. “How do we take police out of things that don't need policing?”

Denver then launched a second model, its civilian response program, in 2019. It brings together paramedics and mental health professionals to respond to crisis calls — no police officers involved.

Now, Denver uses both models — the co-responder program with police, and the all-civilian response program — to cover Denver's crisis needs. Richardson said both programs are necessary, at least in Denver.

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“It's a spectrum of care with behavioral health crises,” he said. “Some of it is really low-level. No threats, no safety concerns, no legal issues.”

But sometimes responders or community members may face serious safety concerns, and that's when a co-response team that includes police officers is needed, Richardson said.

“We want to make sure that that person in crisis is still getting taken care of,” he said.

Getting the Right Responders to the Right Call

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Officials in Philadelphia want the police co-responder program to work in parallel with the city's existing network of civilian-only mental health response teams. The co-responder program is dispatched by 911, while the all-civilian program is activated when residents call 988.

The 988 system launched in July 2022, providing a three-digit number that can be dialed from any phone by people who are suicidal or experiencing a behavioral emergency. Calls are routed to a network of over 200 local and -funded crisis centers.

“A large percentage of Philadelphians are not aware of 988,” said Jill Bowen, commissioner of the Philadelphia Department of Behavioral Health and Intellectual disAbility Services. “I like to say that people are born knowing to call 911, kind of out of the womb and they know to call 911. And we really are trying to reach that kind of level of awareness.”

To help sort incoming calls, 911 dispatch centers in Philadelphia have been hiring mental health professionals. They can screen calls from people in crisis who don't need a police response, and forward them to 988.

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Other cities and states are also struggling with confusion over how to handle the overlap between 911 and 988 calls.

Although 988 is a national network, calls are taken by regional call centers, which are overseen and managed by local governments. The federal Substance Abuse and Mental Health Services Administration said it is working on “building strong coordination between the two services,” but it's currently up to states and counties themselves to figure out how 911 and 988 work together.

National data collected one year after 988's implementation showed that most calls to the service can be handled with conversation and referrals to other services. But 2% of calls to 988 require rapid in-person intervention. In most states, the responding agency is 911, which deploys traditional law enforcement, or co-response teams, if they're available.

Next Steps: A Safe Place to Go

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In states where awareness of 988 is higher, some behavioral health leaders are focused on a lack of continuing care resources for people in crisis.

During a July press conference marking one year since 988, Shari Sinwelski, the head of California's biggest crisis call center, described the ideal crisis response as a three-legged stool: “someone to to, someone to respond, a safe place to go.” The idea was introduced by SAMHSA in 2020.

In California, 44 out of its 58 counties have some form of mobile crisis response, meaning a team that can travel to someone in need, according to a 2021 survey conducted in partnership with the County Behavioral Health Directors Association of California.

However, the preparedness of these teams varies significantly. The survey identified that many of them don't operate 24/7, have long wait times (up to a day), and aren't equipped to handle in crisis.

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The same survey found that around 43% of the state's counties didn't have any physical place for people to go and stabilize during and after a crisis. WellSpace Health is California's second-biggest 988 center, by call volume, and is located in Sacramento County. A few years ago, WellSpace leaders decided it was time to open a crisis stabilization unit.

In summer 2020, WellSpace unveiled the Crisis Receiving for Behavioral Health center, known as “Crib,” in downtown Sacramento. The center receives people experiencing a mental health crisis or drug intoxication and allows them to stay for 24 hours and be connected to other services. The group says it has served more than 7,500 people since opening.

Physical locations linked to services, like Crib, are a crucial part of a well-functioning 988 system, said Jennifer Snow, national director of government relations and policy for the National Alliance on Mental Illness.

“Those crisis stabilization programs are really key to helping somebody not languish in the ER or unnecessarily get caught up in the criminal justice system,” she said.

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Snow said it's too early to know how the nation is progressing overall on building up these kinds of centers.

“This is something I am dying to know, and we just don't,” she said.

Snow explained that the crisis care system has roots in law enforcement, so it tends to replicate law enforcement's decentralized and locally led structure.

“It makes it harder to look at it from a national perspective and, you know, be able to identify exactly where are these services and where are the gaps in services,” she said.

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Building additional crisis centers, and hiring enough response teams to respond quickly, at all hours, in more areas of the U.S., would require significant investment. The current system relies heavily on state and local government funding, and more federal support is needed, Snow said.

In 2022, a group of legislators introduced the 988 Implementation Act in the House of Representatives. They were able to pass several provisions, including securing $385 million for certified community behavioral health clinics, which operate 24/7 crisis care, and $20 million for mobile crisis response pilot programs.

The bill was reintroduced in 2023, with the goal of passing the remaining sections. A significant provision would force Medicare and Medicaid, as well as private health insurance, to reimburse providers for crisis services.

This article is from a partnership that includes CapRadio, WHYY, NPR, and KFF Health News.

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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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This story can be republished for free (details).

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By: Nicole Leonard, WHYY and Kate Wolffe, CapRadio and Simone Popperl
Title: Cities Know the Way Police Respond to Mental Crisis Calls Needs to Change. But How?
Sourced From: kffhealthnews.org/news/article/police-response-mental-crisis-calls-988/
Published Date: Thu, 08 Feb 2024 10:00:00 +0000

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Kaiser Health News

Union With Labor Dispute of Its Own Threatens to Cut Off Workers’ Health Benefits

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Phil Galewitz, KFF Health News
Fri, 26 Jul 2024 09:00:00 +0000

The National Education Association, the nation's largest union, is threatening to cut off health insurance to about 300 Washington, D.C.-based workers on Aug. 1 in an effort to end a bitter contract dispute.

It's a tactic some private employers have used as leverage against unionized workers that has drawn scrutiny from congressional Democrats and is prohibited for state employers in California. Experts on labor say they've never seen a union make the move against its own workers.

“This is like a man-bites-dog situation where the union is now in a position as the employer,” said Paul Clark, a professor of labor and employment relations at Penn State University. “It's not a good look for a union.”

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NEA workers with pressing health needs are worried but say they won't fold. Joye Mercer Barksdale, a writer on the NEA's government relations team, said she needs coverage for a medical procedure to address atrial fibrillation, a cardiac disorder. “This is insane for the NEA to use our health benefits as a bargaining chip,” she said.

But Barksdale said the threat isn't enough to force her to agree to an unacceptable contract. “I am not ready to give in,” she said.

The NEA Staff Organization, the union representing workers at the NEA's headquarters, launched a strike on July 5 in Philadelphia, during the union's annual delegate assembly. It was its second walkout this summer as the two parties negotiate a new contract, navigating sticking points such as wages and remote work.

In response, the NEA ended the conference early. was supposed to speak at the but withdrew, refusing to cross the picket line. The NEA on July 24 endorsed Kamala Harris for president.

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On July 8, the day after the conference had been scheduled to end, the NEA locked out workers. In a letter the day before, the NEA informed its unionized workers that they would not be paid, effective immediately, and their health benefits would expire at the end of July unless a new deal were reached.

“NEA cannot allow NEASO to act again in a way that will bring such lasting harm to our members and our organization,” Kim Anderson, the NEA's executive director, wrote in the letter, obtained by KFF Health News. “We are, and have always been, committed both to our union values and to the importance of conducting ourselves as a model employer.”

Democrats in , including Sens. Sherrod Brown of Ohio and Bob Casey of Pennsylvania, introduced legislation last year to protect striking workers from losing their health benefits, after several large companies, including General Motors, John Deere, RTX (formerly Raytheon Technologies), and the maker of Kellogg's cereals, threatened to or did cut off coverage during labor disputes.

“Workers shouldn't have to choose between their family's health and a fair contract,” Brown said in a statement to KFF Health News.

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The legislation was endorsed by large labor unions including the Service Employees International Union and United Steelworkers, according to a press release from Brown's office. The NEA wasn't among them.

“This tactic is immoral, and it should be illegal,” United Steelworkers' president at the time, Thomas Conway, said in the release.

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Officials at the NEA, which represents teachers and other administrators, declined an interview request. In a statement, the organization's president, Becky Pringle, said “we are making every effort to reach an agreement as quickly as possible” with its staff union.

“As union who have been on strike, we recognize the significance and impact of these important decisions on a personal and family level. We truly value our employees and look forward to continued collaboration with NEASO to develop a new contract that benefits us all,” she said.

Kate Hilts, a digital strategist who works for the NEA, said she fears losing her coverage will leave her unable to afford treatment for a rare autoimmune disease that attacks her kidneys. Her next treatment was slated for August.

“I wake up every day and can't believe this is ,” she said. “You would expect this from an employer that is antiworker or has a terrible labor record, but I am totally flabbergasted that a labor union would do this that bills itself as pro-worker, pro-family, pro-education, and pro-.”

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The NEA staff union has filed multiple charges with the National Labor Relations Board this year, including allegations that the NEA withheld overtime pay and failed to information on the outsourcing of millions of dollars in bargaining unit work.

California is one of the only states that protect striking workers from losing health coverage. The state passed a law in 2021 that blocks the tactic from being used against public employees and another law in 2022 that allows any striking workers who lose their insurance to immediately get heavily discounted coverage through the state's Affordable Care Act marketplace.

If they remain locked out, the NEA workers would be eligible for coverage under COBRA, a federal program that allows people who are fired or laid off to maintain their employer-sponsored insurance for 18 months.

But the coverage can be a financial hardship, as individuals often must pay the entire cost of their insurance premiums, plus a 2% administrative fee.

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Another option for workers would be coverage through the Affordable Care Act marketplace, though that also could be costly. And it may be unclear how soon that coverage would begin or whether insurers would cover their existing doctors.

“I'm hoping the NEA will be so ashamed of what they are doing that, at the very least, they will not take away our health benefits,” Barksdale said.

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By: Phil Galewitz, KFF Health News
Title: Union With Labor Dispute of Its Own Threatens to Cut Off Workers' Health Benefits
Sourced From: kffhealthnews.org/news/article/nea-national-education-association-union-threatens-health-insurance-benefit-lockout/
Published Date: Fri, 26 Jul 2024 09:00:00 +0000

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The CDC’s Test for Bird Flu Works, but It Has Issues

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Arthur Allen and Amy Maxmen
Fri, 26 Jul 2024 09:00:00 +0000

The Centers for Disease Control and Prevention says a glitch in its bird flu test hasn't harmed the agency's outbreak response. But it has ignited scrutiny of its go-it-alone approach in testing for emerging pathogens.

The agency has quietly worked since April to resolve a nagging issue with the test it developed, even as the virus swept through dairy farms and chicken houses across the country and infected at least 13 farmworkers this year.

At a congressional hearing July 23, Rep. Brett Guthrie (R-Ky.) asked about the issue. “Boy, that rings of 2020,” he said, referring to when the nation was caught off guard by the pandemic, in part because of dysfunctional tests made by the CDC. Demetre Daskalakis, director of the CDC's National Center for Immunization and Respiratory Diseases, responded that the agency rapidly developed a workaround that makes its bird flu test reliable.

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“The tests are 100% usable,” he later told KFF , adding that the FDA studied the tests and came to the same conclusion. The imperfect tests, which have a faulty element that sometimes requires testing a sample again, will be replaced soon. He added, “We have made sure that we're offering a high-quality product.”

Still, some researchers were unnerved by the news coming four months after the declared a worrisome bird flu outbreak among cattle. The CDC's test is the only one available for clinical use. Some researchers say its flaws, though manageable, underscore the risk of relying on a single entity for testing.

The problem came to light in April as the agency prepared to distribute its test to about 100 public health labs around the country. CDC detected the issue through a quality control system put in place after the covid test catastrophe of 2020.

Daskalakis said the CDC's original test design was fine, but a flaw emerged when a company contracted by the agency manufactured the tests in bulk. In these tests, one of two components that recognize proteins called H5 in the H5N1 bird flu virus was unreliable, eliminating an important safeguard. By targeting the same protein twice, tests have a built-in backup in case one part fails.

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The agency developed a fix to ensure a reliable result: If only one of the two parts detected H5, the test was considered inconclusive and would be again. With the FDA's blessing, the CDC distributed the tests — with workaround instructions — to public health labs.

Wroblewski, director of infectious diseases at the Association of Public Health Laboratories, said the results of the tests have not been ambiguous, and there is no need to discard the tests.

Still, the agency has asked a different manufacturer to remake the faulty component so that 1.2 million improved tests will be available soon, Daskalakis said. Some of the updated tests are already in stock at the CDC, but the FDA hasn't yet signed off on their use. Daskalakis declined to name the manufacturers.

Meanwhile, the outbreak has grown. Farmworkers continue to lack information about the virus and gear to protect them from it. Rural clinics may miss cases if they don't catch a person's connection to a farm and notify health officials rather than their usual diagnostic testing laboratories.

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Those clinical labs remain unauthorized to test for the bird flu. Several of those labs have spent months working through analyses and red tape so that they can run the CDC's tests. As part of the licensing process, the CDC alerted them to the workaround with the current test, too.

But outside select circles, the news was largely overlooked. “I'm totally surprised by this,” Alex Greninger, assistant director of the of Washington Clinical Virology Laboratory, told KFF Health News this . Greninger's lab is developing its own test and has been trying to obtain CDC test kits to evaluate.

“It's not a red alarm,” he said, but he's worried that as the CDC and the FDA spend months developing and evaluating an updated test, the only one available relies on a single component. If the genetic code underlying that fragment of the H5 protein mutates, the test could give false results.

It's not uncommon for academic and commercial diagnostic labs to make mistakes and catch them during quality control checks, as the CDC did. Still, this isn't the agency's first mishap. In 2016, well before the covid debacle, CDC officials for months directed public health labs to use a Zika test that failed about a third of the time.

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The CDC caught and worked to remediate the situation far more quickly and effectively in this case. Nonetheless, the mishap raises concern. Michael Mina, chief science officer of the telemedicine company eMed.com, said diagnostic companies may be better suited to the task.

“It's a reminder that CDC is not a robust manufacturer of tests” and lacks the resources that industry can marshal for their production, Mina said. “We do not ask CDC to make vaccines and pharmaceuticals, and we do not ask the Pentagon to manufacture missiles.”

The CDC has licensed its updated test design to at least seven clinical diagnostic labs. Such labs are the foundation of testing in the U.S. But none have FDA clearance to use them.

Diagnostic labs are developing their own tests, too. But that has been slow-going. One reason is the lack of guaranteed sales. Another is regulatory uncertainty. Recent FDA guidance could make it harder for nongovernmental laboratories to issue new tests in the early phase of pandemics, said Susan Van Meter, president of the American Clinical Laboratory Association, in a July 1 letter to the FDA.

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Transparency is also critical, scientists said. Benjamin Pinsky, medical director of the clinical virology laboratory at Stanford University, said as a public agency the CDC should make its protocol — its recipe for making the test — easily accessible online.

The World Health Organization does so for its bird flu tests, and with that information in hand, Pinsky's lab has developed an H5 bird flu test suited to the strain circulating this year in the U.S. The lab published its approach this month but doesn't have FDA authorization for its broad use.

The CDC's test recipe is available in a published patent, Daskalakis said.

“We have made sure that tests are out there, and that they work,” he added.

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As the CDC came under fire at the July 23 congressional hearing, Daniel Jernigan, director of the CDC's National Center for Emerging and Zoonotic Infectious Diseases, noted that testing is just one tool. The agency needs money for another promising area — looking for the virus in wastewater. Its current program uses supplemental funds, he said: “It is not in the current budget and will go away without additional .”

——————————
By: Arthur Allen and Amy Maxmen
Title: The CDC's Test for Bird Flu Works, but It Has Issues
Sourced From: kffhealthnews.org/news/article/bird-flu-test-cdc-flaws/
Published Date: Fri, 26 Jul 2024 09:00:00 +0000

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KFF Health News’ ‘What the Health?’: Harris in the Spotlight

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Thu, 25 Jul 2024 18:45:00 +0000

The Host

Julie Rovner
KFF Health News


@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 “ Politics and Policy A to Z,” now in its third edition.

As Vice President Kamala Harris appears poised to become the Democratic Party's presidential nominee, health policy in general and reproductive health issues in particular are likely to have a higher profile. Harris has long been the Biden administration's point person on rights and reproductive health and was active on other health issues while serving as California's attorney general.

Meanwhile, is back for a brief between presidential conventions, but efforts in the GOP-led House to pass the annual spending bills, due by Oct. 1, have run into the usual roadblocks over abortion-related issues.

This week's panelists are Julie Rovner of KFF Health News, Stephanie Armour of KFF Health News, Rachel Cohrs Zhang of Stat, and Alice Miranda Ollstein of Politico.

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Panelists

Stephanie Armour
KFF Health News


@StephArmour1


Read Stephanie's stories.

Rachel Cohrs Zhang
Stat News

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@rachelcohrs


Read Rachel's stories.

Alice Miranda Ollstein
Politico


@AliceOllstein

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Read Alice's stories.

Among the takeaways from this week's episode:

  • President Joe Biden's decision to drop out of the presidential race has turned attention to his likely successor on the Democratic ticket, Vice President Kamala Harris. At this late hour in the campaign, she is expected to adopt Biden's health policies, though many anticipate she'll take a firmer stance on restoring Roe v. Wade. And while abortion rights supporters are enthusiastic about Harris' candidacy, opponents are eager to frame her views as extreme.
  • As he transitions from incumbent candidate to outgoing president, Biden is working to frame his legacy, including on health policy. The president has expressed pride that his signature domestic achievement, the Inflation Reduction Act, took on the pharmaceutical industry, including by forcing the makers of the most expensive into negotiations with Medicare. Yet, as with the Affordable Care Act's delayed implementation and results, most Americans have yet to see the IRA's potential effect on drug prices.
  • Lawmakers continue to be hung up on federal government spending, leaving appropriations work undone as they prepare to leave for summer recess. Fights over abortion are, once again, gumming up the works.
  • In abortion news, Iowa's six-week limit is scheduled to take effect next week, causing rippling problems of abortion access throughout the region. In Louisiana, which added the two drugs used in medication abortions to its list of controlled substances, doctors are having difficulty using the pills for other indications. And doctors who oppose abortion are pushing higher-risk procedures, like cesarean sections, in lieu of pregnancy termination when the mother's is in danger — as states with strict bans, like Texas and Louisiana, are reporting a rise in the use of surgeries, including hysterectomies, to end pregnancies.
  • The Government Accountability Office reports that many states incorrectly removed hundreds of thousands of eligible people from the Medicaid rolls during the “unwinding” of the public health emergency's coverage protections. The Biden administration has been reluctant to call out those states publicly in an attempt to keep the as apolitical as possible.

Also this week, Rovner interviews Anthony Wright, the new executive director of the consumer health advocacy group Families USA. Wright spent the past two decades in California, working with, among others, now-Vice President Kamala Harris on various health issues.

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

Julie Rovner: NPR's “A Study Finds That Dogs Can Smell Your Stress — And Make Decisions Accordingly,” by Rachel Treisman.  

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Alice Miranda Ollstein: Stat's “A Pricey Gilead HIV Drug Could Be Made for Dramatically Less Than the Company Charges,” by Ed Silverman, and Politico's “Federal HIV Program Set To Wind Down,” by Alice Miranda Ollstein and David Lim. 

Stephanie Armour: Vox's “Free Medical School Won't Solve the Doctor Shortage,” by Dylan Scott.  

Rachel Cohrs Zhang: Stat's “How UnitedHealth Harnesses Its Physician Empire To Squeeze Profits out of Patients,” by Bob Herman, Tara Bannow, Casey Ross, and Lizzy Lawrence. 

Also mentioned on this week's podcast:

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Francis Ying
Audio producer

Emmarie Huetteman
Editor

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.

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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Title: KFF Health News' ‘What the Health?': Harris in the
Sourced From: kffhealthnews.org/news/podcast/what-the-health-357-kamala-harris-campaign-health-policy-july-25-2024/
Published Date: Thu, 25 Jul 2024 18:45:00 +0000

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