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Rural Nursing Home Supporters Fear Proposed Staffing Standards Will Trigger More Closures

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Tony Leys
Fri, 15 Sep 2023 09:00:00 +0000

SYRACUSE, Neb. — Many rural communities like this one face a care dilemma: Is it better to have a nursing home that struggles to hire workers or no nursing home at all?

The national debate over that question will heat up now that federal regulators have proposed to improve care by setting minimum staffing levels for all U.S. nursing homes.

Rural nursing homes would have five years to comply with some of the rules, versus three for their urban counterparts. Facilities also could apply for “hardship exemptions.” But industry leaders predict the rules could accelerate a wave of closures that has already claimed hundreds of rural nursing homes.

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Some families that rely on the Good Samaritan Society home in Syracuse fear the regulation could hasten its demise.

The facility is the town's lone nursing home. It is running at barely half its licensed capacity, and managers say they've been turning away prospective residents because they can't find enough staff to care for more.

Lana Obermeyer, whose mother lives there, said employees take good care of residents. “Are they overworked? Probably,” she said. “Isn't everybody these days?”

The Biden administration proposal, released Sept. 1, is intended to ensure higher-quality care by requiring a minimum number of hours of average daily staffing per , including 2.5 hours from certified nurse aides and 33 minutes from registered nurses.

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The proposal also would require around-the-clock coverage by at least one registered nurse at every nursing home. Regulators estimate 1,358 rural nursing homes, including 58 in Nebraska, would need to add nurses to meet that standard.

Patient-safety advocates have long pressed the government to impose such standards to prevent neglect of nursing home residents. They blame the industry for letting its staffing problems fester for decades, and many hoped the federal proposal would be more stringent.

The proposal would not affect assisted living centers, which are designed to care for people with less severe health problems.

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Syracuse, which has about 1,900 people, serves a farming region in southern Nebraska. Its red-brick nursing home sits near a cemetery, a hearing aid store, and a tractor dealership. It would need to hire several more aides and an overnight registered nurse to meet the requirements.

Most of the nursing home's 46 residents are from the area. So are most employees. Staffers often care for their former teachers, coaches, and babysitters. They know each other's families.

If the facility closed, many residents likely would be transferred to larger nursing homes in the city of Lincoln, a 40-minute drive northwest, or Omaha, which is an hour northeast. They would be placed among strangers.

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“I truly think it would kill half of these people,” said Obermeyer, whose mother, Sharon Hudson, has been in the Good Samaritan home five years.

Obermeyer lives less than a block away, and she walks over to see her mom several times a . Hudson also enjoys frequent visits from other locals, who stop by to see her after visiting their own in the facility.

Hudson has advanced Alzheimer's disease. She can no longer speak many words, but she smiles and giggles often, and tries to communicate with garbled sentences. “She's a very happy, happy person,” Obermeyer said.

Ideally, she would be served in a specialized “memory care unit,” for people with dementia. The Good Samaritan home once had one, but the unit closed several years ago for lack of staff. The wing now sits dark.

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Ten Nebraska nursing homes have shut down since 2021, said Jalene Carpenter, president of the Nebraska Health Care Association. Most have been in small towns.

The 's long-term care facilities have raised wages as much as 30% in recent years, partly because Nebraska joined most other states in substantially increasing how much its program pays for nursing home care, Carpenter said. But many of the state's 196 remaining nursing homes are limiting admissions because of staffing shortages, she said. “It's unsustainable.”

Carpenter said part of the problem is that the population of seniors who need care in many rural areas outpaces the supply of working-age adults. Job seekers have plenty of choices outside of health care, many with better hours and less stress. She noted that nine rural Nebraska counties had no registered nurses in 2021.

A prominent consumer advocate scoffed at claims that rural facilities would be unable to comply with the proposed staffing rules.

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“That's always their first response: ‘We're going to have to close,'” said Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care. “It's like, ‘The sky is falling.'”

Smetanka said the industry should have improved working conditions and wages long ago, and she contends the proposed standards are too lenient.

Regulators shouldn't offer rural nursing homes extra time to meet the staffing rule, she said. “Residents in rural facilities have the same level of needs as those in urban facilities,” she said. “Every resident deserves quality care today.”

Smetanka's group favors offering incentives, such as pay raises and housing assistance, to employees in the long-term care industry. It also wants the government to strengthen options for care in people's homes instead of in facilities.

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Industry leaders have suggested easing immigration rules to allow more workers from other countries. Smetanka said that such workers might ease the staffing shortage but that they shouldn't be subjected to the poor conditions and low pay that have driven many previous employees away.

In Iowa, 27 nursing homes have closed over the past two years, according to the Iowa Health Care Association. Most were in rural areas. About 400 remain open in the state.

John Hale, an Iowa advocate for improved long-term care, said he sympathizes with rural residents who worry about facilities closing. But he said companies sometimes use staffing woes as an excuse to shutter money-losing facilities.

Hale has roamed the halls of Iowa's Capitol for years, trying to persuade legislators to protect vulnerable seniors and people with disabilities. He said minimum staffing proposals have always been blocked by the nursing home industry, which receives millions of state and federal tax dollars from Medicaid. The industry's message to government officials boils down to “give us more money and leave us alone,” he said.

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Hale noted Iowa's government sets minimum staffing levels for child care centers to ensure kids' safety, but hasn't done so for seniors in care facilities. “I just wonder what that says about our values as a government and as a people,” he said.

The longtime federal standard for nursing homes has been that they have “sufficient” staff. Hale said that vague standard is akin to replacing speed limit signs with suggestions that motorists drive “at reasonable speeds.”

Nursing homes are required to their staffing to federal regulators, who use formulas to measure how much daily attention residents from various types of professionals, including registered nurses, licensed practical nurses, and certified nursing aides. Some states have set specific minimum staffing levels, but many, including Nebraska and Iowa, have not.

The Good Samaritan home in Syracuse is rated three out of five for overall quality on the nursing home comparison website run by Medicare. Its staffing level is rated at four stars, although its reported ratio of staff hours to residents was below national and Nebraska averages.

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The Good Samaritan Society, which owns the nursing home, is one of the country's largest nonprofit chains of care facilities. In 2021, it reported nearly $78 million in losses on nearly $1 billion in revenue. The company is owned by the giant Sanford Health system, based in South Dakota. It has closed 13 nursing homes in the past two years, mostly in rural areas.

Good Samaritan Society President Nate Schema said he fears the proposed federal staffing standards would spark more closures, forcing rural residents to seek care far from their hometowns. Family members would not be able to visit as often, he said. “Are they going to have to drive 20 or 30 or, God forbid, 100 miles?”

In a letter to federal regulators, Schema wrote that his company owns 139 nursing homes in 19 states, with nearly 1,700 open positions. At one facility in rural South Dakota, he wrote, a night-shift nursing job has been vacant for three years.

The possibility of closure is on the minds of residents and families at the Good Samaritan nursing home in Syracuse.

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Resident Nellie Swale said she knows people who had to transfer to the facility from other nursing homes that closed. They were stressed and saddened by the move, she said. “Old people really depend on routines,” she said.

Certified nursing assistant Karena Cunningham tells residents she hopes the Syracuse nursing home stays open. But, she said, “we can't make them any promises.”

Cunningham considered looking for a less stressful job, but she couldn't leave. “It's my family here. I love the friends I've made,” she said.

The facility currently has 82 employees, with 10 vacant full-time positions. The company said it spent $150,000 in the past year raising pay at the facility. The lowest starting wage for a nurse aide there has reached $18 an hour, a 30% increase from 10 months earlier.

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Cunningham said that with a bigger staff, the nursing home could accept more residents, including those with complicated issues, such as addiction, mental illness, or severe obesity.

A national minimum staffing rule sounds like it would make sense, “in a perfect world,” she said.

“Bring me these people that we're supposed to have for staff,” Cunningham said. “Where are they?”

——————————
By: Tony Leys
Title: Rural Nursing Home Supporters Fear Proposed Staffing Standards Will Trigger More Closures
Sourced From: kffhealthnews.org/news/article/rural-nursing-home-closures-staffing-standards/
Published Date: Fri, 15 Sep 2023 09:00:00 +0000

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Kaiser Health News

When You Think About Your Health, Don’t Forget Your Eyes

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Bernard J. Wolfson
Fri, 22 Sep 2023 09:00:00 +0000

I vividly remember that late Friday afternoon when my eye pressure spiked and I staggered on foot to my ophthalmologist's office as the rapidly thickening fog in my field of vision shrouded passing cars and traffic lights.

The office was already closed, but the whole eye care team was there waiting for me. One of them pricked my eyeballs with a sharp instrument, allowing the ocular fluid that had built up to drain. That relieved the pressure and restored my vision.

But it was the fourth vision-impairing pressure spike in nine days, and they feared it would happen again — into a . So off I went to the emergency room, where I spent the night hooked up to an intravenous tube that delivered a powerful anti-swelling agent.

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Later, when I told this story to friends and colleagues, some of them didn't understand the importance of eye pressure, or even what it was. “I didn't know they could measure blood pressure in your eyes,” one of them told me.

Most people consider their vision to be vitally important, yet many lack an understanding of some of the most serious eye diseases. A 2016 study published in JAMA Ophthalmology, based on an online national poll, showed that nearly half of respondents feared losing their eyesight more than their memory, speech, hearing, or limbs. Yet many “were unaware of important eye diseases,” it found.

A study released this month, conducted by Wakefield Research for the nonprofit Prevent Blindness and Regeneron Pharmaceuticals, showed that one-quarter of adults deemed at risk for diseases of the retina, such as macular degeneration and diabetic retinopathy, had delayed seeking care for vision problems.

“There is significantly less of an emphasis placed on eye than there is on general health,” says Rohit Varma, founding director of the Southern California Eye Institute at Hollywood Presbyterian Medical Center.

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Because eye diseases can be painless and progress slowly, Varma says, “people get used to it, and as they age, they begin to feel, ‘Oh, this is a normal part of aging and it's OK.'” If people felt severe pain, he says, they would go get care.

For many people, though, it's not easy to get an eye exam or eye treatment. Millions are uninsured, others can't afford their share of the cost, and many live in communities where eye doctors are scarce.

“Just because people know they need the care doesn't necessarily mean they can afford it or that they have the access to it,” says Jeff Todd, and president of Prevent Blindness.

Another challenge, reflecting the divide between eye care and general , is that medical insurance, except for , often covers only eye care aimed at diagnosing or treating diseases. More health plans are covering routine eye exams these days, but that generally does not include the type of test used to determine eyeglass and contact lens prescriptions — or the cost of the lenses. You may need separate vision insurance for that. Ask your health plan what's covered.

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Since being diagnosed with glaucoma 15 years ago, I've had more pressure checks, eye exams, eyedrops, and laser surgeries than I can remember. I should know not to take my eyesight for granted. And yet, when my peepers were filling with that vision-threatening fog last March, I felt oddly sanguine.

It turned out that those serial pressure spikes were triggered by an adverse reaction to steroid-based eyedrops prescribed to me following cataract surgery. My ophthalmologist told me later that I had “within hours” of losing my eyesight.

I hope my brush with blindness can inspire people to be more conscious of their eyes.

Eyeglasses or contact lenses can make a huge difference in one's quality of life by correcting refractive errors, which affect 150 million Americans. But don't ignore the risk of far more serious eye conditions that can sneak up on you. They are often manageable if caught early enough.

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Glaucoma, which affects about 3 million people in the U.S., attacks peripheral vision first and can cause irreversible damage to the optic nerve. It runs in families and is five times as prevalent among African Americans as in the general population.

Nearly 10 million in this country have diabetic retinopathy, a complication of diabetes in which blood vessels in the retina are damaged. And some 20 million people age 40 and up have macular degeneration, a disease of the retina associated with aging that diminishes central vision over time.

The formation of cataracts, which cause cloudiness in the eye's natural lens, is very common as people age: Half of people 75 and older have them. Cataracts can cause blindness, but they are eminently treatable with surgery.

If you are over 40 and haven't had a comprehensive eye exam in a while, or ever, put that on your to-do list. And get an exam at a younger age if you have diabetes, a family history of glaucoma, or if you are African American or part of another racial or ethnic group at high risk for certain eye diseases.

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And don't forget children. Multiple eye conditions can affect kids. Refractive errors, treatable with corrective lenses, can cause impairment later in life if they are not addressed early enough.

Healthful lifestyle choices also benefit your eyes. “Anything that helps your general health helps your vision,” says Andrew Iwach, a clinical spokesperson for the American Academy of Ophthalmology and executive director of the Glaucoma Center of San Francisco.

Minimize stress, get regular exercise, and eat a healthy diet. Also, quit smoking. It increases the risk of major eye diseases.

And consider adopting habits that protect your eyes from injury: Wear sunglasses when you go outside, take regular breaks from your computer screen and cellphone, and wear goggles when working around the house or playing sports.

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The Prevent Blindness website offers information on virtually everything related to eye health, including insurance. Other good sources include the American Academy of Ophthalmology's “EyeSmart” site and the National Eye Institute.

So read up and share what you've learned.

“When you get together for the holidays,” says Iwach, “if you aren't sure what to about, talk about your eyes.”

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: Bernard J. Wolfson
Title: When You Think About Your Health, Don't Forget Your Eyes
Sourced From: kffhealthnews.org//article/eye-health-glaucoma-asking-never-hurts/
Published Date: Fri, 22 Sep 2023 09:00:00 +0000

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Kaiser Health News

Biden Administration to Ban Medical Debt From Americans’ Credit Scores

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Noam N. Levey
Thu, 21 Sep 2023 19:47:00 +0000

The Biden administration announced a major initiative to protect Americans from medical debt on Thursday, outlining plans to develop federal rules barring unpaid medical bills from affecting ' credit scores.

The regulations, if enacted, would potentially tens of millions of people who have medical debt on their credit reports, eliminating information that can depress consumers' scores and make it harder for many to get a job, rent an apartment, or secure a car loan.

New rules would also represent one of the most significant federal actions to tackle medical debt, a problem that burdens about 100 million people and forces legions to take on extra work, give up their homes, and ration food and other essentials, a KFF Health News-NPR investigation found.

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“No one in this country should have to go into debt to get the quality care they need,” said Vice President Kamala Harris, who announced the new moves along with Rohit Chopra, head of the Consumer Financial Protection Bureau, or CFPB. The agency will be charged with developing the new rules.

“These measures will improve the credit scores of millions of Americans so that they will better be able to invest in their future,” Harris said.

Enacting new regulations can be a lengthy . Administration officials said Thursday that the new rules would be developed next year.

Such an aggressive step to restrict credit reporting and debt collection by hospitals and other medical providers will also almost certainly stir industry opposition.

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At the same time, the Consumer Financial Protection Bureau, which was formed in response to the 2008 financial crisis, is under fire from Republicans, and its future may be jeopardized by a case before the Supreme Court, whose conservative majority has been chipping away at federal regulatory powers.

But the move by the Biden administration drew strong praise from patients' and consumer groups, many of whom have been pushing for years for the federal to strengthen protections against medical debt.

“This is an important milestone in our collective efforts and will provide immediate relief to people that have unfairly had their credit impacted simply because they got sick,” said Emily Stewart, executive director of Community Catalyst, a Boston nonprofit that has helped lead national medical debt efforts. 

Credit reporting, a threat designed to induce patients to pay their bills, is the most common collection tactic used by hospitals, a KFF Health News analysis has shown.

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“Negative credit reporting is one of the biggest pain points for patients with medical debt,” said Chi Chi Wu, a senior attorney at the National Consumer Law Center. “When we hear from consumers about medical debt, they often talk about the devastating consequences that bad credit from medical debts has had on their financial lives.”

Although a single black mark on a credit score may not have a huge effect for some people, the impact can be devastating for those with large unpaid medical bills. There is growing evidence, for example, that credit scores depressed by medical debt can threaten people's access to housing and fuel homelessness in many communities.

At the same time, CFPB researchers have found that medical debt — unlike other kinds of debt — does not accurately predict a consumer's creditworthiness, calling into question how useful it is on a credit .

The three largest credit agencies — Equifax, Experian, and TransUnion — said they would stop some medical debt on credit reports as of last year. The excluded debts included paid-off bills and those less than $500.

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But the agencies' voluntary actions left out millions of patients with bigger medical bills on their credit reports. And many consumer and patient advocates called for more action. 

The National Consumer Law Center, Community Catalyst, and some 50 other groups in March sent letters to the CFPB and IRS urging stronger federal action to rein in hospital debt collection.

State leaders also have taken steps to expand consumer protections. In June, Colorado enacted a trailblazing bill that prohibits medical debt from being included on ' credit reports or factored into their credit scores.

Many groups have urged the federal government to bar tax-exempt hospitals from selling patient debt or denying medical care to people with past-due bills, practices that remain widespread across the U.S., KFF Health News found.

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Hospital leaders and representatives of the debt collection industry have warned that such restrictions on the ability of medical providers to get their bills paid may have unintended consequences, such as prompting more hospitals and physicians to require upfront payment before delivering care.

Looser credit requirements could also make it easier for consumers who can't handle more debt to get loans they might not be able to pay off, others have warned.

“It is unfortunate that the CFPB and the White House are not considering the host of consequences that will result if medical providers are singled out in their billing, compared to other professions or industries,” said Scott Purcell, chief executive of ACA International, the collection industry's leading trade association.

About This Project

“Diagnosis: Debt” is a reporting partnership between KFF Health News and NPR exploring the scale, impact, and causes of medical debt in America.

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The series draws on original polling by KFF, court , federal data on hospital finances, contracts obtained through public records requests, data on international health systems, and a yearlong investigation into the financial assistance and collection policies of more than 500 hospitals across the country. 

Additional research was conducted by the Urban Institute, which analyzed credit bureau and other demographic data on poverty, race, and health status for KFF Health News to explore where medical debt is concentrated in the U.S. and what factors are associated with high debt levels.

The JPMorgan Chase Institute analyzed records from a sampling of Chase credit card holders to look at how customers' balances may be affected by major medical expenses. And the CED Project, a Denver nonprofit, worked with KFF Health News on a survey of its clients to explore links between medical debt and housing instability. 

KFF Health News journalists worked with KFF public opinion researchers to design and analyze the “KFF Health Care Debt Survey.” The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current debt and 382 adults who had health care debt in the past five years. The margin of sampling error is plus or minus 3 percentage points for the full sample and 3 percentage points for those with current debt. For results based on subgroups, the margin of sampling error may be higher.

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Reporters from KFF Health News and NPR also conducted hundreds of interviews with patients across the country; spoke with physicians, health industry leaders, consumer advocates, debt lawyers, and researchers; and reviewed scores of studies and surveys about medical debt.

——————————
By: Noam N. Levey
Title: Biden Administration to Ban Medical Debt From Americans' Credit Scores
Sourced From: kffhealthnews.org/news/article/medical-debt-credit-score-ban-biden-administration/
Published Date: Thu, 21 Sep 2023 19:47:00 +0000

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KFF Health News’ ‘What the Health?’: Countdown to Shutdown

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Thu, 21 Sep 2023 17:30:00 +0000

The Host

Julie Rovner
KFF


@jrovner


Read Julie's stories.

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Julie Rovner is chief Washington correspondent and host of KFF Health News' weekly health policy news , “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care and Policy A to Z,” now in its third edition.

Health and other federal programs are at risk of shutting down, at least temporarily, as Congress races toward the Oct. 1 start of the fiscal year without passed any of its 12 annual appropriations bills. A small band of conservative House Republicans are refusing to approve spending bills unless domestic spending is cut beyond levels agreed to in May.

Meanwhile, former roils the GOP presidential primary field by vowing to please both sides in the divisive debate.

This week's panelists are Julie Rovner of KFF Health News, Alice Miranda Ollstein of Politico, Rachel Cohrs of Stat News, and Tami Luhby of CNN.

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Panelists

Alice Miranda Ollstein
Politico


@AliceOllstein


Read Alice's stories

Rachel Cohrs
Stat News

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@rachelcohrs


Read Rachel's stories

Tami Luhby
CNN


@Luhby

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Read Tami's stories

Among the takeaways from this week's episode:

  • The odds of a government shutdown over spending levels are rising. While entitlement programs like Medicare would be largely spared, past shutdowns have shown that closing the federal government hobbles things Americans rely on, like food safety inspections and travel.
  • In Congress, the discord isn't limited to spending bills. A House bill to increase price transparency in health care melted down before a vote this week, demonstrating again how hard it is to take on the hospital industry. Legislation on how pharmacy benefit managers operate is also in disarray, though its projected government savings means it could resurface as part of a spending deal before the end of the year.
  • On the Senate side, legislation intended to strengthen primary care is teetering under Bernie Sanders' stewardship — in large part over questions about how to pay for it. Also, this week Democrats broke Alabama Republican Sen. Tommy Tuberville's abortion-related blockade of military promotions (kind of), going around him procedurally to confirm the new chair of the Joint Chiefs of Staff.
  • And some Republicans are breaking with abortion opponents and mobilizing in of legislation to renew the United States President's Emergency Plan for AIDS Relief — the former president who spearheaded the program, George W. Bush. Meanwhile, polling shows President Joe Biden is struggling to claim credit for the new Medicare drug negotiation program.
  • And speaking of past presidents, former President Donald Trump gave NBC an interview over the weekend in which he offered a muddled stance on abortion. Vowing to settle the long, inflamed debate over the procedure — among other things — Trump's comments were strikingly general election-focused for someone who has yet to win his party's nomination.

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

Julie Rovner: The Washington Post's “Inside the Gold Rush to Sell Cheaper Imitations of Ozempic,” by Daniel Gilbert.

Alice Miranda Ollstein: Politico's “The Anti-Vaccine Movement Is on the Rise. The White House Is at a Loss Over What to Do About It,” by Adam Cancryn.

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Rachel Cohrs: KFF Health News' “Save Billions or Stick With Humira? Drug Brokers Steer Americans to the Costly Choice,” by Arthur Allen.

Tami Luhby: CNN's “Supply and Insurance Issues Snarl Fall Covid-19 Vaccine Campaign for Some,” by Brenda Goodman.

Also mentioned in this week's episode:

Credits

Francis Ying
Audio producer

Emmarie Huetteman
Editor

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To hear all our podcasts, click here.

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

——————————
Title: KFF Health News' ‘What the Health?': Countdown to Shutdown
Sourced From: kffhealthnews.org/news/podcast/what-the-health-315-countdown-to-shutdown-september-21-2023/
Published Date: Thu, 21 Sep 2023 17:30:00 +0000

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