Phil Galewitz, KFF Health News
Tue, 21 May 2024 09:00:00 +0000

Angling to tap into strong support for the sweeping health law he helped pass 14 years ago, one of President Joe Biden's latest reelection strategies is to remind voters that former President Donald Trump tried to repeal the Affordable Care Act.

“Folks, he's coming for your health care, and we're not going to let it happen,” Biden says of Trump in a television and digital ad out this month, part of a $14 million investment in the handful of states expected to decide the presidency in November.

The new ad draws on the popularity of the ACA among independent voters and alludes to Biden's edge over Trump on health issues, which the current president hopes will help propel him to victory.

Swaying even a tiny percentage of voters could make a difference for Biden, said Kenneth Miller, an assistant professor of political science at the University of Nevada-Las Vegas.

“It will be so close,” he said. “Any little thing can be a deciding factor.”

Political experts say Biden is wise to draw attention to the ACA, which ended long-standing insurance practices denying coverage to people with preexisting conditions or charging them more — a change that is “popular across the partisan divide” and benefits about half of U.S. households, said Ashley Kirzinger, KFF's associate director of public opinion and survey research.

“Framing the ACA around those protections is a very smart move,” she said.

A new KFF survey found Biden has an edge with independent voters when it comes to health care issues.

Independents trust Biden more than Trump to ensure access to affordable health insurance (47% to 22%) and maintain protections for people with preexisting conditions (47% to 23%).

Biden holds a smaller advantage over Trump in whom independents trust more to address high health care costs (39% to 26%). The survey also found the issue isn't a slam dunk for either candidate: About a third of independent voters said they trust neither Biden nor Trump to address costs.

Democrats are fighting to extend higher government subsidies for most people with ACA coverage, which were increased during the pandemic and are set to expire in 2025. They're also banking on outrage over the Supreme Court's 2022 decision striking down Roe v. Wade, and strict abortion bans that have followed in many Republican-led states, to juice Democratic turnout.

The stakes “could not be higher for Americans who rely on the Affordable Care Act,” Biden campaign spokesperson Michael Tyler told reporters on a call this month.

The Trump campaign did not respond to a request for comment.

At least one Democratic-aligned super PAC is also running health-related ads, including on Trump's appointment of Supreme Court justices who helped overturn the constitutional right to an abortion.

Barry Burden, director of the Elections Research Center at the University of Wisconsin-Madison, said focusing on health care plays to Biden's strengths.

“Biden has been mired by voter concerns about inflation and immigration, where Republicans are preferred,” he said. “Health care is more favorable territory where the Trump campaign does not have much of a defense to offer.”

Some recent polls have shown Trump leading in most battleground states, with voters expressing pessimism about the economy.

But Trump is vulnerable on health care, Miller said. He unsuccessfully tried to repeal the ACA as president and has alluded to trying again if he returns to the White House. In November, he declared “Obamacare Sucks!” on social media, and in March he said he wants to improve the law without saying how.

“These ads are an effort to shake up the agenda,” Miller said. “Biden needs more work reminding Democrat-leaning independent voters who probably voted for him in 2020 that he is the better choice.”

Biden's ad also claims his health care policies have helped save Americans $800 a year. The Biden administration has said that's how much 13 million people buying coverage on ACA insurance marketplaces saved in 2022.

The ad's primary claim, that 100 million people would be harmed if Trump eliminated preexisting condition protections, is misleading, said Robert Speel, director of the Public Policy Initiative at Penn State Behrend. That's because many would retain the protections under their coverage, particularly those on Medicare and employer-sponsored insurance.

“The ad looks too generic to have a significant impact on the outcome of the election, though it may get through to enough of the small universe of swing voters to have at least some potential impact on who wins Pennsylvania,” Speel said.

The KFF survey of 1,243 registered voters conducted April 23-May 1 had a margin of sampling error of plus or minus 4 percentage points.

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By: Phil Galewitz, KFF Health News
Title: Biden Leans Into Health Care, Asking Voters To Trust Him Over Trump
Sourced From: kffhealthnews.org/news/article/biden-health-care-ad-buy-obamacare-aca/
Published Date: Tue, 21 May 2024 09:00:00 +0000

Did you miss our previous article…
https://www.biloxinewsevents.com/watch-medical-residents-are-increasingly-avoiding-abortion-ban-states/

Tue, 21 May 2024 09:00:00 +0000

On KFF Health News' “What the Health?,” chief Washington correspondent Julie Rovner sat down with Atul Grover of the Association of American Medical Colleges to talk about its recent analysis showing that graduating medical students are avoiding training in states with abortion bans and major restrictions. Among those who applied for residencies this year, that was true not only for aspiring OB-GYNs and others who regularly treat pregnant patients, but for all specialties.

Fourteen states, primarily in the Midwest and South, have banned nearly all abortions. The new analysis by the AAMC found that the number of applicants to residency programs in states with near-total abortion bans declined by 4.2%, compared with a 0.6% drop in states where abortion remains legal.

Find more of our reporting on what this trend means for the medical profession here.

listen to the full episode

KFF Health News' ‘What the Health?': Bird Flu Lands as the Next Public Health Challenge

Public health authorities are closely watching an unusual strain of bird flu that has infected dairy cows in nine states and at least one dairy worker. Meanwhile, another major health system suffered a cyberattack, and Congress is moving to extend the availability of telehealth services.

Listen

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Title: Watch: Medical Residents Are Increasingly Avoiding Abortion Ban States
Sourced From: kffhealthnews.org/news/article/watch-medical-residency-abortion-bans-aamc-atul-grover-analysis/
Published Date: Tue, 21 May 2024 09:00:00 +0000

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/