ReportWire

Tag: Access to health care

  • What to know about the impacts Medicaid cuts are having on rural health care

    FRANCONIA, N.H. (AP) — The closing of a health center in rural New Hampshire has raised concerns that the projected cuts in Medicaid are already taking a toll.

    Last month, a site of the Ammonoosuc Community Health Services in Franconia, a town of around 1,000 people, closed for good.

    Ammonoosuc officials and a Democratic senator have blamed Medicaid cuts for the closure of the facility that served 1,400 patients from Franconia, Easton, Lincoln and Sugar Hill. These are all tiny communities around the White Mountains, whose patients typically are older and sicker than in other parts of the state.

    Threats to rural health care

    The closure of the Franconia center reflects the financial struggles facing community health centers and rural health care systems more broadly amid Medicaid cuts and a feared spike in health insurance rates. The government shutdown, which ended last week, was driven by a Democratic demand to extend tax credits, which ensure low- and middle-income people can afford health insurance through the Affordable Care Act, or ACA.

    More than 100 hospitals closed over the past decade, according to the Center For Healthcare Quality and Payment Reform, a policy and advocacy group, and more than 700 more hospitals are at risk of closure. A branch of the HealthFirst Family Care Center, a facility in Canaan, New Hampshire also announced it was closing at the end of October due in part to “changes in Medicaid reimbursement and federal funding” for these facilities.

    On average, the federally-funded community health centers like the one in Franconia are losing money, relying heavily on cash reserves, making service changes and sometimes closing locations to stay afloat, NACHC found. Nearly half have less than 90 days’ cash on hand, according to the association. And the future is even more bleak with at least 2 million community health center patients expected to lose Medicaid coverage by 2034 and 2 million more who are newly uninsured turning to the centers for care.

    Hard choices for CEO

    Ed Shanshala, the CEO of Ammonoosuc, said the Medicaid cuts are to blame for the closure of the Franconia center.

    Shanshala runs a network of five health centers in New Hampshire which relies more than $2 million in federal funding — out of a $12 million budget. He faced a $500,000 shortfall due to the cuts and realized closing Franconia would save about half that money. It also was the only facility where they leased space.

    “We’re really left with no choice,” Shanshala said, adding the closure would save $250,000. Finding additional cuts is hard, given that the centers provide services to anyone under 200% of federal poverty levels, he said. And if he cuts additional services, Shanshala fears some patients will end up in a hospital emergency room or “stop engaging in health care period.”

    Patients struggle to adjust

    Susan Bushby, a 70-year-old housekeeper, talked about how much she loved the staff and feared going to a new health center. She wouldn’t know her way around a larger facility and wouldn’t have the same rapport with the people there.

    “I was very disturbed. I was down right angry,” said Bushby, who was brought to tears as she discussed the challenges of starting over at a new health center. “I just really like it there. I don’t know, I’m just really going to miss it. It’s really hard for me to explain, but it’s going to be sad.”

    Marsha Luce, whose family moved from Washington, D.C. area, in 2000, is especially concerned about the impact on her 72-year-old husband, a former volunteer firefighter who has a left ear and part of his jaw removed due to cancer. He also has heart and memory issues.

    She worries about longer waits to see his doctor and the loss of relationships built up over decades in Franconia.

    “It’s going to be hard,” she said. “But it’s a relationship that’s going to be missed. It’s a relationship that you can talk to people and you tell them something and you go, yeah, well, I’ve had cancer. Oh, let’s see. Oh, yeah. There it is in your chart. Do you know what I mean?”

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  • Expect health insurance prices to rise next year, brokers and experts say

    Pricey prescriptions and nagging medical costs are swamping some insurers and employers now. Patients may start paying for it next year.

    Health insurance will grow more expensive in many corners of the market in 2026, and coverage may shrink. That could leave patients paying more for doctor visits and dealing with prescription coverage changes.

    Price increases could be especially stark in individual coverage marketplaces, where insurers also are predicting the federal government will end some support that helps people buy coverage.

    “We’re in a period of uncertainty in every health insurance market right now, which is something we haven’t seen in a very long time,” said Larry Levitt, an executive vice president at the nonprofit KFF, which studies health care.

    In conference calls to discuss recent earnings reports, insurers ticked off a list of rising costs: More people are receiving care. Visits to expensive emergency rooms are rising, as are claims for mental health treatments.

    Insurers also say more healthy customers are dropping coverage in the individual market. That leaves a higher concentration of sicker patients who generate claims.

    Enrollment in the Affordable Care Act’s insurance marketplaces swelled the past few years. But a crackdown on fraud and a tightening of eligibility verifications that were loosened during the COVID-19 pandemic makes it harder for some to stay covered, Jefferies analyst David Windley noted.

    People who use little care “are disappearing,” he said.

    Prescription drugs pose another challenge, especially popular and expensive diabetes and obesity treatments sometimes called GLP-1 drugs. Those include Ozempic, Mounjaro, Wegovy and Zepbound.

    “Pharmacy just gives me a headache, no pun intended,” said Vinnie Daboul, Boston-based managing director of the employee benefits consultant RT Consulting.

    New gene therapies that can come with a one-time cost of more than $2 million also are having an impact, insurance brokers say. Those drugs, which target rare diseases, and some newer cancer treatments are part of the reason Sun Life Financial covered 47 claims last year that cost over $3 million.

    The financial services company covers high-cost claims for employers that pay their own medical bills. Sun Life probably had no claims that expensive a decade ago and maybe “a handful at best” five years ago, said Jen Collier, president of health and risk solutions.

    Some of these drugs are rarely used, but they cause overall costs to rise. That raises insurance premiums.

    “It’s adding to medical (cost growth) in a way that we haven’t seen in the past,” Collier said.

    Price hikes will be most apparent on the Affordable Care Act’s individual coverage marketplaces. Insurers there are raising premiums around 20% in 2026, according to KFF, which has been analyzing state regulatory filings.

    But the actual hike consumers see may be much bigger. Enhanced tax credits that help people buy coverage could expire at the end of the year, unless Congress renews them.

    If those go away, customer coverage costs could soar 75% or more, according to KFF.

    Business owner Shirley Modlin worries about marketplace price hikes. She can’t afford to provide coverage for the roughly 20 employees at 3D Design and Manufacturing in Powhatan, Virginia, so she reimburses them $350 a month for coverage they buy.

    Modlin knows her reimbursement only covers a slice of what her workers pay. She worries another price hike might push some to look for work at a bigger company that offers benefits.

    “My employee may not want to go to work for a large corporation, but when they consider how they have to pay their bills, sometimes they have to make sacrifices,” she said.

    Costs also have been growing in the bigger market for employer-sponsored coverage, the benefits consultant Mercer says. Employees may not feel that as much because companies generally pay most of the premium.

    But they may notice coverage changes.

    About half the large employers Mercer surveyed earlier this year said they are likely or very likely to shift more costs to their employees. That may mean higher deductibles or that people have to pay more before they reach the out-of-pocket maximum on their coverage.

    For prescriptions, patients may see caps on those expensive obesity treatments or limits on who can take them.

    Some plans also may start using separate deductibles for their pharmaceutical and medical benefits or having patients pay more for their prescriptions, Daboul said.

    Coverage changes could vary around the country, noted Emily Bremer, president of a St. Louis-based independent insurance agency, The Bremer Group.

    Employers aren’t eager to cut benefits, she said, so people may not see dramatic prescription coverage changes next year. But that may not last.

    “If something doesn’t give with pharmacy costs, it’s going to be coming sooner than we’d like to think,” Bremer said.

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    The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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  • Banning UNRWA will lead to a vacuum and more suffering for Palestinians, the agency’s chief says

    Banning UNRWA will lead to a vacuum and more suffering for Palestinians, the agency’s chief says

    RIYADH, Saudi Arabia — The head of the U.N. agency caring for Palestinian refugees said Wednesday that newly passed Israeli laws effectively banning its activities in Israel will leave a vacuum that will cost more lives and create further instability in Gaza and the West Bank.

    Philippe Lazzarini, the commissioner-general of the United Nations Relief and Works Agency, or UNRWA, told The Associated Press in an exclusive interview — the first since the laws were passed — that the legislation is “ultimately against the Palestinians themselves,” effectively denying them a functioning provider of lifesaving services, education and health care.

    UNRWA has been the main agency procuring and distributing aid in the Gaza Strip, where almost the entire population of around 2.3 million Palestinians relies on the agency for survival amid Israel’s nearly 13-month-old war with the militant Hamas group.

    Tens of thousands of displaced Palestinians are sheltering in UNRWA-run schools. Other aid groups say the agency’s strong, decades-old infrastructure across Gaza is irreplaceable. So far, Israel has put forward no plan for getting food, medicine and other supplies to Gaza’s population in UNRWA’s absence.

    Israel alleges that Hamas and other militants have infiltrated UNRWA, using its facilities and taking aid — claims for which it has provided little evidence. The laws, passed by parliament this week, sever all ties with UNRWA and ban its operations in Israel.

    And since the agency’s operations in Gaza and the West Bank must go through Israeli authorities, the laws threaten to close its activities there as well. The laws are expected to come into effect in three months.

    If the Israeli decision is implemented “this would be a total disaster, it is like throwing (out) the baby with the water,” Lazzarini told the AP, speaking in the Saudi capital, Riyadh, where he is attending a conference to discuss the Mideast conflict.

    “This would create a vacuum. It would also feed more instability in the West Bank and Gaza,” he said. “Having UNRWA ending its activities within the three months would also mean more people will die in Gaza.”

    He said the agency is looking for “creative ways to keep our operation going.” He appealed for support from the U.N. General Assembly and donors to keep providing services and called on Israel to rescind the decision or extend the three-month grace period. He said Israel has not officially communicated with the agency following the adoption of the laws.

    For decades, UNRWA has operated networks of schools, medical facilities and other services around Gaza and the West Bank — as well as in neighboring Lebanon, Syria and Jordan. In Gaza especially, it plays a major role in maintaining social services and the economy, as the territory’s largest single employer and the source of education and health care for much of the population.

    The laws threaten to shut down all those operations, impacting the education and welfare of hundreds of thousands of children well into the future, he said.

    “We have today 1 in 2 persons in Gaza below the age of 18, among them 650,000 girls and boys living in the rubble, deeply traumatized at the age of primary and secondary school,” he said. “Getting rid of UNRWA is also a way to tell these children that you will have no future. We are just sacrificing your education. Education is the only thing which has never, ever been taken away from the Palestinians.”

    UNRWA was established to help the estimated 700,000 Palestinians who fled or were driven out of what is now Israel during the 1948 war surrounding Israel’s creation. It now offers support to the refugees and their descendants, who number some 6 million around the region.

    Lazzarini said the Israeli laws are the “culmination of years of attack against the agency.” He said “the objective is to strip the Palestinian from refugee status.”

    International law gives Palestinian refugees and their descendants the right to return to their homes. Israel has refused to allow their return, saying it would end the Jewish majority in the country. Israel has said the refugees should be taken in by their host countries, and officials often argue that UNRWA’s services keep Palestinians’ hopes for return alive.

    In a letter to the U.N, Lazzarini said the Israeli laws and campaign against the agency “will not terminate the refugee status of the Palestinians, which exists independently of UNRWA’s services, but will severely harm their lives and future.”

    Israel claims hundreds of Palestinian militants work for UNRWA, without providing evidence, and that more than a dozen employees took part in Hamas’ Oct. 7, 2023 attack on Israel that ignited the latest war.

    The U.N. has fired nine staffers after internal investigations found they may have participated in the attack. UNRWA has nearly 30,000 staff around the region, including 13,000 in Gaza, most of them Palestinians. Israel also says Hamas fighters operate in UNRWA schools and other facilities in Gaza — and has hit many of them with airstrikes.

    UNRWA denies knowingly aiding armed groups and says it acts quickly to purge any suspected militants from its ranks.

    Lazzarini said Israel has not responded to inquiries from UNRWA for details about other allegations, including that the agency’s premises are used by militant groups.. With the continued fighting, the agency has been unable to verify the claims, he said and called for an independent investigation.

    At least 237 UNRWA staff have been killed in the war in Gaza, a toll among U.N. staff not seen in any other conflict. Over 200 UNRWA facilities have been damaged or destroyed, killing more than 560 people sheltering there.

    Lazzarini spoke on the sidelines of the conference by the Global Alliance for a Two-State Solution, a Saudi government-created initiative attended by foreign ministers from Arab, Muslim, African and European countries.

    “If we want to be successful in any future political transition, we need an agency like UNRWA taking care of education and the primary health of the Palestinian refugees” until there is a viable functioning state or administration to do so, he said.

    ___

    El Deeb reported from Beirut.

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  • Medicare Advantage shopping season arrives with a dose of confusion and some political implications

    Medicare Advantage shopping season arrives with a dose of confusion and some political implications

    Thinner benefits and coverage changes await many older Americans shopping for health insurance this fall. That’s if their plan is even still available in 2025.

    More than a million people will probably have to find new coverage as major insurers cut costs and pull back from markets for Medicare Advantage plans, the privately run version of the federal government’s coverage program mostly for people ages 65 and older.

    Industry experts also predict some price increases for Medicare prescription drug plans as required coverage improvements kick in.

    Voters will learn about the insurance changes just weeks before they pick the next president and as Democrat Kamala Harris campaigns on promises to lower health care costs. Early voting has already started in some states.

    “This could be bad news for Vice President Harris. If that premium is going up, that’s a very obvious sign that you’re paying more,” said Massey Whorley, an analyst for health care consulting company Avalere. “That has significant implications for how they’re viewing the performance of the current administration.”

    Insurance agents say the distraction of the election adds another complication to an already challenging annual enrollment window that starts next month.

    Insurers are pulling back from Medicare Advantage

    Medicare Advantage plans will cover more than 35 million people next year, or around half of all people enrolled in Medicare, according to the federal government. Insurance agents say they expect more people than usual will have to find new coverage for 2025 because their insurer has either ended a plan or left their market.

    The health insurer Humana expects more than half a million customers — about 10% of its total — to be affected as it pulls Medicare Advantage plans from places around the country. Many customers will be able to transfer to other Humana plans, but company leaders still anticipate losing a few hundred thousand customers.

    CVS Health’s Aetna projects a similar loss, and other big insurers have said they are leaving several states.

    Insurers say rising costs and care use, along with reimbursement cuts from the government, are forcing them to pull back.

    Some people can expect a tough search

    When insurers leave Medicare Advantage markets, they tend to stop selling plans that have lower quality ratings and those with a higher proportion of Black buyers, said Dr. Amal Trivedi, a Brown University public health researcher.

    He noted that market exits can be particularly hard on people with several doctors and on patients with cognitive trouble like dementia.

    Most markets will still have dozens of plan choices. But finding a new option involves understanding out-of-pocket costs for each choice, plus figuring out how physicians and regular prescriptions are covered.

    “People don’t like change when it comes to health insurance because you don’t know what’s on the other side of the fence,” said Tricia Neuman, a Medicare expert at KFF, a nonprofit that researches health care.

    Plans that don’t leave markets may raise deductibles and trim perks like cards used to pay for utilities or food.

    Those proved popular in recent years as inflation rose, said Danielle Roberts, co-founder of the Fort Worth, Texas, insurance agency Boomer Benefits.

    “It’s really difficult for a person on a fixed income to choose a health plan for the right reasons … when $900 on a flex card in free groceries sounds pretty good,” she said.

    Don’t “sleep” on picking a Medicare plan

    Prices also could rise for some so-called standalone Part D prescription drug plans, which people pair with traditional Medicare coverage. KFF says that population includes more than 13 million people.

    The Centers for Medicare and Medicaid Services said Friday that premiums for these plans will decrease about 4% on average to $40 next year.

    But brokers and agents say premiums can vary widely, and they still expect some increases. They also expect fewer plan choices and changes to formularies, or lists of covered drugs. Roberts said she has already seen premium hikes of $30 or more from some plans for next year.

    Any price shift will hit a customer base known to switch plans for premium changes as small as $1, said Fran Soistman, CEO of the online insurance marketplace eHealth.

    The changes come as a congressional-approved coverage overhaul takes hold. Most notably, out-of-pocket drug costs will be capped at $2,000 for those on Medicare, an effort championed by Democrats and President Joe Biden in 2022.

    In the long run, these changes will lead to a “much richer benefit,” Whorley said.

    KFF’s Neuman noted that the cap on drug costs will be especially helpful to cancer patients and others with expensive prescriptions. She estimates about 1.5 million people will benefit.

    To ward off big premium spikes because of the changes, the Biden administration will pull billions of dollars from the Medicare trust fund to pay insurers to keep premium prices down, a move some Republicans have criticized. Insurers will not be allowed to raise premium prices beyond $35 next year.

    People will be able to sign up for 2025 coverage between Oct. 15 and Dec. 7. Experts say all the potential changes make it important for shoppers to study closely any new choices or coverage they expect to renew.

    “This is not a year to sleep on it, just re-enroll in the status quo,” said Whorley, the health care analyst.

    ___

    The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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  • The US government wants to make it easier for you to click the ‘unsubscribe’ button

    The US government wants to make it easier for you to click the ‘unsubscribe’ button

    WASHINGTON — In the name of consumer protection, a slew of U.S. federal agencies are working to make it easier for Americans to click the unsubscribe button for unwanted memberships and recurring payment services.

    A broad new government initiative, dubbed “Time Is Money,” includes a rollout of new regulations and the promise of more for industries spanning from healthcare and fitness memberships to media subscriptions.

    “The administration is cracking down on all the ways that companies, through paperwork, hold times and general aggravation waste people’s money and waste people’s time and really hold onto their money,” Neera Tanden, White House domestic policy adviser, told reporters Friday in advance of the announcement.

    “Essentially in all of these practices, companies are delaying services to you or really trying to make it so difficult for you to cancel the service that they get to hold onto your money for longer and longer,” Tanden said. “These seemingly small inconveniences don’t happen by accident — they have huge financial consequences.”

    Efforts being rolled out Monday include a new Federal Communications Commission inquiry into whether to impose requirements on communications companies that would make it as easy to cancel a subscription or service as it was to sign up for one.

    The Federal Trade Commission in March 2023 initiated “click to cancel” rulemaking requiring companies to let customers end subscriptions as easily as they started them.

    Also Monday, the heads of the departments of Labor and of Health and Human Services are asking health insurance companies and group health plans to make improvements to customer interactions with their health coverage, and “in the coming months will identify additional opportunities to improve consumers’ interactions with the health care system,” according to a White House summary.

    The government already has launched several initiatives aimed at improving the consumer experience.

    In October, the FTC announced a proposed rule to ban hidden and bogus junk fees, which can mask the total cost of concert tickets, hotel rooms and utility bills.

    In April, the Transportation Department finalized rules that would require airlines to automatically issue cash refunds for things like delayed flights and to better disclose fees for baggage or reservation cancellations.

    The department also has taken actions against individual companies accused of misleading customers.

    In June, the Justice Department, referred by the FTC, filed a lawsuit against software maker Adobe and two of its executives, Maninder Sawhney and David Wadhwani, for allegedly pushing consumers toward the firm’s “annual paid monthly” subscription without properly disclosing that canceling the plan in the first year could cost hundreds of dollars.

    Dana Rao, Adobe’s general counsel, said in an emailed statement that Adobe disagrees with the lawsuit’s characterization of its business and “we will refute the FTC’s claims in court.”

    “The early termination fees equate to minimal impact to our revenue, accounting for less than half a percent of our total revenue globally, but is an important part of our ability to offer customers a choice in plans that balance cost and commitment,” Rao said.

    Some business advocates are not a fan of the government’s overall efforts to crack down on junk fees.

    Sean Heather, senior vice president of international regulatory affairs and antitrust at the U.S. Chamber of Commerce, said the initiative is “nothing more than an attempt to micromanage businesses’ pricing structures, often undermining businesses’ ability to give consumers options at different price points.”

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  • The US government wants to make it easier for you to click the ‘unsubscribe’ button

    The US government wants to make it easier for you to click the ‘unsubscribe’ button

    WASHINGTON — In the name of consumer protection, a slew of U.S. federal agencies are working to make it easier for Americans to click the unsubscribe button for unwanted memberships and recurring payment services.

    A broad new government initiative, dubbed “Time Is Money,” includes a rollout of new regulations and the promise of more for industries spanning from healthcare and fitness memberships to media subscriptions.

    “The administration is cracking down on all the ways that companies, through paperwork, hold times and general aggravation waste people’s money and waste people’s time and really hold onto their money,” Neera Tanden, White House domestic policy adviser, told reporters Friday in advance of the announcement.

    “Essentially in all of these practices, companies are delaying services to you or really trying to make it so difficult for you to cancel the service that they get to hold onto your money for longer and longer,” Tanden said. “These seemingly small inconveniences don’t happen by accident — they have huge financial consequences.”

    Efforts being rolled out Monday include a new Federal Communications Commission inquiry into whether to impose requirements on communications companies that would make it as easy to cancel a subscription or service as it was to sign up for one.

    The Federal Trade Commission in March 2023 initiated “click to cancel” rulemaking requiring companies to let customers end subscriptions as easily as they started them.

    Also Monday, the heads of the departments of Labor and of Health and Human Services are asking health insurance companies and group health plans to make improvements to customer interactions with their health coverage, and “in the coming months will identify additional opportunities to improve consumers’ interactions with the health care system,” according to a White House summary.

    The government already has launched several initiatives aimed at improving the consumer experience.

    In October, the FTC announced a proposed rule to ban hidden and bogus junk fees, which can mask the total cost of concert tickets, hotel rooms and utility bills.

    In April, the Transportation Department finalized rules that would require airlines to automatically issue cash refunds for things like delayed flights and to better disclose fees for baggage or reservation cancellations.

    The department also has taken actions against individual companies accused of misleading customers.

    In June, the Justice Department, referred by the FTC, filed a lawsuit against software maker Adobe and two of its executives, Maninder Sawhney and David Wadhwani, for allegedly pushing consumers toward the firm’s “annual paid monthly” subscription without properly disclosing that canceling the plan in the first year could cost hundreds of dollars.

    Dana Rao, Adobe’s general counsel, said in an emailed statement that Adobe disagrees with the lawsuit’s characterization of its business and “we will refute the FTC’s claims in court.”

    “The early termination fees equate to minimal impact to our revenue, accounting for less than half a percent of our total revenue globally, but is an important part of our ability to offer customers a choice in plans that balance cost and commitment,” Rao said.

    Some business advocates are not a fan of the government’s overall efforts to crack down on junk fees.

    Sean Heather, senior vice president of international regulatory affairs and antitrust at the U.S. Chamber of Commerce, said the initiative is “nothing more than an attempt to micromanage businesses’ pricing structures, often undermining businesses’ ability to give consumers options at different price points.”

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  • Widespread global tech outage disrupts flights, banks, hospitals and media outlets

    Widespread global tech outage disrupts flights, banks, hospitals and media outlets

    FRANKFURT, Germany — A global technology outage caused by a faulty software update grounded flights, knocked banks and media outlets offline, and disrupted hospitals, small businesses and other services on Friday, highlighting the fragility of a digitized world dependent on just a handful of providers.

    The trouble with the update issued by cybersecurity firm CrowdStrike and affecting computers running Microsoft Windows was not a hacking incident or cyberattack, according to CrowdStrike, which apologized and said a fix was on the way.

    But hours later, the disruptions continued — and escalated.

    Long lines formed at airports in the U.S., Europe and Asia as airlines lost access to check-in and booking services at a time when many travelers are heading away on summer vacations. Hospitals and doctors’ offices had problems with their appointment systems, and cancelled non-urgent surgeries. Several TV stations in the U.S. were also prevented from airing local news early Friday.

    Saskia Oettinghaus, a member of the German Olympic diving team, was among those stuck at the Berlin Airport.

    “We are on our way to Paris for the Olympic Games and now we are at a standstill here for the time being,” Oettinghaus said.

    Other athletes and spectators traveling to Paris were delayed, as were their uniforms and accreditations, but Games organizers said disruptions were limited and didn’t affect ticketing or the torch relay.

    “This is a very, very uncomfortable illustration of the fragility of the world’s core internet infrastructure,” said Ciaran Martin, a professor at Oxford University’s Blavatnik School of Government and former Head of Britain’s National Cyber Security Centre.

    Cyber expert James Bore said real harm would be caused by the outage because systems people have come to rely on at critical times are not going to be available. Hospitals, for example, will struggle to sort out appointments and those who need care may not get it — and it will lead to deaths, he said.

    “All of these systems are running the same software,” Bore said. “We’ve made all of these tools so widespread that when things inevitably go wrong — and they will, as we’ve seen — they go wrong at a huge scale.”

    The head of Germany’s IT security agency, Claudia Plattner, said that “the problems will last some time — we can’t expect a very quick solution.” A forecast for when exactly all systems will be up and running is difficult, but “it won’t be hours,” she added.

    Microsoft spokesperson Frank X. Shaw confirmed in an emailed statement that “a CrowdStrike update was responsible for bringing down a number of Windows systems globally.” Earlier, the company had posted on the social media platform X that it was working to “alleviate impact” and that they were “observing a positive trend in service availability.”

    During an interview on NBC’s “Today Show” Friday, CrowdStrike CEO George Kurtz apologized for the outage, saying the company was “deeply sorry for the impact that we’ve caused to customers, to travelers, to anyone affected by this, including our companies.”

    “We know what the issue is” and are working to remediate it, Kurtz said.

    “It was only the Microsoft operating system” that was affected, though it didn’t happen on every Microsoft Windows system, he said.

    The Austin, Texas-based company’s shares were down nearly 10% in early trading Friday.

    A recording playing on its customer service line said, “CrowdStrike is aware of the reports of crashes on Microsoft ports related to the Falcon sensor,” referring to one of its products used to block online attacks.

    Meanwhile, governments and companies across the world scrambled to respond.

    The White House said President Joe Biden was briefed on the outage and his team has been touch with the company and other impacted entities.

    New Zealand’s acting prime minister, David Seymour, said on X that officials in the country were “moving at pace to understand the potential impacts,” adding that he had no information indicating it was a cybersecurity threat.

    The issue was causing “inconvenience” for the public and businesses, he added.

    On the Milan stock exchange, the FTSE MIB index of blue-chip Italian stocks could not be compiled for an hour, though trading continued.

    Major delays reported at airports grew on Friday morning, with most attributing the problems in booking systems of individual airlines.

    In the U.S., airlines United, American and Delta said that at least some flights were resuming after severe disruptions, though delays would persist.

    Airlines and railways in the U.K. were also affected, with longer than usual waiting times.

    In Germany, Berlin-Brandenburg Airport halted flights for several hours due to difficulties in checking in passengers, while landings at Zurich airport were suspended and flights in Hungary, Italy and Turkey disrupted.

    The Dutch carrier KLM said it had been “forced to suspend most” of its operations.

    Amsterdam’s Schiphol Airport warned that the outage was having a “major impact on flights” to and from the busy European hub. The chaotic morning coincided with one of the busiest days of the year for Schiphol.

    Widespread problems were reported at Australian airports, where lines grew and some passengers were stranded as online check-in services and self-service booths were disabled — although flights were still operating. Meanwhile, passengers stood in long lines at Rome’s Leonardo Da Vinci airport after flights were cancelled following a global power outage.

    In New England, the outage led to delays at airports and for some hospitals to cancel appointments.

    At Mass General Brigham, the largest health care system in Massachusetts, all scheduled non-urgent surgeries, procedures, and medical visits were cancelled Friday because of the outage, according to a spokesperson. Emergency departments remain open and care for patients in the hospital has not been impacted.

    While the outages were being experienced worldwide, Australia appeared to be severely affected by the issue. Disruption reported on the site DownDetector included the banks NAB, Commonwealth and Bendigo, and the airlines Virgin Australia and Qantas, as well as internet and phone providers such as Telstra.

    National news outlets — including public broadcaster ABC and Sky News Australia — were unable to broadcast on their TV and radio channels for hours. Some news anchors went on air online from dark offices, in front of computers showing “blue screens of death.”

    Hospitals in several countries also reported problems.

    Britain’s National Health Service said the outage caused problems at most doctors’ offices across England. NHS England said in a statement said the glitch was affecting the appointment and patient record system used across the public health system.

    Some hospitals in northern Germany canceled all elective surgery scheduled for Friday, but emergency care was unaffected.

    Shipping was disrupted too: A major container hub in the Baltic port of Gdansk, Poland, the Baltic Hub, said it was battling problems resulting from the global system outage.

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    Kurtenbach reported from Bangkok and Graham-McLay from Wellington, New Zealand. Associated Press journalists around the world contributed.

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  • Kyiv hit with heaviest bombardment in months

    Kyiv hit with heaviest bombardment in months

    KYIV, Ukraine — The sky was crystal clear as Oksana Femeniuk took her daughter to Ukraine’s largest children’s hospital for routine dialysis.

    Around 10 a.m, air-raid sirens blared. Sixteen-year old Solomiia was undergoing the treatment that required her to sit still for up to five hours and could not be interrupted. Her mother had to flee to the hospital’s basement shelter without her.

    Hurtling toward them at 435 to 497 miles per hour was a Russian Kh-101 cruise missile, according to Ukraine’s security service, the United Nations and open-source investigators. Using painstaking trial and error, Russia has modified the weapon over the last year to defeat Ukraine’s air defense systems by flying at low altitude and hugging terrain, according to military analysts.

    Minutes later the world turned black. Neither the patient nor her mother would remember the moment the missile struck. But they remember the chaos that ensued after regaining consciousness: Femeniuk thought she would choke from the fumes. Solomiia woke to find the ceiling crumpled over her small body.

    In an operating room in the next building, pediatric surgeon Oleh Holubchenko had been preparing to operate on an infant with a congenital facial defect. Covered in shrapnel wounds, he realized that the blast wave had catapulted him to the other side of the operating room.

    The toll of Russia’s heaviest bombardment of Kyiv in almost four months — one of the deadliest of the war — shows the devastating human cost of Russia’s improved targeting tactics.

    The hospital’s director general, Volodymyr Zhovnir, stood at the scene of the explosion, eclipsed by the towering building with shattered windows. No children died, thank God, he said, but they lost a dear colleague, Dr. Svitlana Lukianchuk.

    Lukianchuk was hurrying along the children and parents from the toxicology building, which would later be destroyed, to the shelter. She returned to empty out more rooms. and then, the explosion, Femeniuk remembers.

    Solomiia was born with chronic renal failure, making hemodialysis part of her life.

    After the full-scale invasion, Femeniuk left her three children and husband behind in the small village near Rivne, in western Ukraine, to live in the capital so the girl could access the treatment she needs.

    Leaving her daughter during the air raid was a difficult decision. But the 34-year old mother had to project strength, she said. Her daughter was being brave by staying, knowing she could not interrupt her treatment. Femeniuk could not reveal to her daughter that she was actually terrified.

    As the air-raid siren blared, the girl was on her phone watching videos. Given how long dialysis can take, she tends to get bored.

    She awoke to find the ceiling in front of her eyes and the head doctor tending to her covered in blood and on her knees.

    The girl’s first impulse was to put her hands up to the ceiling to keep tons of concrete and debris from crushing her small body. She was trapped with a few other patients and hospital staff, and they were safely pulled out of the rubble.

    “The first thing I thought about was my mom, if she is alive or not. Then I thought: ‘Am I alive or not?’” she said, her fingers painted with small flowers, fidgeting as she spoke. Mother and daughter recounted their experience from the Kyiv City Children’s Clinical Hospital, where Solomiia was transferred.

    In the shelter, the exit was blocked and the fire blazing outside soon invaded the small space. Femeniuk called her husband, telling him she didn’t know if she would survive and she didn’t know if Solomiia was still alive.

    Eventually, those taking shelter managed to push their way out and to their horror they realized that the very building they had been in, that some of their children had been in, was hit. Femeniuk began picking up pieces of rubble in panic, calling out her daughter’s name. Then she saw the nurse who had been assisting them, covered in blood.

    Solomiia had been evacuated after the blast, the nurse said. She was safe.

    Meanwhile, in the operating room, it took Holubchenko fifteen minutes to realize that he was covered in shrapnel wounds. The doctor was too busy evacuating patients, starting with the 5-month old whose surgery was eventually completed elsewhere.

    “My colleagues and I who were in the operating room received shrapnel wounds to the body, the face, back, arms and legs,” he said. “There are glass windows in the operating room, the doors. All of it was just blown off, all destroyed.”

    In the hospital ward, he looked out to the street from a shattered window.

    “There used to be a wall here,” he said.

    When he went outside and realized the toxicology building had collapsed, his mind reverted to the times he would have consultations with patients there and check-ups. Now half the building was caved in.

    But he didn’t dwell on the thought for long and joined a line of volunteers, health workers and emergency crews removing debris, piece by piece.

    “Everyone wanted to do something,” he said.

    The assault hit seven of the city’s 10 districts. The strike on the Okhmatdyt children’s hospital, where 627 children were being cared for at the time, drew ire from Ukrainian officials and the international community. Two adults were killed, including a female doctor, and 50 were injured.

    Russia denied responsibility for the hospital strike, insisting it doesn’t attack civilian targets in Ukraine despite abundant evidence to the contrary, including AP reporting. Moscow insisted it was a Ukrainian air defense missile that struck the hospital.

    Artem Starosiek, the founder of the Ukainian group Molfar, which analyzes events based on open-source evidence, said there were overwhelming signs of Russia’s culpability. The missile used in the attack bears the characteristics of the Kh-101, he said, pointing to the shape of the body, tail and location of the wings, he said.

    That it was a clear blue day also played an important role, he said. Launching the modified missile during a sunny day is optimal for the weapon’s optoelectronic system to recognize the target correctly, he said.

    “The force of the warhead’s explosion is important; an air-defense missile could not have caused such consequences,” he said.

    By SAMYA KULLAB – Associated Press

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  • Forced labor, same-sex marriage, shoplifting on the ballot in California this year

    Forced labor, same-sex marriage, shoplifting on the ballot in California this year

    SACRAMENTO, Calif. — Forced labor, same-sex marriage and shoplifting are among the 10 statewide ballot measures that California voters are set to consider in November.

    The California secretary of state assigned proposition numbers to the measures on Wednesday after the Legislature added two more bond proposals to the ballot.

    Here’s a look at what voters will decide in November:

    This asks voters for permission to borrow $10 billion for public school construction and repairs. Most of the money, $8.5 billion, would go to elementary and secondary schools. The rest, or $1.5 billion, would go to community colleges. No money would be available for the California State University or University of California systems.

    This would remove the ban on same-sex marriage from the California Constitution. Voters added that ban to the constitution in 2008. But the U.S. Supreme Court has prevented California from enforcing the ban since 2013. Still, the language banning same-sex marriage remains in the state constitution. The proposed amendment would remove the ban and replace it with language saying, “The right to marry is a fundamental right.”

    This asks voters for permission to borrow $10 billion for various climate programs. The largest chunk of the money, $3.8 billion, would help pay to improve drinking water systems and prepare for droughts and floods. Programs preparing for wildfires would receive $1.5 billion while programs combating sea level rise would get $1.2 billion.

    The rest would be divided up among parks and outdoor recreation programs, clean air initiatives and programs preparing for extreme heat, protecting biodiversity and helping make farms and ranches sustainable.

    This would change the state constitution to make it easier for local governments to borrow money, provided they use the funds to build affordable housing or public infrastructure. Local governments, excluding school districts, currently can borrow money only if two-thirds of voters approve.

    This would lower that threshold to 55% for affordable housing and public infrastructure projects. Public infrastructure includes water and sewer systems, public transportation, libraries, broadband internet and hospitals.

    This would change the California Constitution to ban forced labor in any form. The constitution currently bans involuntary servitude, or forced labor, except as a punishment for crime. That exemption has become a target of criminal justice advocates concerned about prison labor conditions. It is not uncommon for people who are incarcerated to be put to work earning less than $1 an hour.

    This eventually would increase California’s minimum wage to $18 per hour. It is currently $16 per hour for most people and $20 per hour for fast food workers. Health care workers will eventually see their minimum wage reach $25 per hour, according to a law that Democratic Gov. Gavin Newsom signed last year.

    This would repeal a state law prohibiting cities and counties from capping rents on single-family homes, condominiums and apartments built after 1995. Supporters say the proposal would help prevent homelessness.

    Similar measures failed in 2018 and 2020 amid fierce opposition led by landlord groups and the real-estate industry. Opponents argued the proposal would hurt mom-and-pop landlords and discourage the construction of affordable housing.

    State lawmakers in 2019 approved a 10% statewide cap on annual rent increases. The law exempted new construction for 15 years and is set to expire in 2030. Several cities including Los Angeles, San Francisco and San Jose also have local rent control policies.

    This would permanently allow California’s Medicaid program to pay pharmacies directly for prescription drugs. California started doing this in 2019 after Newsom signed an executive order allowing the payments. This measure would make it a law.

    The measure also would require some health care providers to spend almost all of the money they get from a federal prescription drug program directly on patient care instead of other things.

    This proposition appears to be directed at the AIDS Healthcare Foundation. The measure has the backing of the California Apartment Association, which helped pay for an ad criticizing the AIDS Healthcare Foundation. The foundation has said it is being targeted for its support for rent control.

    This would make the state pay doctors more money for treating patients who are covered by Medicaid, the government-funded health insurance program for people with low incomes.

    Managed care organizations contract with the state to provide these health benefits. The state taxes these organizations to help pay for the Medicaid program. This measure would require the state to use a portion of that tax money to increase how much Medicaid pays doctors.

    This would make the crime of shoplifting a felony for repeat offenders and increase penalties for some drug charges, including those involving the synthetic opioid fentanyl. It also would give judges the authority to order those with multiple drug charges to get treatment.

    Proponents said the initiative is necessary to close loopholes in existing laws that have made it challenging for law enforcement to punish shoplifters and drug dealers.

    Opponents, including Democratic state leaders and social justice groups, said the proposal would disproportionately imprison poor people and those with substance use issues rather than target ringleaders who hire large groups of people to steal goods for them to resell online.

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  • Senior doctors in England agree pay deal with UK government that will end year-long dispute

    Senior doctors in England agree pay deal with UK government that will end year-long dispute

    LONDON — Senior doctors in England have accepted a pay offer from the British government that ends a yearlong dispute with unprecedented strike action.

    The British Medical Association and the Hospital Consultants and Specialists Association, which represent the senior doctors, who are known as consultants, said Friday that 83% of those casting a vote backed the offer.

    The pay increases will see those who have been consultants between four and seven years getting a 2.85% uplift. It also addresses some gender pay issues in the state-owned National Health Service and enhances parental leave options

    Consultants have held several strikes over the past year, which has hobbled the NHS as it tries to grapple with financial constraints and the backlogs caused by the coronavirus pandemic.

    Dr. Vishal Sharma, who chairs the BMA consultants committee, said the fight was “not yet over” and that there is “some way to go” before pay gets back to equivalent levels 15 years ago. The relative decline in pay for consultants has, he said, led to an exodus of senior doctors abroad.

    Junior doctors — those at the early stages of their careers, who form the backbone of hospital and clinical care as they train up to be specialists in a particular field — remain in dispute with the government and have walked off the job for days at a time, with their senior colleagues drafted in to cover for emergency services, critical care and maternity services during the strikes.

    Matthew Taylor, chief executive of the NHS Confederation, said leaders in the health service will “breathe a sigh of relief” that consultants have settled but urged the government and junior doctors to come to an agreement.

    “The potential for further junior doctor strikes looms large, which could lead to more operations and appointments being canceled and place more pressure on already stretched services,” he said.

    NHS figures show more than 1.4 million appointments and operations have been canceled over the past year of industrial action, with even more patients joining waiting lists.

    Britain has endured a year of rolling strikes across the health sector as staff sought pay rises to offset the soaring cost of living. Unions say wages, especially in the public sector, have fallen in real terms over the past decade, and double-digit inflation in late 2022 and early 2023, fueled by sharply rising food and energy prices, left many workers struggling to pay their bills.

    On Friday, for example, much of England had no train services because of a fresh strike by drivers in their own long-running pay dispute.

    Many groups within the NHS, such as nurses and ambulance crews, have reached pay deals with the government, but the union representing junior doctors has held out, and negotiations broke down late last year.

    Britain’s Conservative government has sought to put the blame for many of the problems in the NHS on the junior doctors, while the main opposition Labour Party, which is way ahead in opinion polls ahead of a general election, points the finger at Prime Minister Rishi Sunak for personally blocking progress.

    Sunak said the end of the consultants’ strike is “excellent news for patients.”

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  • Insurer delays and denials hamper patients seeking at-home breathing machines

    Insurer delays and denials hamper patients seeking at-home breathing machines

    Lou Gehrig’s disease took away Grace Armant’s ability to speak, but the 84-year-old still has plenty to say about her insurance.

    UnitedHealthcare has rejected several requests from her doctors for coverage of a machine Armant needs to breathe as she deals with the fatal illness.

    “They are no good,” Armant said, typing slowly into a device that speaks for her. “I can’t do without the machine.”

    Doctors around the country say UnitedHealthcare and other insurers have made it harder to get coverage for certain home ventilators that patients like Armant need as their lungs fail. They say patients often must struggle first with less effective — and cheaper — devices before some insurers will pay. In other cases, insurers balk at paying for a second machine needed when patients transfer from their bed to a wheelchair.

    Temple University doctoral student Jaggar DeMarco waited more than three years to get his.

    “Breathing is not a luxury,” he said. “It’s really the bare minimum, and that’s what we’re asking for.”

    Some physicians believe insurers are making it harder on patients because more of the devices are being prescribed. Spending by the federal government’s Medicare program on the ventilators jumped from about $3 million to nearly $269 million between 2009 and 2017, according to the U.S. Department of Health and Human Services Office of Inspector General.

    Insurers say they do cover the machines, but that coverage can depend on several factors.

    These “noninvasive” ventilators help patients breathe around the clock by forcing air into the lungs, often through a mask. They are called noninvasive because they don’t require trachea surgery to open the airway, like ones used in hospitals.

    The machines have battery backups so they can keep working when the power goes out. They also are more powerful than other devices meant to be used mainly at night for conditions like sleep apnea. At around $1,200 a month, they can be three times as expensive as those devices.

    These ventilators can help prolong the life of someone with Lou Gehrig’s disease, also known as amyotrophic lateral sclerosis, doctors say.

    But insurance rejections have picked up for those patients and people dealing with advanced cases of chronic obstructive pulmonary disease, said Chuck Coolidge, chief strategy officer for VieMed, which provides respiratory equipment for patients in 46 states.

    That includes both initial approvals and reauthorizations, he said.

    “In early 2023, it was almost like a switch flipped,” he said.

    UnitedHealthcare spokeswoman Heather Soule said her company covers the machines and re-evaluates requests if it gets new information. Coverage can depend on the patient’s condition, terms of their health plan or guidelines from the federal government’s Medicare program.

    Those guidelines give insurers room to reject many ventilator requests, even those for seriously ill patients, said Dr. John Hansen-Flaschen, a pulmonary medicine expert with the University of Pennsylvania.

    Government-funded Medicare Advantage plans run by UnitedHealthcare now deny nearly all initial requests for the ventilators, said Dr. Cathy Lomen-Hoerth, a neurologist with the University of California San Francisco.

    In West Virginia, Dale Harper says it took several months and a personal plea before UnitedHealthcare would cover a ventilator for his 25-year-old son, Jacob, who has a rare and aggressive form of ALS.

    After appeals from Jacob’s doctor failed, Harper called a number on his insurance card and asked for a supervisor.

    “I said, ‘I can feed him, I can help him go to the bathroom, I can move him from one place to the other,’” the Winfield, West Virginia, resident recalled. “The only thing I cannot do is breathe for him … and he can’t breathe.”

    Harper said ventilator coverage was approved within an hour of that call early last year.

    Doctors caring for Armant, who lives outside New Orleans, say they usually get decent ventilator coverage.

    “No one thought there would be a problem,” said Deidre Devier, an LSU Health experimental psychologist who specializes in cognitive disorders.

    They first sought coverage in May, 2022, and Devier said Armant has only had it for around three months near the end of that year. She said a medical device company has been providing Armant’s ventilator for free while her case was appealed. But those appeals have ended.

    Armant’s daughter said she’s considering starting hospice care, which would allow for ventilator coverage but prevent her mom from seeing her regular doctors. She’s also looking online for a refurbished machine.

    “She doesn’t have $20,000″ to buy the machine, Terrellyn Armant said.

    Representatives of both patients with UnitedHealthcare coverage gave the insurer written permission to discuss their cases, but Soule declined to comment on the record.

    Coverage complications aren’t limited to UnitedHealthcare. DeMarco, the Temple student, said Aetna denied a request for a second breathing machine, and then several appeals. Eventually, his father’s employer essentially overruled the insurer and allowed coverage.

    Doctors recommend a second ventilator for people who use wheelchairs during the day. That avoids mistakes in adjusting the machine’s settings when moving someone from their bed.

    “I’m constantly angry that my life and what I can do with (it) is sometimes determined by insurance companies and bureaucracy,” said the 30-year-old DeMarco, who has chronic respiratory failure.

    An Aetna representative said the company could not comment on individual cases. But he added that Aetna does cover second ventilators in certain circumstances. Aetna’s policy bulletin says they are medically necessary for people who need an additional ventilator for their wheelchair during the day.

    Ventilator coverage problems started picking up after technology improvements made the devices easier to use, according to Dr. Lisa Wolfe, a professor at Northwestern’s Feinberg School of Medicine. That led to a rise in use for patients with conditions that are not immediately life-threatening.

    She said she thinks insurers are reacting to that expanded use.

    ALS patients without ventilator access have limited options. They can use a device that’s covered but doesn’t work as well. They may get ventilator coverage by entering hospice care or having a tracheostomy.

    They also might wind up bouncing in and out of hospitals, said Hansen-Flaschen, the Penn physician.

    “Or they die prematurely, and it’s a wretched death because they can’t breathe,” he said.

    ___

    The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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  • Abortion fight puts Vice President Harris at center of 2024 election campaign

    Abortion fight puts Vice President Harris at center of 2024 election campaign

    WASHINGTON — Vice President Kamala Harris is taking center stage in the Democrats’ renewed push for abortion rights during this year’s election and she will mark the 51st anniversary of the Roe v. Wade ruling on Monday in Wisconsin.

    It will be the first in a series of events hosted by Harris, and it comes one day before she joins President Joe Biden at another campaign event focused on abortion in Virginia. First lady Jill Biden and second gentleman Doug Emhoff are also expected to be there.

    In her speech in Wisconsin, Harris plans to hammer former President Donald Trump for saying he is “proud” to have helped overturn Roe v. Wade, which he enabled by nominating three conservative justices to the U.S. Supreme Court during his term.

    “Proud that women across our nation are suffering?” Harris will say, according to excerpts released by her office. “Proud that women have been robbed of a fundamental freedom? That doctors could be thrown in prison for caring for patients? That young women today have fewer rights than their mothers and grandmothers?”

    Back in Washington, Biden on Monday will convene a meeting of his reproductive health care access task force to discuss threats to emergency care and new steps for implementing executive orders on the subject.

    The Democratic president said in a statement that “tens of millions of women now live in states with extreme and dangerous abortion bans,” and “because of Republican elected officials, women’s health and lives are at risk.”

    The administration plans to announce new steps to strengthen access to contraception and help file complaints under a law that’s intended to ensure emergency health care access. The law is the subject of another legal battle that will be decided by the U.S. Supreme Court, which will consider whether it requires providing abortions in situations where a woman’s health is at risk.

    “President Biden and Vice President Harris stand with the vast majority of Americans who believe that the right to choose should be fundamental, and that healthcare decisions should be made by a woman with the help of her doctor — not politicians,” White House gender policy adviser Jen Klein said in previewing the effort. “We’ve shown and will continue to show that commitment by decisively taking action to protect access to reproductive health care.”

    Although the loss of Roe v. Wade was a historic defeat for Democrats, the party successfully harnessed anger over the decision during the 2022 midterm elections, and they hope to do the same thing this year as Biden runs for a second term.

    The White House has repeatedly turned to Harris, the first woman to serve as vice president, to make its case.

    “One does not have to abandon their faith or deeply held beliefs to agree that the government should not be telling her what to do with her body,” she said in a recent appearance on ABC’s “The View.” “If she chooses she will talk with her priest, her pastor, her rabbi, her imam. But it should not be the government telling her what to do.”

    Harris also suggested that too many people took Roe v. Wade for granted before it was overturned.

    “We kind of believed that it was always going to be there,” she said. “And look what happened.”

    Harris’ outspokenness on abortion contrasts with Biden’s more reticent approach. Although he is a longtime supporter of abortion rights, he mentions less often and sometimes avoids using the word abortion even when he discusses the issue.

    “I think the real star from a messaging standpoint is the vice president,” said Mini Timmaraju, head of Reproductive Freedom for All, the activist organization formerly known as the National Abortion Rights Action League. “Look, Joe Biden picked Kamala Harris. Joe Biden has asked Kamala Harris to lead on this issue. This is going to set us up for a great contrast with the other side.”

    After Harris’ appearance on “The View,” she received a notable assessment from Kayleigh McEnany, a former Trump spokeswoman who co-hosts a show on Fox News.

    “She brought up abortion again and again and again,” McEnany said. No matter the topic, “she pivoted right back to abortion because she knows what is true, which is the GOP has lost every single abortion ballot initiative post-Roe.”

    McEnany described herself as pro-life, but said “what Kamala is doing, right or wrong, is very powerful among young women.”

    While Harris and Democrats have embraced abortion as a campaign issue, Republicans are shying away or calling for a truce.

    Nikki Haley, the former South Carolina governor who is running for the Republican presidential nomination, recently made a plea to “find consensus” on the divisive issue.

    “As much as I’m pro-life, I don’t judge anyone for being pro-choice, and I don’t want them to judge me for being pro-life,” she said during a primary debate in November.

    Trump has taken credit for helping to overturn Roe v. Wade, but he has balked at laws like Florida’s ban on abortions after six weeks, which was signed by Gov. Ron DeSantis, another Republican candidate.

    “You have to win elections,” Trump said during a recent Fox News town hall.

    Harris’ team is still working out the schedule for the rest of her events focused on abortion. Each stop is likely to feature a speech and a more intimate conversation with healthcare providers or women who have been affected by restrictions.

    Wisconsin, Harris’ first stop, is a key battleground state with an ongoing legal battle over abortion. When Roe v. Wade was overturned, Republicans argued that an 1849 law that was still on the books would effectively ban the procedure except in situations where a mother’s life was at risk.

    “These extremists want to roll back the clock to a time before women were treated as full citizens,” Harris plans to say in her speech on Monday.

    Clinics across the state stopped offering abortions until a court ruled the law did not apply to abortions. Republicans have appealed the decision, and the case will likely be decided by the state supreme court.

    Abortion has reshaped Harris’ tenure as vice president after earlier struggles when dealing with intractable issues like migration from Central America.

    Jamal Simmons, a former communications director for Harris, said abortion “focused her attention and her office in a way that nothing had before.”

    “Focusing on abortion rights tapped into the vice president’s legal background, her political values and her substantive knowledge in a way that I saw no other issue do while I was there,” he said.

    Vice presidents are rarely decisive figures in reelection campaigns. However, Harris has faced additional scrutiny because of Biden’s age — he would be 82 at the start of a second term — and her status as the first woman, Black person and person of South Asian descent to serve in her position.

    The battle over abortion will also bolster her visibility.

    “The president and the vice president appeal to different parts of the party,” Simmons said. “They’re stronger as a team.”

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  • A push to expand Medicaid has Kansas governor embracing politics and cutting against her brand

    A push to expand Medicaid has Kansas governor embracing politics and cutting against her brand

    TOPEKA, Kan. — Democratic Gov. Laura Kelly is more aggressive and openly political in pushing to expand Medicaid in Kansas as the Republican-controlled Legislature prepares to open its annual session Monday following five years of failed efforts to provide state health coverage to another 150,000 people.

    Kelly faces leaders of GOP supermajorities whose priorities are to cut income taxes and rein in local property taxes, not to expand Medicaid.

    But Kelly’s new plan includes hitting expansion-opposing Republicans hard later this year during races for legislative seats, an approach that cuts against years of self-branding as a bipartisan problem-solver who doesn’t care about politics.

    “My previous approach, which has always been to try to bring people together and work collaboratively and come up with consensus and then get good policy on the books — that hasn’t worked,” Kelly said during a recent interview.

    “Taking a more aggressive approach and — to be direct, a more political approach to it — might be the answer,” she added.

    For months, Kelly has toured the state for news conferences and roundtables to build support for Medicaid expansion. She said she modeled her campaign on one by Democratic Gov. Roy Cooper in North Carolina, where a GOP-dominated legislature expanded coverage as of Dec. 1.

    Kansas is among only 10 states that have not expanded Medicaid in line with the 2010 federal Affordable Care Act, which promises federal funds to cover 90% of the new costs. In two other states, Georgia and Mississippi, top Republicans have signaled willingness to discuss expansion this year so the issue isn’t a dead letter.

    In Kansas, conservative opposition is rooted in small-government beliefs and decades of skepticism about social services. In the fall, House Speaker Dan Hawkins and Senate President Ty Masterson, both Wichita-area Republicans, derided Kelly’s events with business leaders, hospital administrators and health advocates as a “Welfare Express Tour” for “more government dependency.”

    “It’s about not using taxpayer dollars to fund free healthcare for a new population of able-bodied childless adults who don’t want to work,” Hawkins said in an email.

    For some Kansas residents, the issue is getting by.

    In Newton, 46-year-old Robyn Adams works 15 to 20 hours a week while she cares for her 15-year-old daughter and uses a manufacturer’s program to avoid paying $1,500 every two weeks for shots to manage her rheumatoid arthritis.

    She lost Medicaid coverage by working more hours, but not enough to qualify for federal subsidies for private insurance. Even covering a $40 copay before a doctor’s visit can be a financial challenge, so paying a larger monthly insurance premium is out of the question, she said.

    “We need insurance, too,” she said of low-income families. “Without the expansion, I don’t know — a lot of families are going to be in trouble.”

    To attract GOP votes, Kelly has mandated that those who would newly qualify for Medicaid verify annually they are working. But Masterson told reporters, “It really doesn’t change the underlying facts.”

    In Kansas, childless adults without disabilities don’t qualify for Medicaid. Parents like Adams aren’t covered when their household incomes hit 38% of the federal poverty level. For a single parent of one child, it’s less than $7,500; for a family of four, it’s $11,400.

    An expansion would make both groups eligible if they earn up to 138% of the federal poverty level. A single, childless adult could earn $20,100; a single parent and one child, about $27,200; and a family of four, $41,400.

    Of the people who would qualify, 73% are in families with at least one full- or part-time worker, according to KFF, the research organization formerly known as the Kaiser Family Foundation. Many work in services and others are independent contractors, said Sean Gatewood, a former Kansas House member and spokesperson for the KanCare Advocates Network, a pro-expansion coalition.

    Kelly’s plan would increase the cost of the Kansas Medicaid program by 31%, about $1.35 billion a year. However, federal funds would cover all but $135 million, with the state imposing fees on hospitals and large private health insurance companies for most of the rest.

    The federal government also is offering remaining non-expansion states another financial bonus. A promise of an additional $1.8 billion over two years was crucial for GOP lawmakers in North Carolina. Kelly’s office expects Kansas to receive a total bonus of between $370 million and $450 million.

    But even if there is enough support to pass a bill expanding eligibility, Hawkins, Masterson and their allies can keep a plan from even clearing committees. Democrats’ attempts to offer expansion plans during debates on other measures have been ruled out of order, and even Republicans backing expansion have stood with their leaders on that point.

    Yet Kelly and other advocates see plenty of reasons to keep pushing, including North Carolina Gov. Cooper’s success.

    Cooper argued GOP lawmakers in his state felt pressure from an unusual coalition that included rural chambers of commerce and “tough-on-crime Republican sheriffs” who felt they were dealing with too many people who simply needed access to health care, “not handcuffs.”

    As for non-expansion states, Cooper said in a news conference: “I hope that they can take some of the lessons of the coalitions of people that we’ve been able to put together to try to succeed.”

    ___

    Associated Press writer Gary Robertson in Raleigh, North Carolina, also contributed.

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  • Thousands of doctors in Britain walk off the job in their longest-ever strike

    Thousands of doctors in Britain walk off the job in their longest-ever strike

    LONDON — Thousands of doctors walked off the job in Britain on Wednesday, the start of a six-day strike that was set to be the longest in the history of the state-funded National Health Service.

    Managers said tens of thousands scheduled appointments and operations will be canceled during the walkout across England and Wales by junior doctors, those in the first years of their careers. The doctors, who form the backbone of hospital and clinic care, plan to stay off the job until 7 a.m. on Tuesday.

    Senior doctors and other medics have had to be drafted in to cover for emergency services, critical care and maternity services.

    Julian Hartley, chief executive of heath care managers’ organization NHS Providers, said the strike came at one of the toughest times of the year for the health service, “immediately after the Christmas and New Year period because of the pressures the demands, and of course we’ve got flu, we’ve got COVID.

    “So there’s going to be an impact on patients that will be significant,” he said.

    Britain has endured a year of rolling strikes across the health sector as staff sought pay rises to offset the soaring cost of living.

    The walkouts have strained the already stretched health service still struggling to recover from backlogs created by the coronavirus pandemic.

    Nurses, ambulance crews and senior doctors have reached pay deals with the government, but the union representing junior doctors has held out, and negotiations have stalled. The government says it won’t hold further talks unless doctors call off the strike, while the union says it won’t negotiate unless it receives a “credible” pay offer.

    “The notion that we’re hellbent on calling strikes and all we want to do is call strikes is not what we want,” said Dr. Vivek Trivedi, co-chair of the British Medical Association’s Junior Doctors Committee. “What we want is to negotiate an offer we can put to our members and for our members to accept it.”

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  • California is expanding health care coverage for low-income immigrants in the new year

    California is expanding health care coverage for low-income immigrants in the new year

    SACRAMENTO, Calif. — More than 700,000 immigrants living illegally in California will gain access to free health care starting Monday under one of the state’s most ambitious coverage expansions in a decade.

    It’s an effort that will eventually cost the state about $3.1 billion per year and inches California closer to Democrats’ goal of providing universal health care to its roughly 39 million residents.

    Democratic Gov. Gavin Newsom and lawmakers agreed in 2022 to provide health care access to all low-income adults regardless of their immigration status through the state’s Medicaid program, known as Medi-Cal.

    California is the most populous state to guarantee such coverage, though Oregon began doing so in July.

    Newsom called the expansion “a transformative step towards strengthening the health care system for all Californians” when he proposed the changes two years ago.

    Newsom made the commitment when the state had the largest budget surplus in its history. But as the program kicks off next week, California faces a record $68 billion budget deficit, raising questions and concerns about the economic ramifications of the expansion.

    “Regardless of what your position is on this, it doesn’t make sense for us to be adding to our deficit,” said Republican Sen. Roger Niello, the vice-chair of the Senate Budget and Fiscal Review Committee.

    Immigration and health care advocates, who spent more than a decade fighting for the changes, have said the expanded coverage will close a gap in health care access and save the state money in the long run. Those who live in the state illegally often delay or avoid care because they aren’t eligible for most coverage, making it more expensive to treat them when they end up in emergency rooms.

    “It’s a win-win, because it allows us to provide comprehensive care and we believe this will help keep our communities healthier,” said Dr. Efrain Talamantes, chief operating officer at AltaMed in Los Angeles, the largest federally qualified health center in California.

    The update will be California’s largest health care expansion since the 2014 implementation of former President Barack Obama’s Affordable Care Act, which allowed states to include adults who fall below 138% of the federal poverty level in their Medicaid programs. California’s uninsured rate dropped from about 17% to 7%.

    But a large chunk of the population was left out: adults living in the United States without legal permission. They are not eligible for most public benefit programs, even though many have jobs and pay taxes.

    Some states have used their tax dollars to cover a portion of health care expenses for some low-income immigrants. California first extended health care benefits to low-income children without legal status in 2015 and later added the benefits for young adults and people over the age of 50.

    Now the last remaining group, adults ages 26 to 49, will be eligible for the state’s Medicaid program.

    The state doesn’t know exactly how many people will enroll through the expansion, but state officials said more than 700,000 people will gain full health coverage allowing them to access preventative care and other treatment. That’s larger than the entire Medicaid population of several states.

    “We’ve had this asterisk based on immigration status,” said Anthony Wright, executive director of Health Access California, a consumer advocacy group. “Just from the numbers point of view, this is a big deal.”

    Republicans and other conservative groups worry the new expansion will further strain the overloaded health care system and blasted the cost of the expansion.

    State officials estimated the expansion will cost $1.2 billion the first six months and $3.1 billion annually thereafter from the budget. Spending for the Medi-Cal program, which is now about $37 billion annually, is the second-largest expense in the California budget, according to an analysis by the nonpartisan Legislative Analyst’s Office.

    Earlier this month, the state Department of Finance sent a letter urging state agencies to cut costs in light of the deficit. It has not given specific directions about the Medicaid expansion, state officials told The Associated Press in December.

    California’s expansion of Medicaid will face other challenges. The state is chugging through a review of Medicaid enrollees’ eligibility for the first time in more than three years that was prompted by the end of some federal pandemic policies. Many immigrants who had their coverage protected during the COVID-19 pandemic now find themselves ineligible because they no longer financially qualify.

    John Baackes, CEO of L.A. Care Health Plan, the state’s largest Medi-Cal plan with nearly 2.6 million members, said roughly 20,000 members have lost their Medicaid coverage during the review process this past year and are looking to secure new insurance plans. His organization is juggling to help people navigate through both processes.

    “People are being bombarded with information,” Baackes said. “I can’t imagine if somebody were having to maneuver through all this, why they wouldn’t be terribly confused.”

    “The phones are ringing off the walls,” he said.

    Fear and distrust are also barriers for the expansion, said Sarah Dar, policy director for the California Immigrant Policy Center.

    Many immigrants avoid accepting any public programs or benefits out of fear it will eventually prevent them from gaining legal status under the “public charge” rule. The federal law requires those seeking to become permanent residents or gain legal status to prove they will not be a burden to the U.S., or a “public charge.” The rule no longer considers Medicaid as a factor under President Joe Biden’s administration, but the fear remains, she said.

    More resources and effort are required to reach this population “because of the history of just being completely excluded and not interfacing with the health care system or with government programs at all for so long,” Dar said.

    California has more work to do to see the state’s uninsured rate hit zero, known as “universal coverage,” Dar said.

    For one thing, immigrants living in the U.S. without legal permission are still not eligible to purchase insurance from Covered California, the state-run exchange offering steep discounts for people who meet certain income requirements. A bill pending in the state Legislature, supported by the California Immigrant Policy Center, would change that.

    “It’s going to be another really big undertaking,” Dar said. “And we know that revenues are down … but it’s our job to make the case that, in times of economic downturn and whatnot, these are the communities that need the support the most.”

    ___

    Associated Press Reporter Adam Beam contributed to this report.

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  • Families say autism therapy helped their kids. Indiana's Medicaid cuts could put it out of reach

    Families say autism therapy helped their kids. Indiana's Medicaid cuts could put it out of reach

    INDIANAPOLIS — Shaunna Thompson was running out of childcare options. Her daughter Abbie was expelled from daycare in 2022 because of “all over the place” behavior. Thompson found an in-home provider for the toddler, but was told Abbie was “too much” to watch every day of the week.

    The experiences motivated Thompson to seek assistance for her daughter, who also was missing developmental milestones. Abbie, now 3, was diagnosed with autism spectrum disorder in October of last year.

    By March, Thompson enrolled her in applied behavior analysis — a therapy based on learning and behavior focused on improving communicative, social and motor skills — at a local facility in northern Indiana for 40 hours a week. Abbie, nonverbal most of her life, has since said her first word: “Mom.”

    “It brought tears to my eyes” Thompson said.

    But Thompson and other families reliant on Medicaid worry changes coming in January will limit access to the therapy as Indiana attempts to limit the cost and, along with other states, cut the size of the low-income health care program.

    Indiana’s Family and Social Services Administration said the cost of Medicaid reimbursement for the behavioral therapy, commonly referred to as ABA, has ballooned in recent years because of the growing number of children seeking the services and the amount that providers have billed the state. The state plans a universal, hourly reimbursement rate for the therapy, but the planned amount is lower than what providers have previously received on average.

    Advocates and centers worry this will mean accepting fewer patients or even closing, as has happened in other states such as Colorado this year.

    “Companies just kept leaving and it just kind of turned into a crisis situation,” said J.J. Tomash, who leads an ABA provider in Colorado called BehaviorSpan. He blamed Medicaid reimbursement rates that have not kept up with the cost of living.

    Medicaid began covering the services in 2016, and providers in Indiana set their own rates until now. But centers say the new rates are still not enough to keep them running and are far below the previous statewide average of $97 per hour.

    Indiana Act for Families, a coalition opposing the new rates, said the proposal is 10% below providers’ operating costs. Although Indiana has said the new rates are aligned with pay in other states, the coalition argued the state used outdated data in their comparison.

    Miles Hodge, owner and co-founder of Shine Pediatric Therapy in Indianapolis, said the effects of the new rates will take their toll over time. The state said the rates will be up for review every four years, a time frame Hodge said does not keep up with inflation.

    “It could leave a lot of people underwater,” he said.

    About 6,200 children and young adults received the services under Medicaid in 2022, the state said.

    With a standard patient to therapist ratio of 1-to-1, ABA is an “extremely staff intensive model,” Hodge said. Across the state, he expects staff pay and benefits to be hit, which he said could lead to high turnover and inconsistent care for patients.

    Hodge predicted his center will have to take fewer patients who are on Medicaid because of the changes.

    The Indiana agency overseeing Medicaid said the therapy is the only major service category that did not have a uniform reimbursement rate, and the rising cost of the services was unsustainable. ABA expenditures increased more than 50% per year for the last three years, according to the agency.

    In 2022, ABA claims represented $420 million in Medicaid spending, the state said. Total Medicaid expenditures in state fiscal year 2022 totaled more than $16 billion.

    The move comes at the same time as states unwind pandemic-era protections that kept millions of people covered by Medicaid. In Indiana, the number of people enrolled in Medicaid steadily grew every month from March 2020 until May 23, when the federal budget law ended the protections.

    Indiana’s total enrollment has fallen every month since then.

    States setting universal rates is common, but low reimbursement endangers access to key services for individuals with disabilities, said Jennifer Lav, senior attorney with the National Health Law Program.

    Lower rates in a time of high inflation can lead to staff turnover and shortages, issues that can compound in rural areas, she said.

    ABA is not without critics. Zoe Gross, advocacy director at the Autistic Self-Advocacy Network, said ABA’s goal is to eliminate behaviors considered autistic and teaches children to conform with neurotypical behaviors.

    “It teaches you that the way you naturally behave is not OK,” she said.

    But families who have found it helpful find it hard to imagine a future without access.

    In Westfield, a suburb of Indianapolis, 29-year-old Natasha Virgil said her family’s ability to participate in activities outside their home markedly improved once 6-year-old Elijah Hill began ABA therapy.

    “My biggest thing is making sure that he has a fighting chance to be able to live in this world and have the skills to survive,” Virgil said, holding her 4-month-old daughter and watching Elijah play with soap bubbles near the family’s Christmas tree.

    It’s difficult already for parents of children with disabilities to hold jobs between numerous therapy sessions and doctor’s appointments, Virgil said.

    “I don’t think I would ever be able to be where we are if we didn’t pursue ABA,” she said

    Chanel McClure, mother of 2-year-old King, said she has lost sleep over the pending change. She interviewed multiple centers before finding the ABA therapy she wanted for King. He was on a waiting list for another 11 months.

    Now almost 3, King is nonverbal and attends speech, occupational and developmental therapy. Since beginning ABA, McClure said he has learned new ways to communicate and is comfortable playing with other children. His therapists are working to address elopement or wandering that can be common in children with autism.

    “King just bloomed like a flower,” McClure said.

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  • Top White House cyber aide says recent Iran hack on water system is call to tighten cybersecurity

    Top White House cyber aide says recent Iran hack on water system is call to tighten cybersecurity

    WASHINGTON — A top White House national security official said recent cyber attacks by Iranian hackers on U.S. water authorities — as well as a separate spate of ransomware attacks on the health care industry — should be seen as a call to action by utilities and industry to tighten cybersecurity.

    Deputy national security adviser Anne Neuberger said in an interview on Friday that recent attacks on multiple American organizations by the Iranian hacker group “Cyber Av3ngers” were “unsophisticated” and had “minimal impact” on operations. But the attacks, Neuberger said, offered a fresh warning that American companies and operators of critical infrastructure “are facing persistent and capable cyber attacks from hostile countries and criminals” that are not going away.

    “Some pretty basic practices would have made a big difference there,” said Neuberger, who serves as a top adviser to President Joe Biden on cyber and emerging technology issues. “We need to be locking our digital doors. There are significant criminal threats, as well as capable countries — but particularly criminal threats — that are costing our economy a lot.”

    The hackers, who U.S. and Israeli officials said are tied to Tehran’s Islamic Revolutionary Guard Corps, breached multiple organizations in several states including a small municipal water authority in the western Pennsylvania town of Aliquippa. The hackers said they were specifically targeting organizations that used programmable logic controllers made by the Israeli company Unitronics, commonly used by water and water treatment utilities.

    Matthew Mottes, the chairman of the Municipal Water Authority of Aliquippa, which discovered it had been hacked on Nov. 25, said that federal officials had told him the same group also breached four other utilities and an aquarium.

    The Aliquippa hack prompted workers to temporarily halt pumping in a remote station that regulates water pressure for two nearby towns, leading crews to switch to manual operation.

    The hacks, which authorities said began on Nov. 22, come as already fraught tensions between the U.S. and Iran have been heightened by the two-month-old Israel-Hamas war. The White House said that Tehran has supported Houthi rebels in Yemen who have carried out attacks on commercial vessels and have threatened U.S. warships in the Red Sea.

    Iran is the chief sponsor of both Hamas, the militant group which controls Gaza, as well as the Houthi rebels in Yemen.

    The U.S. has said they have uncovered no information that Iran was directly involved in Hamas’ Oct. 7 attack on Israel that triggered the massive retaliatory operation by Israeli Defense Forces in Gaza. But the Biden administration is increasingly voicing concern about Iran attempting to broaden the Israeli-Hamas conflict through proxy groups and publicly warned Tehran about the Houthi rebels’ attacks.

    “They’re the ones with their finger on the trigger,” White House national security adviser Jake Sullivan told reporters earlier this week. “But that gun — the weapons here are being supplied by Iran. And Iran, we believe, is the ultimate party responsible for this.”

    Neuberger declined to comment on whether the recent cyber attack by the Iranian hacker group could portend more hacks by Tehran on U.S. infrastructure and companies. Still, she said the moment underscored the need to step up cybersecurity efforts.

    The Iranian “Cyber Av3ngers” attack came after a federal appeals court decision in October prompted the EPA to rescind a rule that would have obliged U.S public water systems to include cybersecurity testing in their regular federally mandated audits. The rollback was triggered by a federal appeals court decision in a case brought by Missouri, Arkansas and Iowa, and joined by a water utility trade group.

    Neuberger said that measures spelled out in the scrapped rule to beef up cybersecurity for water systems could have “identified vulnerabilities that were targeted in recent weeks.”

    The administration, earlier this year, unveiled a wide-ranging cybersecurity plan that called for bolstering protections on critical sectors and making software companies legally liable when their products don’t meet basic standards.

    Neuberger also noted recent criminal ransomware attacks that have devastated health care systems, arguing those attacks spotlight the need for government and industry to take steps to tighten cyber security.

    A recent attack targeting Ardent Health Services prompted the health care chain that operates 30 hospitals in six states to divert patients from some of its emergency rooms to other hospitals while postponing certain elective procedures. Ardent said it was forced to take its network offline after the Nov. 23 cyberattack.

    A recent global study by the cybersecurity firm Sophos found nearly two-thirds of health care organizations were hit by ransomware attacks in the year ending in March, double the rate from two years earlier but dipping slightly from 2022.

    “The president’s made it a priority. We’re pushing out actionable information. We’re pushing out advice,” Neuberger said. “And we really need the partnership of state and local governments and of companies who are operating critical services to take and implement that advice quickly.”

    —

    Associated Press writers Frank Bajak in Boston and Marc Levy in Harrisburg, Pa., contributed reporting.

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  • Pope says he's doing better but skips his window appearance facing St. Peter's Square

    Pope says he's doing better but skips his window appearance facing St. Peter's Square

    VATICAN CITY — For a second Sunday, an ailing Pope Francis skipped his popular window appearance to the public in St. Peter’s Square, but in televised remarks said he’s doing better even though his voice wouldn’t let him read all his comments aloud.

    As he did a week earlier, Francis delivered very brief remarks from the chapel of the Vatican hotel where he lives and where he is recovering from what he has said is infectious bronchitis. Thousands of people in the square followed his words from giant screens set up outdoors.

    Francis, whose 87th birthday is later this month, also said he is following from afar the workings of the U.N. climate conference in Dubai. The pontiff was due to go to the COP28 conference on Friday to address the gathering.

    During his first chapel appearance on Nov. 26, he insisted he would make the trip despite his illness. He instead canceled it following his doctors’ orders and stayed at the Vatican, where he has received antibiotics intravenously.

    “Dear brothers and sisters, good day. Also today, I won’t be able to read everything. I’m getting better, but the voice still isn’t” enough to read everything, Francis said. He then passed the microphone to a priest who read prepared remarks, including about the end of the truce in the Israeli-Hamas war.

    “It’s painful that the truce has been broken,” Francis said in the remarks read by the priest. ”That means death, destruction and misery,” the pontiff said. He called for the release of the remaining hostages who were seized from Israel in the Hamas’ Oct. 7 attack, and lamented the lack of basic necessities of life in Gaza after Israel launched its war against Hamas.

    On Thursday, Francis told an audience of health care workers that he was advised against making the Dec. 1-3 trip to the United Arab Emirates because “it’s very hot there, and you go from heat to air conditioning,” Of his current illness, Francis told that audience: “Thank God it wasn’t pneumonia. It’s a very acute, infectious bronchitis.”

    Previously the Vatican had said Francis was suffering from a lung inflammation and the flu. Francis had a previous case of acute bronchitis in the spring, when he was hospitalized for three days so he could receive intravenous antibiotics.

    Francis said that “even from a distance, I am following with great attention the work of COP28 in Dubai. I am close” to the conference. He said he was renewing his appeal so that “climate change is answered by concrete political change.”

    In his Sunday remarks about climate change, Francis urged the end of what he called “bottlenecks” caused by nationalism, and “patterns of the past.” He added: “let’s embrace a common vision, committing all of us and now, without delay, to a necessary global ecological conversion.”

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  • Obesity drug Wegovy cut risk of serious heart problems by 20%, study finds

    Obesity drug Wegovy cut risk of serious heart problems by 20%, study finds

    The popular weight-loss drug Wegovy reduced the risk of serious heart problems by 20% in a large, international study that experts say could change the way doctors treat certain heart patients.

    The research is the first to document that an obesity medication can not only pare pounds, but also safely prevent a heart attack, stroke or a heart-related death in people who already have heart disease — but not diabetes.

    The findings could shift perceptions that the new class of obesity drugs are cosmetic treatments and put pressure on health insurers to cover them.

    “It moves from a kind of therapy that reduces body weight to a therapy that reduces cardiovascular events,” said Dr. Michael Lincoff, the study’s lead author and a heart expert at the Cleveland Clinic.

    Wegovy is a high-dose version of the diabetes treatment Ozempic, which already has been shown to reduce the risk of serious heart problems in people who have diabetes. The new study looked to see if the same was true in those who don’t have that disease.

    Experts have known for years that losing weight can improve heart health, but there hasn’t been a safe and effective obesity medication proven to reduce specific risks, said Dr. Francisco Lopez-Jimenez, a heart expert at the Mayo Clinic. He expects the new findings to change treatment guidelines and “dominate the conversation” for years to come.

    “This is the population who needs the medicine the most,” said Lopez-Jimenez, who had no role in the study.

    In the U.S., there are about 6.6 million people like those tested in the study, experts said.

    The results were published Saturday in the New England Journal of Medicine and presented at a medical conference in Philadelphia. Novo Nordisk, the maker of Wegovy and Ozempic, has asked the U.S. Food and Drug Administration to include the heart benefits on Wegovy’s label, like on Ozempic’s.

    The new study, paid for by the company, included more than 17,500 people in 41 countries. Participants were age 45 and older, had a body mass index of 27 or higher and were tracked for more than three years on average. They took typical drugs for their heart conditions, but they were also randomly assigned to receive weekly injections of Wegovy or a dummy shot.

    The study found that 569, or 6.5%, of those who got the drug versus 701, or 8%, of those who received the dummy shot had a heart attack or stroke or died from a heart-related cause. That’s an overall reduction of 20% in the risk of those outcomes, the researchers reported.

    The drop appeared to be fueled primarily by the difference in heart attacks, but the number of serious health complications reported were too small to tell whether the individual outcomes were caused by the drug or by chance.

    Study volunteers who took Wegovy lost about 9% of their weight while the placebo group lost less than 1%.

    The Wegovy group also saw drops in key markers of heart disease, including inflammation, cholesterol, blood sugars, blood pressure and waist circumference, noted Dr. Martha Gulati, a heart expert at Cedars-Sinai Medical Center in Los Angeles. Changes in those markers began early in the study, before participants lost much weight.

    “It means to me that it’s more than just weight loss, how this drug works,” said Gulati, who had no role in what she called a landmark study.

    Still, “it remains unclear” how much of the results were a benefit of losing weight or the drug itself, an editorial accompanying the study noted.

    About a third of all study volunteers reported serious side effects. About 17% in the Wegovy group and about 8% in the comparison group left the study, mostly because of nausea, vomiting, diarrhea and other stomach-related problems.

    Nearly three-quarters of participants were men and nearly 84% were white. Gulati and others said future research needs to include more women and racial and ethnic minorities.

    Wegovy is part of a new class of injectable medications for obesity. On Wednesday, the U.S. Food and Drug Administration approved Eli Lilly’s Zepbound, a version of the diabetes drug Mounjaro, for weight control.

    Both carry high price tags — monthly costs are about $1,300 for Wegovy and about $1,000 for Zepbound. And both have been in shortage for months, with manufacturers promising to boost supplies.

    The medications are often not covered by private health insurance or subject to strict preauthorization requirements. Medicare, the government health plan for older Americans, is prohibited from covering drugs for weight loss alone. But drugmakers and obesity treatment advocates have been pushing for broader coverage, including asking Congress to pass legislation to mandate that Medicare pay for the drugs.

    Results from the latest study and others that show the obesity drugs have a direct effect on costly health problems could be a factor in shifting the calculus of coverage, said Dr. Mark McClellan, former chief of the Centers for Medicare and Medicaid Services and the FDA. In 2006, Medicare was allowed to cover weight-loss surgery to treat the complications of severe obesity, if not obesity itself, he noted.

    That approach “may end up being relevant here,” he said.

    ___

    The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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  • After an Israeli airstrike, crowded Gaza hospital struggles to treat wounded children

    After an Israeli airstrike, crowded Gaza hospital struggles to treat wounded children

    BUREIJ REFUGEE CAMP, Gaza Strip — The gray film covering the faces of children rushed to Al-Aqsa Hospital in central Gaza Thursday made it hard to distinguish between the living and the dead.

    After two Israeli airstrikes flattened an entire block of apartment buildings in the Bureij refugee camp and damaged two U.N. schools-turned-shelters, rubble-covered Palestinians big and small arrived at a hospital too packed to take them.

    Tiny, motionless bodies lay flat against the hospital’s hard floor. A small boy bled out onto the tiles as medics tried to staunch the flow from his head. A baby lay next to him with an oxygen mask strapped on — covered in ash, his chest struggled to rise and fall. Their father sat beside them.

    “Here they are, America! Here they are, Israel!” he screamed. “They are children. Our children die every day.”

    More than 3,700 Palestinian children and minors have been killed in just under a month of fighting, and bombings have driven more than half the territory’s 2.3 million people from their homes, while food, water and fuel run low.

    As Israeli troops encircle Gaza City and press ahead with a ground offensive, the death toll is expected to grow.

    The war was triggered by the Hamas militant group’s brutal cross-border attack on Oct. 7, which killed some 1,400 people in Israel and took some 240 others hostage. More than 9,000 Palestinians in Gaza have been killed since then, according to the Health Ministry in Hamas-ruled Gaza. It is the fifth and by far deadliest war between the two enemies.

    It was not immediately clear why Israel targeted Bureij, which is located in central Gaza in an area where Israel has urged people to go to stay safe from heavy fighting further north.

    The army said that airstrikes across Gaza had targeted Hamas military command centers hidden in civilian areas. But its statement did not mention Bureij specifically. Israel accuses Hamas of using civilians as human shields.

    The Bureij strikes Thursday killed at least 15, Gaza’s Civil Defense said. It said dozens of others were believed to be buried in the rubble.

    Paramedics and first-responders have struggled to evacuate the injured and the dead due to crippled infrastructure and fuel shortages. Instead, casualties flow into hospitals in the arms of relatives, neighbors or anyone able to transport the wounded.

    In Bureij, which is home to an estimated 46,000 people, Palestinians hacked at the rubble, searching for survivors. A young girl found under the deluge was carried into the emergency room. With her foot bloody and her face covered in ash, she insisted to medics she was fine.

    ___

    Frankel reported from Jerusalem.

    ___

    Find more of AP’s coverage at https://apnews.com/hub/israel-hamas-war

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