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End of Pandemic Internet Subsidies Threatens a Health Care Lifeline for Rural America

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Sarah Jane Tribble, KFF Health News
Wed, 05 Jun 2024 09:00:00 +0000

FORT HALL RESERVATION, Idaho — Myrna Broncho realized just how necessary an internet connection can be after she broke her leg.

In fall 2021, the 69-year-old climbed a ladder to the top of a shed in her pasture. The roof that protects her horses and cows needed to be fixed. So, drill in hand, she pushed down.

That's when she slipped.

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Broncho said her leg snapped between a pair of ladder rungs as she fell, “and my bone was sticking out, and the only thing was holding it was my sock.”

Broncho arm-crawled back to her house to reach her phone. She hadn't thought to take it with her because, she said, “I never really dealt with phones.”

Broncho needed nine surgeries and rehabilitation that took months. Her hospital was more than two hours away in Salt Lake and her home internet connection was vital for her to keep track of and appointments, as well as communicate with her medical staff.

During the pandemic, federal lawmakers launched the Affordable Connectivity Program with the goal of connecting more people to their jobs, schools, and doctors. More than 23 million low-income households, including Broncho's, eventually signed on. The program provided $30 monthly subsidies for internet bills, or $75 discounts in tribal or high-cost areas like Broncho's.

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Now, the ACP is out of money.

In early May, Sen. John Thune (R-S.D.) challenged an effort to continue funding the program, saying during a commerce committee hearing that the program needed to be revamped.

“As is currently designed, ACP does a poor job of directing to those who truly need it,” Thune said, adding that too many people who already had internet access used the subsidies.

There has been a flurry of activity on Capitol Hill, with lawmakers first attempting and failing to attach funding to the must-pass Federal Aviation Administration reauthorization. Afterward, Sen. Peter Welch (D-Vt.) traveled to his home state to tell constituents in tiny White Junction that Congress was still working toward a solution.

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As the program funding dwindled, both Democrats and Republicans pushed for new legislative action with proposals trying to address concerns like the ones Thune raised.

On May 31, as the program ended, President Joe Biden's administration continued to call on Congress to take action. Meanwhile, the administration announced that more than a dozen companies — including AT&T, Verizon, and Comcast — would offer low-cost plans to ACP enrollees, and the administration said those plans could affect as many as 10 million households.

According to a survey of participants released by the Federal Communications Commission, more than two-thirds of households had inconsistent or no internet connection before enrolling in the program.

Broncho had an internet connection before the subsidy, but on this reservation in rural southeastern Idaho, where she lives, about 40% of the 200 households enrolled in the program had no internet before the subsidy.

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Nationwide, about 67% of nonurban residents reported having a broadband connection at home, with nearly 80% of urban residents, said John Horrigan, a national expert on technology adoption and senior fellow at the Benton Institute for Broadband & Society. Horrigan reviewed the data collected by a 2022 Census survey.

The FCC said on May 31 that ending the program will affect about 3.4 million rural and more than 300,000 households in tribal areas.

The end of federal subsidies for internet bills will mean “a lot of families who will have to make the tough choice not to have internet anymore,” said Amber Hastings, an AmeriCorps member serving the Shoshone-Bannock Tribes on the reservation. Some of the families Hastings enrolled had to agree to a plan to pay off past-due bills before joining the program. “So they were already in a tough spot,” Hastings said.

Matthew Rantanen, director of technology for the Southern California Tribal Chairmen's Association, said the ACP was “extremely valuable.”

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“Society has converted everything online. You cannot be in this society, as a societal member, and operate without a connection to broadband,” Rantanen said. Not being connected, he said, keeps Indigenous communities and someone like “Myrna at a disadvantage.”

Rantanen, who advises tribes nationwide about building broadband on their , said from the ACP's subsidies were twofold: They helped individuals get connected and encouraged providers to build infrastructure.

“You can guarantee a return on investment,” he said, explaining that the subsidies ensured customers could pay for internet service.

Since Broncho signed up for the program last year, her internet bill had been fully paid by the discount.

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Broncho used the money she had previously budgeted for her internet bill to pay down credit card debt and a loan she took out to pay for the headstones of her mother and brother.

As the ACP's funds ran low, the program distributed only partial subsidies. So, in May, Broncho received a bill for $46.70. In June, she expected to pay the full cost.

When asked if she would keep her internet connection without the subsidy, Broncho said, “I'm going to try.” Then she added, “I'm going to have to” even if it means taking a lesser service.

Broncho said she uses the internet for shopping, watching shows, banking, and .

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The internet, Broncho said, is “a necessity.”

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By: Sarah Jane Tribble, KFF Health News
Title: End of Pandemic Internet Subsidies Threatens a Health Care Lifeline for Rural America
Sourced From: kffhealthnews.org/news/article/acp-federal-internet-discount-program-ends-tribes/
Published Date: Wed, 05 Jun 2024 09:00:00 +0000

Kaiser Health News

Indiana Weighs Hospital Monopoly as Officials Elsewhere Scrutinize Similar Deals

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Samantha Liss
Fri, 14 Jun 2024 09:00:00 +0000

TERRE HAUTE, Ind. — Locals in this city of 58,000 are used to having to wait at railroad crossings for one of the dozens of daily cargo trains to pass through.

But a proposed merger between the two hospitals on either side of the city could exacerbate the problem in emergencies if the hospitals shut down some services, such as trauma care, at one site, which the proposal cites as a possibility. Tom High, fire chief of a nearby township, said some first responders would be forced to transport critical patients farther, risking longer delays, if they become what locals call “railroaded” by a passing train.

That's just one of the fears in this community as Indiana officials review whether to allow Union Hospital, licensed as a 341-bed facility, to purchase the county's only other acute care hospital, the 278-bed Terre Haute Regional Hospital. The proposed deal also raises concerns about reduced tax revenue, worsening care, and higher prices.

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Within the next few months, the Indiana Department of must find “clear evidence” that the proposed merger would improve health outcomes, access, and the quality of care. Those benefits must “outweigh any potential disadvantages.”

As the nation's health care industry has become more concentrated amid a steady clip of mergers in recent decades, it's common for one large system to dominate a market. In this case, the deal would be Indiana's first merger under the COPA law, short for Certificate of Public Advantage, that the state enacted in 2021. Such laws allow deals that the Federal Trade Commission otherwise considers illegal because they reduce competition and often create monopolies. To mitigate the negative effects of a monopoly, the merged hospitals typically agree to conditions imposed by state regulators.

Union Hospital said it's time to move “beyond competition” for the sake of the region, which has struggled to keep jobs and raise life expectancy rates. Hospital spokesperson Neil Garrison said the merger would ultimately improve care, increase access, and cut costs. Leaders of Regional Hospital, which is owned by for-profit chain HCA Healthcare, did not respond to questions about the proposal.

One unusual implication arises, though: If the merger is approved, the surrounding county would lose tax revenue from one of its larger businesses. Union Hospital, which as a nonprofit is exempt from paying taxes, would be acquiring tax-paying Terre Haute Regional, which paid roughly $508,000 in county taxes for 2023, said Vigo County Auditor Jim Bramble. That's the equivalent of the starting salaries of about nine sheriff's deputies, per the county's $83 million 2024 budget.

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Garrison said the hospital system is aware of the tax implications for the county and is “exploring opportunities” to address it.

Meanwhile, Roland Kohr, formerly a pathologist at Regional and a county coroner, frets about erasing competition that forced the hospitals to add services or match the other. “The push to introduce new technologies, to recruit more physicians, that may not happen,” he said.

The FTC has urged states to avoid COPAs, pointing to research that found they “have resulted in significant price increases and contributed to declines in quality of care.” The fallout of similar mergers has triggered federal sanctions in North Carolina and pushback from locals and legislators in Tennessee.

“A merged hospital system that faces little remaining competition after the merger usually has little incentive to follow through with its promises because patients have no other choice,” wrote Chris Garmon, a University of Missouri-Kansas City economist who has studied COPA mergers, in a warning to Indiana health officials about the proposed merger.

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Indiana already has among the highest hospital prices in the country, according to a study by the Rand Corp. research organization. The Indiana Legislature spent the past year to rein in prices. Gloria Sachdev, of Indianapolis-based Employers' Forum of Indiana, which pushed for those pricing limits on behalf of frustrated business leaders, is worried a Union-Regional merger would undo those gains and raise prices further.

Indiana's COPA restricts how much the hospital could increase charges, Garrison said.

Elsewhere, the largest COPA-created hospital system in the country, Ballad Health, has reported that the time patients spend in its ERs in Virginia and Tennessee before being hospitalized has more than tripled, reaching nearly 11 hours, in the six years since that monopoly of 20 hospitals formed. Still, Tennessee has awarded Ballad top marks even when certain quality metrics, including its ER speed, fall below established benchmarks.

Ballad Health spokesperson Molly Luton said the system's performance has improved since those statistics were gathered.

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Last fall, some Tennesseans unsuccessfully urged a county board to call on the state to better regulate the hospital system. This spring, state lawmakers refused to hear testimony from who drove five hours to Nashville to testify for a bill that sought to limit future COPA mergers in the state — which ultimately didn't make it to a full vote.

Problems have also occurred when a COPA — and its oversight — are , leaving the merged hospital system as an “unregulated monopoly.” After North Carolina repealed its COPA in 2015, a subsidiary of HCA Healthcare bought Mission Health, a COPA-created monopoly in Asheville, for $1.5 billion in 2019. The monopoly in Asheville remained but none of the COPA's conditions applied to the new owner.

Last year, government inspectors found “deficiencies” at Mission Health that contributed to four patient deaths and posed an “immediate jeopardy” to patients' health and safety, according to the 384-page federal inspection . North Carolina Attorney General Joshua Stein sued HCA's subsidiary last year, alleging the ER was “significantly degraded,” and that the company failed to maintain certain critical services, including oncology care, a violation of a purchase agreement Stein's office negotiated with it because the company acquired a nonprofit.

HCA said it promptly addressed the issues and denied Stein's allegations in its legal response to the ongoing , arguing it has expanded services since its purchase. HCA also argued that the agreement is silent about maintaining the quality of care.

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Back in Indiana, Union Hospital laid the groundwork for its merger more than three years ago when its leaders provided the language for COPA legislation to then-state Sen. Jon Ford, a Republican in Terre Haute, believing he would be “the best champion for this proposal,” according to legislative testimony from Taylor Hollenbeck, an RJL Solutions consultant on the merger. Ford, listed on the legislature's site as the bill's co-author, did not respond to requests for comment.

Union CEO Steve Holman testified in the bill's hearings that the county's public health rankings — with an average life expectancy ranking 68th out of 92 counties in the state — should be a “call to action” to do something “big and bold.”

Terre Haute Mayor Brandon Sakbun agrees the merger could what he called the county's “abysmal” public health statistics. Last year, he was elected the city's youngest mayor at age 27 on a promise to “turn Terre Haute around.” The region's workforce has steadily declined and local leaders have pinned their hopes on a new casino and a manufacturer of battery parts for electric vehicles to reverse this trend.

Sakbun's father is an OB-GYN at Union, but the mayor said that doesn't color his opinion and that he supports the hospital merger despite the loss of the tax base. He believes it will help recruit medical and other professionals to an area that has struggled to attract top talent.

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“Do I believe that this is the one that bucks the research?” Sakbun said. “I truthfully do.”

KFF Health correspondent Brett Kelman contributed to this article.

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By: Samantha Liss
Title: Indiana Weighs Hospital Monopoly as Officials Elsewhere Scrutinize Similar Deals
Sourced From: kffhealthnews.org/news/article/indiana-copa-hospital-monopoly-scrutiny/
Published Date: Fri, 14 Jun 2024 09:00:00 +0000

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California Lawmakers Preserve Aid to Older, Disabled Immigrants

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Vanessa G. Sánchez
Fri, 14 Jun 2024 09:00:00 +0000

California lawmakers on Thursday passed a 2024-25 budget that rejected Gov. Gavin Newsom's proposal to cut in-home supportive services for low-income older, blind, and disabled immigrants lacking legal residency. However, the Democratic governor has not said whether he'll use his line-item veto authority to help close the state's $45 billion deficit.

The legislature, controlled by Democrats, passed a $211 billion general fund spending plan for the fiscal year starting July 1 by drawing more from the state's rainy-day fund and reducing corporate tax deductions to prevent cuts to and social services.

“Our legislative budget plan achieves those goals with targeted, carefully calibrated investments in safety-net programs that protect our most vulnerable,” said Assembly member Jesse Gabriel, chair of the Assembly's budget committee, in Sacramento.

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Newsom and lawmakers are expected to continue talks.

“What was approved represents a two-house agreement between the Senate and the Assembly – not an agreement with the governor,” said state Department of Finance spokesperson H.D. Palmer. “We've made good progress, but there's still more work to do.”

Newsom had proposed eliminating the new in-home benefit for qualified immigrants to save nearly $95 million in the next fiscal year, with no plans to bring it back. Lawmakers not only rejected Newsom's cut to the in-home services program; they also refused the governor's proposal to slash $300 million a year from public health agencies. However, they accepted delaying food assistance to low-income older immigrants without legal residency.

The In-Home Supportive Services program helps low-income older, blind, and disabled individuals care in their homes, which helps keep them out of more costly nursing and residential facilities. The program works by paying $16 to $21 an hour to caregivers, many of them family members.

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Advocates applauded lawmakers for rejecting the cut. They had urged the governor to adopt the legislature's budget, arguing the state could end up paying more in the long as Medi-Cal recipients tap nursing services. The state has estimated the annual per-person cost of nursing homes is $124,189, with the roughly $28,000 average cost for people without legal residency in the in-home services program.

“These individuals would need to essentially go into costly hospital or nursing care,” said Ronald Coleman Baeza, managing policy director at the California Pan-Ethnic Health Network. “It's not only cruel for undocumented immigrants, but it doesn't make sense as a fiscal decision either.”

The governor has said he's to maintain fiscal discipline while preserving Medi-Cal benefits for immigrants. California was the first state to expand Medicaid eligibility to all qualified immigrants regardless of legal status, phasing it in over several years: in 2016, adults ages 19-26 in 2020, people 50 and older in 2022, and all remaining adults this year.

“It's a core of I think who we are as a state, and we should be as a nation,” Newsom said in May.

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As part of the Medi-Cal expansion, the state authorized nearly 3,000 older, blind, and disabled immigrants without legal residency to access paramedical services and daily care, meal preparation, bathing, feeding, and transportation to medical appointments. Advocates estimate 17,000 immigrants qualify.

“Fixing California's deficit means making tough choices, so the Assembly came to these negotiations focused on preserving programs that matter most to Californians,” said Assembly Speaker Robert Rivas, a Central Coast Democrat, in an earlier statement.

Lawmakers did agree to Newsom's proposal to delay around $165 a month in food assistance to low-income immigrants without legal residency ages 55 and older. Lawmakers had approved the benefit two years ago, but the governor proposed delaying it by two fiscal years to 2027.

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: Vanessa G. Sánchez
Title: California Lawmakers Preserve Aid to Older, Disabled Immigrants
Sourced From: kffhealthnews.org/news/article/california-lawmakers-aid-immigrants-in-home-services-budget-newsom/
Published Date: Fri, 14 Jun 2024 09:00:00 +0000

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Kaiser Health News

KFF Health News’ ‘What the Health?’: SCOTUS Rejects Abortion Pill Challenge — For Now 

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Thu, 13 Jun 2024 18:50:00 +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 Politics and Policy A to Z,” now in its third edition.

A unanimous Supreme Court turned back a to the FDA's approval and rules for the abortion pill mifepristone, finding that the anti-abortion doctor group that sued lacked standing to do so. But abortion foes have other ways they intend to curtail availability of the pill, which is commonly used in medication abortions, which now make up nearly two-thirds of abortions in the U.S.

Meanwhile, the Biden administration is proposing regulations that would bar credit agencies from medical debt on individual credit reports. And former President Donald Trump, signaling that drug prices remain a potent campaign issue, attempts to take credit for the $35-a-month cap on insulin for Medicare beneficiaries — which was backed and signed into law by Biden.

This 's panelists are Julie Rovner of KFF Health News, Anna Edney of Bloomberg News, Rachana Pradhan of KFF Health News, and Emmarie Huetteman of KFF Health News.

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Panelists

Anna Edney
Bloomberg


@annaedney


Read Anna's stories.

Emmarie Huetteman
KFF Health News

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@emmarieDC


Read Emmarie's stories.

Rachana Pradhan
KFF Health News


@rachanadpradhan

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Read Rachana's stories.

Among the takeaways from this week's episode:

  • All nine Supreme Court justices on June 13 rejected a challenge to the abortion pill mifepristone, ruling the plaintiffs did not have standing to sue. But that may not be the last word: The leaves open the possibility that different plaintiffs — including three states already part of the case — could raise a similar challenge in the future, and that the court could then vote to block access to the pill.
  • As the presidential race heats up, and former President Donald Trump are angling for health care voters. The Biden administration this week proposed eliminating all medical debt from Americans' credit scores, which would expand on the previous, voluntary move by the major credit agencies to erase from credit reports medical bills under $500. Meanwhile, Trump continues to court vaccine skeptics and wrongly claimed credit for Medicare's $35 monthly cap on insulin — enacted under a law backed and signed by Biden.
  • Problems are compounding at the pharmacy counter. Pharmacists and drugmakers are the highest numbers of drug shortages in more than 20 years. And independent pharmacists in particular say they are struggling to keep drugs on the shelves, pointing to a recent Biden administration policy change that reduces costs for seniors — but also cash flow for pharmacies.
  • And the Southern Baptist Convention, the nation's largest branch of Protestantism, voted this week to restrict the use of in vitro fertilization. As evidenced by recent flip-flopping stances on abortion, Republican candidates are feeling pressed to satisfy a wide range of perspectives within even their own party.

Also this week, Rovner interviews KFF president and Drew Altman about KFF's new “Health Policy 101” primer. You can learn more about it here.

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

Julie Rovner: HuffPost's “How America's Mental Health Crisis Became This Family's Worst Nightmare,” by Jonathan Cohn.

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Anna Edney: Stat News' “Four Tops Singer's Lawsuit Says He Visited ER for Chest Pain, Ended Up in Straitjacket,” by Tara Bannow.

Rachana Pradhan: The New York Times' “Abortion Groups Say Tech Companies Suppress Posts and Accounts,” by Emily Schmall and Sapna Maheshwari.

Emmarie Huetteman: CBS News' “As FDA Urges Crackdown on Bird Flu in Raw Milk, Some States Say Their Hands Are Tied,” by Alexander Tin.

Also mentioned on this week's podcast:

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Credits

Francis Ying
Audio producer

Emmarie Huetteman
Editor

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?': SCOTUS Rejects Abortion Pill Challenge — For Now 
Sourced From: kffhealthnews.org/news/podcast/what-the-health-351-supreme-court-abortion-pill-mifepristone-june-13-2024/
Published Date: Thu, 13 Jun 2024 18:50:00 +0000

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