Kaiser Health News
In a Fractious Rerun, GOP Rivals Haley and DeSantis Debate Health Care. Trump Sits It Out.
Thu, 11 Jan 2024 19:50:00 +0000
The race to win the quickly approaching Iowa caucuses was the theme running through Wednesday night's Republican presidential debate hosted by CNN at Drake University in Des Moines, Iowa. Front-runner Donald Trump was again absent and only two other candidates made the cut: Florida Gov. Ron DeSantis and former South Carolina Gov. Nikki Haley.
DeSantis and Haley fired a frenzy of attacks at each other's records and positions. The faceoff was moderated by CNN “State of the Union” co-anchors Jake Tapper and Dana Bash.
Our PolitiFact partners fact-checked the debate in real time. You can read the full coverage here.
The two candidates touched on a variety of health care topics. As in previous debates, they each questioned the other's anti-abortion bona fides and reaffirmed their own. They sparred over covid-19 policies as well as whether to push China out of the U.S. supply chain for pharmaceuticals and other health-related products.
Asked whether, as president, they would preserve the Affordable Care Act's Medicaid expansion, both said — after being pressed for clarification — they would like to convert the program to a block grant. That's generally understood to be an approach in which federal funding is capped but state flexibility is increased.
Forty states and the District of Columbia, but not South Carolina or Florida, have expanded Medicaid under the ACA, which is credited with providing insurance coverage to millions more Americans.
Block-granting Medicaid isn't a new idea. The approach has long been favored by Republicans and was advanced by the Trump administration. It's strongly opposed by Democrats.
In terms of health care policy, Haley again promised to add transparency to the U.S. system, emphasize competition, and put patients “in the driver's seat.” She also promised tort reform.
DeSantis argued for “health care that's accessible, that's affordable, and that's accountable, and particularly an emphasis on mental health.” He also pointed to his Florida experience. “We got accountability for the pharmacy benefit middlemen that are causing your drug prices to go up,” he said, and claimed another victory in the war on high drug costs.
The FDA last week approved Florida's plan to import certain medicines from Canada for some state agencies. But the plan faces hurdles, including Canada's government, which has warned it won't allow U.S. imports if they risk causing drug shortages for Canadians.
Meanwhile, primary front-runner Trump again declined an invitation to debate. He instead participated in a Fox News town hall, also in Des Moines.
He claimed responsibility for the Supreme Court's decision to overturn Roe v. Wade: “I did it. And I am proud to have done it,” he said.
But in response to a voter who sought assurances he would ban abortion nationwide if he won another presidential term, Trump acknowledged the politics of the issue. He told the voters “you still have to win elections” and that “a lot” of Republicans have been “decimated” as a result of advocating strict abortion bans. He carefully avoided saying what kind of ban, precisely, he would propose if he made it back to the White House.
Trump also revisited some of his favorite controversial covid-related themes. He minimized the role played by Anthony Fauci, who directed the National Institutes of Health's National Institute of Allergy and Infectious Diseases and was a pandemic medical adviser in Trump's administration. Trump called Fauci, who has been a lightning rod among Republican voters, “not a huge factor” in his pandemic policies but said the scientist took on outsize prominence in the Biden White House.
Trump waded into controversy about the virus's origins, outlining his own theory on how it spread from China.Â
“It came out of Wuhan, the labs,” he said. “I think it was done out of incompetence.”
“I believe that a scientist went out, said hello to his girlfriend, and that was the end of that. She died, and then people started dying all over the place. But who knows, who knows?” (PolitiFact examined that claim and others from Wednesday night's town hall event.)
Meanwhile, entrepreneur Vivek Ramaswamy did not qualify to participate in the CNN forum. Candidates needed at least 10% support among respondents in three CNN-approved national or Iowa polls to make the debate stage, including one poll of likely Iowa Republican caucusgoers. Former New Jersey Gov. Chris Christie announced on the day of the debate that he was dropping out of the race.
What follows are health care-related fact checks excerpted from PolitiFact's coverage:
Life Expectancy and Social Security
DeSantis and Haley sparred over whether to raise the Social Security retirement age.
Haley said life expectancy is longer today, so the age to start collecting Social Security and Medicare benefits, currently 65, should be raised. She said people in or near retirement should be protected from any retirement age increase, while people in their 20s should be told that “we're going to change the retirement age to reflect life expectancy.”
DeSantis said he wouldn't raise the retirement age, citing an erosion in life expectancy over the past few years.
“The problem now, in the last five years, is life expectancy is going down,” DeSantis said. “So, I don't see how you can raise the retirement age when our life expectancy is collapsing in this country.” PolitiFact readers asked whether U.S. life expectancy is decreasing. We found that both candidates can point to data that supports their position.
During his town hall, Trump criticized both Haley and DeSantis over their stances on the retirement age, saying they both favor raising the age of Medicare eligibility above 65.
Gender-Affirming Care
DeSantis: On gender-affirming surgery for minors, “[Haley] said she's against [it]. That wasn't what she said this summer. She was asked about it. It's on video, and she said the law should stay out of it.”
DeSantis is partially correct. Haley has said “the law should stay out of it,” but has also strongly opposed gender-affirming care for minors.
In a June CBS interview, Haley said when determining what care should be available for transgender youth, the “law should stay out of it, and I think parents should handle it.” She followed up by saying, “When that child becomes 18, if they want to make more of a permanent change, they can do that.”
Haley's campaign pointed to a May ABC News appearance during which she said that a minor shouldn't be allowed to have a “gender-changing procedure” and opposed “taxpayer dollars” funding one.
In Wednesday's CNN debate, Haley reiterated, “We shouldn't have any gender transitions before the age of 18.”
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Title: In a Fractious Rerun, GOP Rivals Haley and DeSantis Debate Health Care. Trump Sits It Out.
Sourced From: kffhealthnews.org/news/article/gop-presidential-debate-haley-desantis-health-care-issues-trump-town-hall/
Published Date: Thu, 11 Jan 2024 19:50:00 +0000
Kaiser Health News
The Lure of Specialty Medicine Pulls Nurse Practitioners From Primary Care
Michelle Andrews
Fri, 17 May 2024 09:00:00 +0000
For many patients, seeing a nurse practitioner has become a routine part of primary care, in which these “NPs” often perform the same tasks that patients have relied on doctors for.
But NPs in specialty care? That's not routine, at least not yet. Increasingly, though, nurse practitioners and physician assistants are joining cardiology, dermatology, and other specialty practices, broadening their skills and increasing their income.
This development worries some people who track the health workforce, because current trends suggest primary care, which has counted on nurse practitioners to backstop physician shortages, soon might not be able to rely on them to the same extent.
“They're succumbing to the same challenges that we have with physicians,” said Atul Grover, executive director of the Research and Action Institute at the Association of American Medical Colleges. The rates NPs can command in a specialty practice “are quite a bit higher” than practice salaries in primary care, he said.
When nurse practitioner programs began to proliferate in the 1970s, “at first it looked great, producing all these nurse practitioners that go to work with primary care physicians,” said Yalda Jabbarpour, director of the American Academy of Family Physicians' Robert Graham Center for Policy Studies. “But now only 30% are going into primary care.”
Jabbarpour was referring to the 2024 primary care scorecard by the Milbank Memorial Fund, which found that from 2016 to 2021 the proportion of nurse practitioners who worked in primary care practices hovered between 32% and 34%, even though their numbers grew rapidly. The proportion of physician assistants, also known as physician associates, in primary care ranged from 27% to 30%, the study found.
Both nurse practitioners and physician assistants are advanced practice clinicians who, in addition to graduate degrees, must complete distinct education, training, and certification steps. NPs can practice without a doctor's supervision in more than two dozen states, while PAs have similar independence in only a handful of states.
About 88% of nurse practitioners are certified in an area of primary care, according to the American Association of Nurse Practitioners. But it is difficult to track exactly how many work in primary care or in specialty practices. Unlike physicians, they're generally not required to be endorsed by a national standard-setting body to practice in specialties like oncology or cardiology, for example. The AANP declined to answer questions about its annual workforce survey or the extent to which primary care NPs are moving toward specialties.
Though data tracking the change is sparse, specialty practices are adding these advanced practice clinicians at almost the same rate as primary care practices, according to frequently cited research published in 2018.
The clearest evidence of the shift: From 2008 to 2016, there was a 22% increase in the number of specialty practices that employed nurse practitioners and physician assistants, according to that study. The increase in the number of primary care practices that employed these professionals was 24%.
Once more, the most recent projections by the Association of American Medical Colleges predict a dearth of at least 20,200 primary care physicians by 2036. There will also be a shortfall of non-primary care specialists, including a deficiency of at least 10,100 surgical physicians and up to 25,000 physicians in other specialties.
When it comes to the actual work performed, the lines between primary and specialty care are often blurred, said Candice Chen, associate professor of health policy and management at George Washington University.
“You might be a nurse practitioner working in a gastroenterology clinic or cardiology clinic, but the scope of what you do is starting to overlap with primary care,” she said.
Nurse practitioners' salaries vary widely by location, type of facility, and experience. Still, according to data from health care recruiter AMN Healthcare Physician Solutions, formerly known as Merritt Hawkins, the total annual average starting compensation, including signing bonus, for nurse practitioners and physician assistants in specialty practice was $172,544 in the year that ended March 31, slightly higher than the $166,544 for those in primary care.
According to forecasts from the federal Bureau of Labor Statistics, nurse practitioner jobs will increase faster than jobs in almost any other occupation in the decade leading up to 2032, growing by 123,600 jobs or 45%. (Wind turbine service technician is the only other occupation projected to grow as fast.) The growth rate for physician assistants is also much faster than average, at 27%. There are more than twice as many nurse practitioners as physician assistants, however: 323,900 versus 148,000, in 2022.
To Grover, of the AAMC, numbers like this signal that there will probably be enough NPs, PAs, and physicians to meet primary care needs. At the same time, “expect more NPs and PAs to also flow out into other specialties,” he said.
When Pamela Ograbisz started working as a registered nurse 27 years ago, she worked in a cardiothoracic intensive care unit. After she became a family nurse practitioner a few years later, she found a job with a similar specialty practice, which trained her to take on a bigger role, first running their outpatient clinic, then working on the floor, and later in the intensive care unit.
If nurse practitioners want to specialize, often “the doctors mentor them just like they would with a physician residency,” said Ograbisz, now vice president of clinical operations at temporary placement recruiter LocumTenens.com.
If physician assistants want to specialize, they also can do so through mentoring, or they can receive “certificates of added qualifications” in 10 specialties to demonstrate their expertise. Most employers don't “encourage or require” these certificates, however, said Jennifer Orozco, chief medical officer at the American Academy of Physician Associates.
There are a number of training programs for family nurse practitioners who want to develop skills in other areas.
Raina Hoebelheinrich, 40, a family nurse practitioner at a regional medical center in Yankton, South Dakota, recently enrolled in a three-semester post-master's endocrinology training program at Mount Marty University. She lives on a farm in nearby northeastern Nebraska with her husband and five sons.
Hoebelheinrich's new skills could be helpful in her current hospital job, in which she sees a lot of patients with acute diabetes, or in a clinic setting like the one in Sioux Falls, South Dakota, where she is doing her clinical endocrinology training.
Lack of access to endocrinology care in rural areas is a real problem, and many people may travel hundreds of miles to see a specialist.
“There aren't a lot of options,” she said.
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By: Michelle Andrews
Title: The Lure of Specialty Medicine Pulls Nurse Practitioners From Primary Care
Sourced From: kffhealthnews.org/news/article/nurse-practitioners-trend-primary-care-specialties/
Published Date: Fri, 17 May 2024 09:00:00 +0000
Did you miss our previous article…
https://www.biloxinewsevents.com/clean-needles-save-lives-in-some-states-they-might-not-be-legal/
Kaiser Health News
Clean Needles Save Lives. In Some States, They Might Not Be Legal.
Ed Mahon, Spotlight PA and Sarah Boden, WESA
Fri, 17 May 2024 09:00:00 +0000
Kim Botteicher hardly thinks of herself as a criminal.
On the main floor of a former Catholic church in Bolivar, Pennsylvania, Botteicher runs a flower shop and cafe.
In the former church's basement, she also operates a nonprofit organization focused on helping people caught up in the drug epidemic get back on their feet.
The nonprofit, FAVOR ~ Western PA, sits in a rural pocket of the Allegheny Mountains east of Pittsburgh. Her organization's home county of Westmoreland has seen roughly 100 or more drug overdose deaths each year for the past several years, the majority involving fentanyl.
Thousands more residents in the region have been touched by the scourge of addiction, which is where Botteicher comes in.
She helps people find housing, jobs, and health care, and works with families by running support groups and explaining that substance use disorder is a disease, not a moral failing.
But she has also talked publicly about how she has made sterile syringes available to people who use drugs.
“When that person comes in the door,” she said, “if they are covered with abscesses because they have been using needles that are dirty, or they've been sharing needles — maybe they've got hep C — we see that as, ‘OK, this is our first step.'”
Studies have identified public health benefits associated with syringe exchange services. The Centers for Disease Control and Prevention says these programs reduce HIV and hepatitis C infections, and that new users of the programs are more likely to enter drug treatment and more likely to stop using drugs than nonparticipants.
This harm-reduction strategy is supported by leading health groups, such as the American Medical Association, the World Health Organization, and the International AIDS Society.
But providing clean syringes could put Botteicher in legal danger. Under Pennsylvania law, it's a misdemeanor to distribute drug paraphernalia. The state's definition includes hypodermic syringes, needles, and other objects used for injecting banned drugs. Pennsylvania is one of 12 states that do not implicitly or explicitly authorize syringe services programs through statute or regulation, according to a 2023 analysis. A few of those states, but not Pennsylvania, either don't have a state drug paraphernalia law or don't include syringes in it.
Those working on the front lines of the opioid epidemic, like Botteicher, say a reexamination of Pennsylvania's law is long overdue.
There's an urgency to the issue as well: Billions of dollars have begun flowing into Pennsylvania and other states from legal settlements with companies over their role in the opioid epidemic, and syringe services are among the eligible interventions that could be supported by that money.
The opioid settlements reached between drug companies and distributors and a coalition of state attorneys general included a list of recommendations for spending the money. Expanding syringe services is listed as one of the core strategies.
But in Pennsylvania, where 5,158 people died from a drug overdose in 2022, the state's drug paraphernalia law stands in the way.
Concerns over Botteicher's work with syringe services recently led Westmoreland County officials to cancel an allocation of $150,000 in opioid settlement funds they had previously approved for her organization. County Commissioner Douglas Chew defended the decision by saying the county “is very risk averse.”
Botteicher said her organization had planned to use the money to hire additional recovery specialists, not on syringes. Supporters of syringe services point to the cancellation of funding as evidence of the need to change state law, especially given the recommendations of settlement documents.
“It's just a huge inconsistency,” said Zoe Soslow, who leads overdose prevention work in Pennsylvania for the public health organization Vital Strategies. “It's causing a lot of confusion.”
Though sterile syringes can be purchased from pharmacies without a prescription, handing out free ones to make drug use safer is generally considered illegal — or at least in a legal gray area — in most of the state. In Pennsylvania's two largest cities, Philadelphia and Pittsburgh, officials have used local health powers to provide legal protection to people who operate syringe services programs.
Even so, in Philadelphia, Mayor Cherelle Parker, who took office in January, has made it clear she opposes using opioid settlement money, or any city funds, to pay for the distribution of clean needles, The Philadelphia Inquirer has reported. Parker's position signals a major shift in that city's approach to the opioid epidemic.
On the other side of the state, opioid settlement funds have had a big effect for Prevention Point Pittsburgh, a harm reduction organization. Allegheny County reported spending or committing $325,000 in settlement money as of the end of last year to support the organization's work with sterile syringes and other supplies for safer drug use.
“It was absolutely incredible to not have to fundraise every single dollar for the supplies that go out,” said Prevention Point's executive director, Aaron Arnold. “It takes a lot of energy. It pulls away from actual delivery of services when you're constantly having to find out, ‘Do we have enough money to even purchase the supplies that we want to distribute?'”
In parts of Pennsylvania that lack these legal protections, people sometimes operate underground syringe programs.
The Pennsylvania law banning drug paraphernalia was never intended to apply to syringe services, according to Scott Burris, director of the Center for Public Health Law Research at Temple University. But there have not been court cases in Pennsylvania to clarify the issue, and the failure of the legislature to act creates a chilling effect, he said.
Carla Sofronski, executive director of the Pennsylvania Harm Reduction Network, said she was not aware of anyone having faced criminal charges for operating syringe services in the state, but she noted the threat hangs over people who do and that they are taking a “great risk.”
In 2016, the CDC flagged three Pennsylvania counties — Cambria, Crawford, and Luzerne — among 220 counties nationwide in an assessment of communities potentially vulnerable to the rapid spread of HIV and to new or continuing high rates of hepatitis C infections among people who inject drugs.
Kate Favata, a resident of Luzerne County, said she started using heroin in her late teens and wouldn't be alive today if it weren't for the support and community she found at a syringe services program in Philadelphia.
“It kind of just made me feel like I was in a safe space. And I don't really know if there was like a come-to-God moment or come-to-Jesus moment,” she said. “I just wanted better.”
Favata is now in long-term recovery and works for a medication-assisted treatment program.
At clinics in Cambria and Somerset Counties, Highlands Health provides free or low-cost medical care. Despite the legal risk, the organization has operated a syringe program for several years, while also testing patients for infectious diseases, distributing overdose reversal medication, and offering recovery options.
Rosalie Danchanko, Highlands Health's executive director, said she hopes opioid settlement money can eventually support her organization.
“Why shouldn't that wealth be spread around for all organizations that are working with people affected by the opioid problem?” she asked.
In February, legislation to legalize syringe services in Pennsylvania was approved by a committee and has moved forward. The administration of Gov. Josh Shapiro, a Democrat, supports the legislation. But it faces an uncertain future in the full legislature, in which Democrats have a narrow majority in the House and Republicans control the Senate.
One of the bill's lead sponsors, state Rep. Jim Struzzi, hasn't always supported syringe services. But the Republican from western Pennsylvania said that since his brother died from a drug overdose in 2014, he has come to better understand the nature of addiction.
In the committee vote, nearly all of Struzzi's Republican colleagues opposed the bill. State Rep. Paul Schemel said authorizing the “very instrumentality of abuse” crossed a line for him and “would be enabling an evil.”
After the vote, Struzzi said he wanted to build more bipartisan support. He noted that some of his own skepticism about the programs eased only after he visited Prevention Point Pittsburgh and saw how workers do more than just hand out syringes. These types of programs connect people to resources — overdose reversal medication, wound care, substance use treatment — that can save lives and lead to recovery.
“A lot of these people are … desperate. They're alone. They're afraid. And these programs bring them into someone who cares,” Struzzi said. “And that, to me, is a step in the right direction.”
At her nonprofit in western Pennsylvania, Botteicher is hoping lawmakers take action.
“If it's something that's going to help someone, then why is it illegal?” she said. “It just doesn't make any sense to me.”
This story was co-reported by WESA Public Radio and Spotlight PA, an independent, nonpartisan, and nonprofit newsroom producing investigative and public-service journalism that holds power to account and drives positive change in Pennsylvania.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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By: Ed Mahon, Spotlight PA and Sarah Boden, WESA
Title: Clean Needles Save Lives. In Some States, They Might Not Be Legal.
Sourced From: kffhealthnews.org/news/article/clean-needles-syringe-services-programs-legal-gray-area-risk-pennsylvania/
Published Date: Fri, 17 May 2024 09:00:00 +0000
Kaiser Health News
Watch: John Oliver Dishes on KFF Health News’ Opioid Settlements Series
Fri, 17 May 2024 09:00:00 +0000
Opioid manufacturers, distributors, and retailers are paying tens of billions of dollars in restitution to settle lawsuits related to their role in the nation's overdose epidemic. A recent broadcast of “Last Week Tonight With John Oliver” examined how that money is being spent by state and local governments across the United States.
The segment featured reporting from the KFF Health News series “Payback: Tracking the Opioid Settlement Cash.” You can learn more about the issue and read our collection of articles by Aneri Pattani here.
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Title: Watch: John Oliver Dishes on KFF Health News' Opioid Settlements Series
Sourced From: kffhealthnews.org/news/article/watch-john-oliver-kff-health-news-payback-opioid-settlements-series/
Published Date: Fri, 17 May 2024 09:00:00 +0000
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