ReportWire

Tag: Access to health care

  • Why did Oregon GOP senators stay home? A look at the tension

    Why did Oregon GOP senators stay home? A look at the tension

    PORTLAND, Ore. — Partisan tensions in Oregon skyrocketed this week because Republican state senators didn’t show up to work Wednesday, denying Democrats who control the chamber a quorum. The move cast doubt on planned votes on legislation about gun control, abortion rights and gender-affirming health care.

    Here’s what to know about where Republicans and Democrats are divided and what’s at stake.

    WHAT’S HAPPENING AT THE OREGON LEGISLATURE?

    Republican state senators skipped a Senate floor session Wednesday.

    According to the office of Democratic Senate President Rob Wagner, 10 Republicans and the chamber’s lone independent were absent.

    In Oregon, two-thirds of the state House and Senate members need to be present to conduct business, or 20 of the 30 current members. Currently, 17 senators are Democrats, 12 are Republicans and one is an independent.

    Two bills on gun control and access to abortion and gender-affirming health care were scheduled for floor votes in the Senate this week. Because Democrats control the Legislature, the bills were expected to pass, but now their fate is unclear because there may not be enough lawmakers present in the chamber to begin proceedings.

    WHAT DO REPUBLICANS SAY?

    Republicans said they were protesting over bill summaries not being written in plain language.

    They based their boycott on a 1979 state law that requires the summaries of bills to be readable by those with an eighth- or ninth-grade education — measured by a score of at least 60 on something called the Flesch readability test.

    GOP Senate Minority Leader Tim Knopp says a Republican staff member discovered the existence of the law last month. Knopp couldn’t say when the law has previously been followed, if ever.

    Asked whether the Republican boycott was due to the bills on gun control and abortion and gender-affirming care, Knopp said: “It’s about every bill. But those bills specifically also don’t qualify under this law, and they refuse to fix them.”

    He didn’t say how long Republicans planned to continue their protest.

    WHAT IS THE FLESCH READABILITY TEST?

    The Flesch readability test was designed in the 1940s to measure how easy it is to read and understand a text. It takes into account factors like word and sentence length to determine the grade level of a text.

    Scores range from 1 to 100, with 100 being the easiest to read and 1 being the most difficult. A score between 60 and 70 indicates an eighth- or ninth-grade reading level.

    Oregon’s 44-year-old law says bill summaries must have a score of 60 or above.

    WHAT DO DEMOCRATS SAY?

    Democrats say they don’t believe the Republicans left because of the readability of bill summaries, but rather to obstruct the passage of legislation they oppose.

    Senate President Wagner says it’s no coincidence the walkout began when state lawmakers were about to consider the bills on flashpoint topics like abortion, transgender health care and gun control.

    Democratic Senate Majority Leader Kate Lieber said that Republicans appear to be “weaponizing” an old law for political gain.

    WHAT’S AT STAKE?

    If Republican senators deny a quorum for the rest of the legislative session, which doesn’t end until late June, they could kill the bills on gun control, abortion rights and gender-affirming care.

    However, a new ballot measure approved by Oregon voters in November bars lawmakers who have 10 or more unexcused absences from running for reelection.

    The two bills are central to Democrats’ legislative agenda this session.

    The wide-ranging bill on abortion and gender-affirming care would implement a series of measures, including shielding patients and providers from lawsuits originating in states where such care is now restricted. It would also require public universities and community colleges with student health centers to provide medication abortion and emergency contraception.

    Additionally, it would expand insurance coverage for gender-affirming health care by barring insurers from defining as cosmetic procedures that are prescribed as medically necessary for treating gender dysphoria, among other things.

    The parts of the proposal that have proved to be the most contentious have to do with minors. Under the legislation, doctors would be allowed to provide an abortion to anyone regardless of age, and it would bar them in certain cases from disclosing that to parents.

    Democratic lawmakers have said such scenarios are rare. But critics said this could exclude parents from key aspects of their child’s health care.

    The gun control measure would increase the purchasing age to 21 for AR-15-style rifles and similar weapons, impose penalties for possessing undetectable firearms, and allow for more limited concealed-carry rights.

    Source link

  • Congress eyes work rules for millions covered by Medicaid

    Congress eyes work rules for millions covered by Medicaid

    WASHINGTON — More than a half million of the poorest Americans could be left without health insurance under legislation passed by House Republicans that would require people to work in exchange for health care coverage through Medicaid.

    It’s one of dozens of provisions tucked into a GOP bill that would allow for an increase in the debt limit but curb government spending over the next decade. The bill is unlikely to become law, though. It is being used by House Republicans to draw Democrats to the negotiating table and avoid a debt default.

    Democrats have strongly opposed the Medicaid work requirement provision, saying it won’t incentivize people to get a job and will drive up the number of uninsured in the country.

    Here’s a look at how the proposal might save taxpayers money but cost some Americans access to health care coverage.

    WHO WOULD BE REQUIRED TO WORK?

    The work requirements say able-bodied adults ages 19 to 55 who don’t have children or other dependents would be required to work, train for a job or perform community service to stay on Medicaid. They would have to put in at least 80 hours a month to stay on the government-sponsored health care coverage.

    About 84 million people are enrolled in Medicaid, and the Congressional Budget Office estimates 15 million would be subject to the requirement. The Health and Human Services Department, however, predicts millions more — about a third of enrollees altogether — would be required to work.

    WHY ARE WORK REQUIREMENTS CONTROVERSIAL?

    Republicans say the move would help push Americans into jobs that eventually might put them in a position to move off of government aid.

    The requirements would also be more equitable for those who are working to support their families, said House Majority Leader Steve Scalise, R-La.

    “That single mom that’s working two or three jobs right now to make ends meet under this tough economy, she doesn’t want to have to pay for somebody who’s sitting at home,” Scalise said.

    Democrats argue that work requirements could unfairly push people out of Medicaid, too.

    Some people were wrongly kicked off Medicaid in Arkansas when the state briefly introduced work requirements, Chiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid Services, told lawmakers. In some cases, people were not required to work but didn’t fill out the required paperwork.

    “It’s not just people who are subject to the requirements that often get caught up in red tape,” she said. “It can often be people who are exempted.”

    About 1 in 4 people who were required to work lost coverage during Arkansas’ experience with work requirements in 2018.

    Work requirements can put Medicaid enrollees in a bind. While no one has been kicked off Medicaid over the last three years because of the pandemic, that changed in April when the federal government required states to review income eligibility for all enrollees to see who now makes too much money to qualify for the health care benefits.

    People who picked up work, earned a small raise or switched jobs are finding that those new incomes could soon cost them coverage.

    Amy Shaw, 39, of Rochester, New Hampshire, lost her family’s Medicaid coverage in April because of her husband’s 50-cent raise to $17 per hour at an auto parts store. Shaw wouldn’t be subject to the GOP’s work requirement because she has two daughters, but the family’s case illustrates how modest incomes can push people out of Medicaid coverage — and cost them big time.

    Suddenly, instead of a $3 copay, she was billed $120 for a cancer screening ordered by her doctor. Meanwhile, their rent increased by 40% since the pandemic started, and the cost of food, utilities and other essential have gone up.

    “It just seems like the system is set up so that you don’t want to go back (to work) because you lose more than you gain,” Shaw said. “It makes me not want to go and get my mammogram and my colonoscopy. I don’t even want to go to these appointments because it’s going to cost so much money.”

    HOW MUCH WOULD THE REPUBLICAN PROPOSAL SAVE?

    That largely depends on how many people who would be required to work opt not to or don’t fill out the proper paperwork to remain covered.

    The Congressional Budget Office estimates the requirements would save $109 billion over the next decade. Those savings would come in two ways: from about 600,000 people who would be dropped from Medicaid, then 900,000 who would lose federal funding for their Medicaid, but remain enrolled in the program through their state.

    That analysis also says the bill would do little to improve employment among Medicaid enrollees.

    WHAT’S NEXT?

    The House GOP bill won’t pass a Democratic-controlled Senate or be signed into law by President Joe Biden in its current state.

    But don’t expect the issue of work requirements and trimming Medicaid benefits to go away anytime soon. The number of people enrolled in Medicaid has ballooned in recent years, growing by more than 20 million since 2020.

    If you ask Democrats, that’s a great thing — they’ve pointed to the record low uninsured rate that’s given more people access to medical care. Democratic-led states have also pitched new ways to expand Medicaid under the Biden administration, granting more access to recently released convicts and new mothers, for example.

    Republicans, however, want to scale back safety net programs to pre-pandemic levels. And, Republicans in some states are already trying to implement work requirements of their own. Arkansas Gov. Sarah Huckabee Sanders asked the federal government to OK a proposal that would move anyone who doesn’t comply with work requirements off Medicaid’s private insurance to traditional fee-for-service Medicaid.

    ___

    Associated Press writers Holly Ramer in Concord, New Hampshire, and Kevin Freking and Lisa Mascaro in Washington contributed.

    Source link

  • Error, confusion plague review kicking millions off Medicaid

    Error, confusion plague review kicking millions off Medicaid

    WASHINGTON — Days out from a surgery and with a young son undergoing chemotherapy, Kyle McHenry was scrambling to figure out if his Florida family will still be covered by Medicaid come Monday.

    One form on the state’s website said coverage for their sick 5-year-old son, Ryder, had been denied. But another said the family would remain on Medicaid through next year. Still, a letter from the state said McHenry now makes too much money for him, his wife and their older son to qualify after the end of the month.

    Three phone calls and a total of six frustrating hours on hold with Florida’s Department of Children and Families later, the McHenrys finally got the answer they were dreading on Thursday: Most of the family is losing Medicaid coverage, although Ryder remains eligible because of his illness.

    “I’m trying not to go into panic,” McHenry’s wife, Allie McHenry, told The Associated Press earlier in the week.

    The McHenrys are among the first casualties in an unprecedented nationwide review of the 84 million Medicaid enrollees over the next year that will require states to remove people whose incomes are now too high for the federal-state program offered to the poorest Americans.

    Millions are expected to be left without insurance after getting a reprieve for the past three years during the coronavirus pandemic, when the federal government barred states from removing anyone who was deemed ineligible.

    Advocacy groups have warned for months that confusion and errors will abound throughout the undertaking, wrongly leaving some of the country’s poorest people suddenly without health insurance and unable to pay for necessary medical care.

    Medicaid enrollees are already reporting they’ve been erroneously kicked off in a handful of states that have begun removing people, including Arizona, Arkansas, Florida, Idaho, Iowa, New Hampshire and South Dakota, according to data gathered by the AP.

    Trevor Hawkins is seeing the problems play out firsthand in Arkansas, where officials told the AP that the state is moving “as fast as possible” to wrap up a review before year’s end.

    Hawkins spends his days driving winding roads across the state providing free legal services to people who have lost coverage or need help filling out pages of forms the state has mailed to them. In between his drives, he fields about a half-dozen phone calls daily from people seeking guidance on their Medicaid applications.

    “The notices are so confusing,” said Hawkins, who works for Legal Aid of Arkansas. “No two people have had the same experience with losing their coverage. It’s hard to identify what’s really the issue.”

    Some people have been mailed pre-populated application forms that include inaccurate income or household information but leave Medicaid enrollees no space to fix the state’s errors. Others have received documents that say Medicaid recipients will lose their coverage before they’ve even had an opportunity to re-apply, Hawkins said.

    Tonya Moore, 49, went for weeks without Medicaid coverage because the state used her 21-year-old daughter’s wages, including incomes from two part-time jobs that she no longer worked, to determine she was ineligible for the program. County officials told Moore she had to obtain statements from the businesses — about an hour’s drive from Moore’s rural home in Highland, Arkansas — to prove her daughter no longer worked there. Moore says she wasn’t able to get the documents before being kicked off Medicaid on April 1.

    By last week, Moore had run out of blood pressure medication and insulin used to control her diabetes and was staring down a nearly empty box of blood sugar test strips.

    “I got a little panicky,” she said at the time. “I don’t know how long it’s going to take to get my insurance.”

    Moore was reinstated on Medicaid as of Monday with Legal Aid’s help.

    The McHenry family, in Winter Park, Florida, also worries the state has mixed up their income while checking their eligibility for Medicaid.

    After their son Ryder was diagnosed with cancer in September 2021, Allie McHenry quit her job to take care of him, leaving the family with a single income from Kyle McHenry’s job as a heavy diesel mechanic. She signed the family up for Medicaid then but says they were initially denied because the state wrongly counted disability payments for Ryder’s cancer as income. She’s concerned the state included those payments in its latest assessment but has been unable to get a clear answer, after calling the state three times and being disconnected twice after staying on hold for hours.

    “It is always a nightmare trying to call them,” Allie McHenry said of her efforts to reach the state’s helpline. “I haven’t had the heart or strength to try and call again.”

    Notices sent to the McHenrys and reviewed by the AP show they were given less than two weeks’ warning that they’d lose coverage at the end of April. The federal government requires states to tell people just 10 days in advance that they’ll be kicked off Medicaid.

    The family’s experience isn’t surprising. Last year, Congress, so worried that some states were ill-equipped to properly handle the number of calls that would flood lines during the Medicaid process, required states to submit data about their call volume, wait times and abandonment rate. The federal Centers for Medicare and Medicaid Services will try to work with states where call wait times are especially high, a spokesperson for the agency said.

    Some doctors and their staffs are taking it upon themselves to let patients know about the complicated process they’ll have to navigate over the next year.

    Most of the little patients pediatrician Lisa Costello sees in Morgantown, West Virginia are covered by Medicaid, and she’s made a point to have conversations with parents about how the process will play out. She’s also encouraging her colleagues to do the same. West Virginia officials have sent letters to nearly 20,000 people telling them that they’ll lose coverage on Monday.

    Some people might not realize they no longer have Medicaid until they go to fill a prescription or visit the doctor in the coming weeks, Costello said.

    “A lot of it is educating people on, ‘You’re going to get this information; don’t throw it away,’” she said. “How many of us get pieces of mail and toss it in the garbage because we think it’s not important?”

    Every weekday, about a dozen staffers at Adelante Healthcare, a small chain of community clinics in Phoenix, call families they believe are at risk of losing Medicaid. Colorful posters on the walls remind families in both English and Spanish to ensure their Medicaid insurance doesn’t lapse.

    That’s how Alicia Celaya, a 37-year-old waitress in Phoenix, found out that she and her children, ages 4, 10 and 16, will lose coverage later this year.

    When she and her husband were laid off from their jobs during the COVID-19 pandemic, they enrolled in Medicaid. Both have returned to working in the restaurant industry, but Celaya and her children remained on Medicaid for the free health care coverage because she’s unable to come up with the hundreds of dollars to pay the monthly premiums for her employer-sponsored health insurance.

    The clinic is helping her navigate the private health insurance plans available through the Affordable Care Act’s marketplace and trying to determine whether her children qualify for the federal Children’s Health Insurance Program, known in Arizona as KidsCare. Celaya said she’d never be able to figure out the marketplace, where dozens of plans covering different doctors are offered at varying price points

    “I’m no expert on health insurance,” she said.

    ___

    Snow reported from Phoenix. Associated Press correspondents Andrew DeMillo in Little Rock, Arkansas, Anthony Izaguirre in Tallahassee, Florida, and Leah Willingham in Morgantown, West Virginia, contributed to this report.

    Source link

  • Cosmetic to critical: Blue states help trans health coverage

    Cosmetic to critical: Blue states help trans health coverage

    PORTLAND, Ore. — For most of her life in New Mexico, Christina Wood felt like she had to hide her identity as a transgender woman. So six years ago she moved to Oregon, where she had readier access to the gender-affirming health care she needed to live as her authentic self.

    Once there, Wood, 49, was able to receive certain surgeries that helped her transition, but electrolysis, or permanent hair removal, wasn’t fully covered under the state’s Medicaid plan for low-income residents. Paying out-of-pocket ate up nearly half her monthly income, but it was critical for Wood’s mental health.

    “Having this facial hair or this body hair, it doesn’t make me feel feminine. I still look in the mirror and I see that masculine person,” she said. “It’s stressful. It causes anxiety and PTSD when you’re having to live in this body that you don’t feel like you should be in.”

    That is likely about to change. Oregon lawmakers are expected to pass a bill that would further expand insurance coverage for gender-affirming care to include things like facial hair removal and Adam’s apple reduction surgery, procedures currently considered cosmetic by insurers but seen as critical to the mental health of transitioning women.

    The wide-ranging bill is part of a wave of legislation this year in Democratic-led states intended to carve out safe havens amid a conservative movement that seeks to ban or limit gender-affirming care elsewhere, eliminate some rights and protections for transgender people and even bar discussion of their existence in settings such as classrooms.

    More than a half-dozen states, from New Jersey to Vermont to Colorado, have passed or are considering bills or executive orders around transgender health care, civil rights and other legal protections. In Michigan, for example, Democratic Gov. Gretchen Whitmer last month signed a bill outlawing discrimination on the basis of gender identity and sexual orientation for the first time in her state.

    “Trans people are just being used as a political punching bag,” said Rose Saxe, deputy director of the American Civil Liberties Union’s LGBT and HIV Project. “Denying this health care doesn’t make them not trans. It just makes their lives much harder.”

    Gender-affirming care includes a wide range of social and medical interventions, such as hormone treatments, counseling, puberty blockers and surgery.

    Oregon’s bill would bar insurers and the state’s Medicaid plan from defining procedures like electrolysis as cosmetic when they are prescribed as medically necessary for treating gender dysphoria. It also would shield providers and patients from lawsuits originating in states where such procedures are restricted.

    “We’re actually very committed to accessibility of coverage. Because you can say something is legal, but if it’s not truly affordable or accessible, that is not a full promise,” said Democratic state Rep. Andrea Valderrama, the bill’s chief sponsor.

    Access to procedures such as electrolysis is also necessary as a matter of public safety, said Blair Stenvick, communications manager for the LGBTQ+ advocacy group Basic Rights Oregon.

    “Facial hair can be a trigger for harassment,” Stenvick said, and being able to present as a woman “helps folks to not get targeted and identified as a trans person and then attacked.”

    The bill has sparked fervent debate, with hundreds of people submitting written testimony both for and against it and an emotionally charged public hearing at the Capitol in Salem last month that went on for several hours. The Democratic-controlled House is expected to vote on the bill Monday over Republican opposition before it heads to the Senate, which is also dominated by Democrats.

    Oregon’s measure mirrors a nationwide trend in Democratic-led states.

    Shield protections similar to what is being proposed in Oregon have been enacted this year in Colorado, Illinois, New Jersey and New Mexico, and other bills are awaiting the signatures of Govs. Jay Inslee in Washington and Tim Walz in Minnesota. California, Massachusetts and Connecticut passed their own measures last year. They largely bar authorities from complying with subpoenas, arrest warrants or extradition requests from states that have banned gender-affirming treatments.

    Meanwhile a measure passed last month by lawmakers in Maryland would expand the list of procedures covered by Medicaid, and Democratic Gov. Wes Moore has said he plans to sign it.

    And lawmakers in Nevada’s Democratic-held Legislature are also pushing to expand gender-affirming health care and develop policies regarding the treatment of transgender prisoners, among other things.

    The series of bills face an uncertain fate under Republican Gov. Joe Lombardo, who has shied away from the anti-transgender rhetoric and policy proposals that fellow GOP officeholders and candidates across the country have embraced. Lawmakers have just over a month to vote on them before the legislative session ends in June. But regardless of their outcome, an open debate over transgender health care protections in the important swing state promises to further heighten national attention on the issue.

    “They know that this is not a political stunt,” state Sen. Melanie Scheible, the bill’s sponsor and member of Nevada’s newly formed LGBTQ+ Caucus, said of the governor’s office. “I’m not trying to give them a bill to veto just so I can complain about it later.”

    Some opponents of gender-affirming health care say they’re concerned that young people may undergo certain physical transition procedures that are irreversible or transition socially in settings such as schools without their parents’ knowledge.

    Advocates for gender-affirming health procedures counter that they can be, literally, a matter of life or death.

    Kevin Wang, medical director for the LGBTQI+ Program at Swedish Health Services in Seattle, said such care alleviates the depression, anxiety and self-harm seen in patients with gender dysphoria. Studies show that transgender people, particularly youth, consider and attempt suicide at higher rates than the general population.

    “These are not aesthetic procedures,” Wang said. “Accessing these services can be absolutely life-saving because we’re preventing future harm.”

    Some legal experts, however, warn that laws that protect gender-affirming care but lack strong enforcement mechanisms or funding to investigate violations may not result in meaningful change.

    For example, Oregon already bars insurance companies from discrimination on the basis of gender identity. And the state agency overseeing health insurance rules already requires companies to cover procedures deemed medically necessary by a doctor to treat gender dysphoria and bars them from defining them as cosmetic.

    But insurers have rarely faced major consequences for violations, said Ezra Young, a civil rights attorney and visiting assistant professor of law at Cornell Law School.

    “Where’s the task force that’s going to enforce the law?” Young said. “Where are the lawyers that are going to do this? Where is the funding to educate insurance adjusters that they can’t do this?”

    “If you’re leaving it to relatively poor transgender people to litigate a case in court … that’s not a meaningful remedy.”

    Christina Wood, the transplant to Oregon, said she was lucky to have had the resources and ability to move to a state where she could more easily complete her transition, compared with other states that have fewer protections.

    “It’s scary to live in this world right now. But … I’m not going to back down, and I’m going to advocate for people in my situation,” Wood said.

    “I never had a voice when I was younger. Christopher never had a voice. Christina has a voice. And so that’s what I plan to do.”

    ___

    Associated Press writers Gabe Stern in Carson City, Nevada, Joey Cappellitti in Lansing, Michigan, and Brian Witte in Baltimore contributed to this report.

    ___

    Rush and Stern are corps members for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.

    Source link

  • Dying patients protest looming telehealth crackdown

    Dying patients protest looming telehealth crackdown

    At age 93, struggling with the effects of a stroke, heart failure and recurrent cancer, Teri Sheridan was ready to end her life using New Jersey’s law that allows medically assisted suicide — but she was bedbound, too sick to travel.

    So last Nov. 17, surrounded by three of her children, Sheridan drank a lethal dose of drugs prescribed by a doctor she had never met in person, only online. She died within minutes.

    Soon, others who seek Sheridan’s final option may find it out of reach, the unintended result of a federal move to roll back online prescribing of potentially addictive drugs allowed during the COVID-19 pandemic.

    “How much should one person suffer?” said Sheridan’s daughter, Georgene White, 68. “She wanted to just go to sleep and not wake up.”

    Online prescribing rules for controlled drugs were relaxed three years ago under emergency waivers to ensure critical medications remained available during the COVID-19 pandemic. Now, the U.S. Drug Enforcement Agency has proposed a rule that would reinstate most previously longstanding requirements that doctors see patients in person before prescribing narcotic drugs such as Oxycontin, amphetamines such as Adderall, and a host of other potentially dangerous drugs.

    The aim is to reduce improper prescribing of these drugs by telehealth companies that boomed during the pandemic. Given the ongoing opioid epidemic, allowing continued broad use of telemedicine prescribing “would pose too great a risk to the public health and safety,” the proposed rule said. It also cracks down on how doctors can prescribe other less-addictive drugs, like Xanax, used to treat anxiety, and buprenorphine, a narcotic used to treat opioid addiction.

    The rule would allow some of these drugs to be prescribed with telemedicine for an initial 30-day dose, though patients would need to be seen in person to get a refill. And patients who have been referred to a new doctor by one they had previously met in person could continue to receive prescriptions for the drugs via telemedicine.

    DEA Administrator Anne Milgram called the plan “telemedicine with guardrails.”

    The agency, with input from the Department of Health and Human Services, is working to finalize the rule by May 11, when the COVID public health emergency officially ends, an HHS spokeswoman said. If approved by then, the new requirements would take effect in November.

    The proposal has sparked a massive backlash, including more than 35,000 comments to a federal portal and calls from advocates, members of Congress and medical groups to reconsider certain patients or provisions.

    “They completely forgot that there was a population of people who are dying,” said Dr. Lonny Shavelson, a California physician who chairs the American Clinicians Academy on Medical Aid in Dying, a coalition of doctors who help patients access care under so-called right-to-die laws.

    Among the biggest complaints: The rule would delay or block access for patients who seek medically assisted suicide and hospice care, critics said. Many of the comments — including nearly 10,000 delivered in person to DEA offices — came from doctors and patients protesting the effect of the rule on seriously ill and dying patients.

    “Please do not make the end of life harder for me,” wrote Lynda Bluestein, 75, of Bridgeport, Connecticut. In March, Bluestein, who has terminal fallopian tube cancer, reached a settlement with the state of Vermont that will allow her to be the first non-resident to use its medically assisted suicide law. By the time she’s ready to use the drugs, she expects to be too ill to travel to see a doctor in person for the prescription, she wrote.

    The clash between desperate patients who need treatment and DEA’s efforts to bar telehealth companies from overprescribing dangerous medications was inevitable, said David Herzberg, a historian of drugs at the University of Buffalo.

    “The balancing act is so tricky,” he said.

    Laws in 10 states and Washington, D.C. allow dying people with a prognosis of six months or less to end their lives with a lethal combination of medications covered by the DEA rule. But such patients are often too sick to visit a doctor in person ¬– or they live hundreds of miles from the nearest willing and qualified provider, Shavelson said.

    There are similar issues for the 1.7 million Medicare recipients enrolled in hospice care in the U.S., said Judi Lund Person, who oversees regulatory compliance for the National Hospice and Palliative Care Organization. Rolling back online prescribing flexibilities could mean a dying patient would wait for days for drugs to ease pain and other symptoms.

    “They just don’t have time for that,” she said.

    Shavelson and his colleagues called for an exception to the rule for the hundreds of patients a year who qualify for medically assisted suicide. Both the American Medical Association and the California Medical Association sent letters asking the DEA to carve out provisions for doctors prescribing the most dangerous category of drugs to patients receiving hospice or palliative care.

    “These patients are extremely fragile and their medical conditions do not allow them to easily access a physician’s office,” wrote Dr. Donaldo D. Hernandez, president of the California group. Such people pose a “reduced risk for abuse” given their clear need for the medications.

    Congress directed DEA in 2008 to create exceptions for certain providers to permit remote prescribing, but the agency has not done so, Virginia Democrat Sen. Mark Warner said in a statement last month.

    DEA officials did not respond to questions about whether COVID-19 telehealth waivers would remain in effect if the proposed rule isn’t finalized by May 11 or whether the agency will allow exceptions for remote prescribing.

    During the pandemic, prescriptions for medically assisted suicide went up, in some cases significantly. In Oregon, for instance, they climbed nearly 49%, to 432 in 2022 from 290 in 2019. The number of deaths under the law in that state rose, too, to 246 from 170. Nationally, at least 1,300 people die each year using the process, according to available state figures.

    Telemedicine was key to access during the COVID emergency, said Dr. Robin Plumer, the New Jersey doctor who prescribed the drugs Teri Sheridan took. Plumer has overseen 80 assisted suicide deaths since 2020. Without online prescribing, 35% to 40% of her patients wouldn’t have been able to use the law.

    “I feel like we’ve taught people over the past couple of years that telemedicine does work in so many areas and it’s a great improvement for people,” especially for those who are homebound or dying, Plumer said.

    “And what?” she said. “They’re suddenly going to yank that away?”

    —-

    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.

    Source link

  • Transgender adults brace for treatment cutoffs in Missouri

    Transgender adults brace for treatment cutoffs in Missouri

    Ellie Bridgman spent her Thursday night shift at a local gas station in Union, Missouri, planning for the day she’ll lose access to gender-affirming treatments the transgender and nonbinary 23-year-old credits with making “life worth living.”

    A first-of-its-kind emergency rule introduced this week by Missouri’s Republican Attorney General Andrew Bailey will impose numerous restrictions on both adults and children before they can receive puberty-blocking drugs, hormones or surgeries “for the purpose of transitioning gender.”

    Transgender rights advocates have vowed to challenge the rule in court before it takes effect April 27. But promises of swift legal action have done little to ease the worries of trans Missourians like Bridgman who say it may be time to flee the state.

    Before gender-affirming medical treatments can be provided by physicians, the regulation requires people to have experienced an “intense pattern” of documented gender dysphoria for three years and to have received at least 15 hourly sessions with a therapist over at least 18 months. Patients also would first have to be screened for autism and “social media addiction,” and any psychiatric symptoms from mental health issues would have to be treated and resolved.

    Some individuals will be allowed to maintain their prescriptions while they promptly receive the required assessments.

    Bridgman, who uses she/they pronouns, is autistic and has depression. She said she sees only two options: move across the country, away from all her friends and family, to a state that protects access to gender-affirming care, or accept the serious health risks that could come with illegally buying hormones online.

    She headed to a pharmacy Friday afternoon to pay out of pocket for all her remaining refills.

    “Placing restrictions on transitioning for people with depression is just a way for them to completely bar us from transitioning at all,” Bridgman said. “For lots of trans people, dysphoria is the cause of depression. You can’t treat the depression without treating the underlying dysphoria.”

    Before Bridgman started hormone replacement therapy last summer, she said “life felt meaningless” and suicidal thoughts crowded her head. Gender-affirming care was her “last chance at life,” she said.

    The regulation comes as Republican lawmakers across the country, including in Missouri, have advanced hundreds of measures aimed at nearly every facet of transgender existence, with a particular emphasis on health care.

    At least 13 states have enacted laws restricting or banning gender-affirming care for minors. Bills await action from governors in Montana, North Dakota and neighboring Kansas, and nearly two dozen other states are considering legislation to restrict or ban care.

    National groups advocating for LGBTQ+ rights contend the Missouri regulation — based on a state law against deceptive and unfair business practices — goes further than most restrictions enacted elsewhere.

    Three states have imposed restrictions on gender-affirming care via regulation or administrative order, but Missouri’s regulation is the only one that also limits treatments for adults.

    Cathy Renna, a spokesperson for the National LGBTQ Task Force, said the rule demonstrates how Republicans are now successfully broadening the scope of gender-affirming care restrictions beyond minors, which advocates had been warning about for months.

    “When they see one thing work in one state, they’ll try to replicate it in another,” Renna warned.

    Bailey’s restriction comes after a former employee at a transgender youth clinic in St. Louis alleged that physicians at the Washington University Transgender Center were rushing to provide treatment without appropriate patient assessment.

    Bailey said he is investigating the clinic but has not yet issued a report. The claims of mistreatment have been disputed by others, including another former employee and patients. Neither Bailey nor the university responded to phone and email messages seeking comment.

    Dr. Meredithe McNamara, an assistant professor of pediatrics specializing in adolescent medicine at the Yale School of Medicine, said evidence widely supports maintaining access to hormone therapy and other gender-affirming care.

    As part of a consent process, Bailey’s rule requires that patients be shown materials containing nearly two dozen specific statements raising concerns about gender-affirming treatments — a practice doctors like McNamara have denounced as a form of conversion therapy.

    “There is no evidence that shows that psychotherapy as the only treatment is effective,” she said.

    Stacy Cay, an autistic trans woman in Kansas City, has been stockpiling vials of injectable estrogen in anticipation of restrictions. The 30-year-old comedian and model realized she only required a small dose and has saved up enough estrogen to last about a year. When that runs out, she will have to travel across state lines to fill prescriptions or consider moving elsewhere.

    Cay said her persistent depression will cut off her access to hormones under the regulation and that her autism diagnosis could complicate her path to receiving future care. While the regulation does not specify whether autism disqualifies a person for gender-affirming care, it does mandate an assessment.

    A 2020 study from natural sciences journal Nature Communications estimated that transgender and gender-diverse people, or those whose gender expressions do not conform to gender norms, are 3-6 times more likely to be autistic compared to cisgender people. They were also more likely to have other developmental and psychiatric conditions, including depression.

    “They know a lot of us are autistic, and it’s part of their strategy to paint us as unstable — that we can’t be trusted to make our own medical decisions,” Cay said.

    Attorneys from Lambda Legal and the American Civil Liberties Union say they plan to challenge the new rule in court.

    Missouri falls under the 8th U.S. Circuit Court of Appeals — the same court that upheld a preliminary injunction last year preventing Arkansas from enforcing a first-in-the-nation ban on trans children receiving gender-affirming treatments. Federal judges have also blocked enforcement of a similar law in Alabama.

    Republican legislators leading Missouri’s effort to ban gender-affirming treatments for minors said Friday that they have no plans to expand their legislation to include adults.

    Separate bills passed by the Missouri House and Senate would ban treatments for children younger than 18 but would impose no restrictions for adults who are covered by private insurance or willing to pay for their own health care.

    “I believe it is detrimental to a person’s body, probably even their psyche, to go through treatments like that,” said state Sen. Mike Moon, lead sponsor of the Senate legislation. “Adults have the opportunity to make decisions such as these.”

    ___

    Schoenbaum reported from Raleigh, North Carolina, and Lieb reported from Jefferson City. Associated Press editor Jeff McMillan contributed from Scranton, Pennsylvania.

    Source link

  • Missouri to restrict transgender care for minors, adults

    Missouri to restrict transgender care for minors, adults

    COLUMBIA. Mo. — Missouri’s attorney general announced new restrictions Thursday on transgender care for adults in addition to minors in a move that is believed to be a first nationally and has advocacy groups threatening to sue.

    Attorney General Andrew Bailey announced plans to restrict transgender health care weeks ago, when protesters rallied at the Capitol to urge lawmakers to pass a law banning puberty blockers, hormones and surgeries for children. But the discussion was focused on minors, not adults.

    Missouri Attorney General spokeswoman Madeline Sieren clarified in a statement later in the day that adults also would be covered.

    “We have serious concerns about how children are being treated throughout the state, but we believe everyone is entitled to evidence-based medicine and adequate mental health care,” Sieren said.

    The rule, which incudes a required 18 months of therapy before receiving gender-affirming health care, is set to take effect April 27 and expire next February.

    The ACLU and Lambda Legal said in a joint statement that they would “take any necessary legal action” and urged those affected to call.

    “The Attorney General’s so-called emergency rule is based on distorted, misleading, and debunked claims and ignores the overwhelming body of scientific and medical evidence supporting this care,” the statement said.

    Robert Fischer, the spokesman for the LGBT rights groups PROMO, said he was not aware of similar restrictions elsewhere.

    “He’s essentially attacking the entire trans community at this point,” Fischer said of Bailey. “It’s no longer just about children.”

    The National Center for Transgender Equality called the order “deeply wrong” in a tweet, adding that “trans people of all ages across the state of Missouri deserve access to health care.”

    The restrictions are in response to a former employee’s allegations of mistreatment at a transgender youth clinic in St. Louis run by Washington University. Bailey is investigating the center.

    “My office is stepping up to protect children throughout the state while we investigate the allegations and how they are harming children,” Bailey said in a statement.

    University spokespeople didn’t immediately respond to phone or email messages from The Associated Press seeking comment.

    Moving forward, doctors who provide gender-affirming health care must first provide them a lengthy list of potential negative side effects and information warning against those treatments, according to a copy of the rule released Thursday.

    Health care providers will need to ensure “any psychiatric symptoms from existing mental health comorbidities of the patient have been treated and resolved” before providing gender-affirming treatments under the new rule. Physicians also must screen patients for social media addiction, autism and signs of “social contagion with respect to the patient’s gender identity.”

    The FDA approved puberty blockers 30 years ago to treat children with precocious puberty — a condition that causes sexual development to begin much earlier than usual. Sex hormones — synthetic forms of estrogen and testosterone — were approved decades ago to treat hormone disorders or as birth control pills.

    The FDA has not approved the medications specifically to treat gender-questioning youth, but they have been used for many years for that purpose “off label,” a common and accepted practice for many medical conditions. Doctors who treat transgender patients say those decades of use are proof the treatments are not experimental.

    Critics have raise concerns about children changing their minds. Yet the evidence suggests detransitioning is not as common as opponents of transgender medical treatment for youth contend, though few studies exist and they have their weaknesses.

    Bailey’s rule was released the same day Missouri’s Republican-led House voted to ban access to transgender-related health care for minors.

    The House voted 103-52 along mostly party lines in favor of the ban, although the bill’s passage seems uncertain in the Senate.

    The House proposal is stricter than what was passed by the GOP-led Senate, where Democrats have more influence through the use of stall tactics.

    Senators compromised to exempt care for minors whose treatment is already underway. The Senate bill also would expire after four years.

    The House version includes no exceptions for current treatments and would remain in effect indefinitely.

    Republican Senate leaders said it’s unlikely that the House version will make it through the Senate.

    “We’ve already passed legislation on this issue out of the Senate,” Senate President Pro Tem Caleb Rowden said. “We would expect the House to appreciate how hard and difficult it was and to take up our bill and pass it.”

    Both the House and Senate proposals would ban inmates and prisoners from accessing gender-affirming surgeries and would end coverage of any gender-affirming treatments for Missouri patients on Medicaid, the federal health insurance program.

    The Human Rights Campaign have condemned the legislation in a statement, describing gender-affirming care as medically necessary.

    At least 13 states have now enacted laws restricting or banning gender-affirming care for minors: Alabama, Arkansas, Arizona, Georgia, Idaho, Indiana, Iowa, Kentucky, Mississippi, Tennessee, Utah, South Dakota and West Virginia. Bills are awaiingt action from governors in Kansas, Montana and North Dakota. Federal judges have blocked enforcement of laws in Alabama and Arkansas, and nearly two dozen states are considering bills this year to restrict or ban care.

    House debate on the bill became emotional as some Democrats argued the ban on health care will hurt transgender children.

    “You are erasing my grandchild,” said St. Louis Democratic Rep. Barbara Phifer, whose grandson is transgender.

    Republican sponsor Rep. Brad Hudson, of Cape Fair, criticized Democrats for threatening to end political partnerships and friendships with Republicans over the bill.

    Hudson said his bill “seeks to protect kids” and that it’s unfair that Democrats are describing it as hateful towards transgender children.

    “A yes vote is a vote to protect kids from sex-change drugs and surgeries,” Hudson said.

    ——

    Associated Press writer David A. Lieb contributed to this report from Jefferson City, Missouri.

    Source link

  • Biden says he’s expanding some migrants’ health care access

    Biden says he’s expanding some migrants’ health care access

    WASHINGTON — President Joe Biden announced Thursday that hundreds of thousands of immigrants brought to the U.S. illegally as children will be able to apply for Medicaid and the Affordable Care Act’s health insurance exchanges.

    The action will allow participants in the Obama-era Deferred Action for Childhood Arrivals program, or DACA, to access government-funded health insurance programs.

    “They’re American in every way except for on paper,” Biden said in a video released on his Twitter page. “We need to give Dreamers the opportunities and support they deserve.”

    The action is likely to generate significant pushback from conservative leaders of states that have been have been reluctant to expand Medicaid and critical of the Biden administration’s response to migrants who enter the U.S. illegally. While the federal government provides funding and guidelines for Medicaid, the program is administered by the states.

    Then-President Barack Obama launched the 2012 DACA initiative to shield from deportation immigrants who were brought to the U.S. illegally by their parents as children and to allow them to work legally in the country. However, the immigrants, known as “Dreamers,” were still ineligible for government-subsidized health insurance programs because they did not meet the definition for having “lawful presence” in the U.S. Biden’s Department of Health and Human Services will aim to change that by the end of the month.

    The White House action comes as the DACA program is in legal peril and the number of people eligible is shrinking.

    An estimated 580,000 people were still enrolled in DACA at the end of last year, according to U.S. Citizenship and Immigration Services. That number is down from previous years. Court orders currently prevent the U.S. Department of Homeland Security from processing new applications. The DACA program has been mired in legal challenges for years, while Congress has been unable to reach consensus on broader immigration reforms.

    DACA recipients can work legally and must pay taxes, but they don’t have full legal status and are denied many benefits, including access to federally funded health insurance, available to U.S. citizens and foreigners living in the U.S.

    During the COVID-19 pandemic, many people signed up for Medicaid, the program that provides health care coverage for the poorest Americans. And the government increased federal subsidies to drive down the cost of insurance plans on the Affordable Care Act’s marketplace. As of last year, just 8% of Americans were without health insurance, according to Health and Human Services.

    But immigrants living in the U.S. without documentation are far more likely than others to not have health insurance. More than a third of DACA recipients are estimated to be without health care coverage, HHS said. About half of the roughly 20 million immigrants who are living in the U.S. without documentation are uninsured, according to research from the Kaiser Family Foundation.

    Providing more people with insurance could have a positive impact on the entire health care system because it would give more people access to routine checkups and avoid emergency visits, said Jamila Michener, associate professor of government and policy at Cornell University.

    “Having sizeable groups of people who live, work, go to school and make their home in the U.S. but cannot access vital health benefits is bad for everyone,” Michener said in an email. “It makes preventive care less accessible thus driving up the cost of emergency care.”

    While there’s bipartisan support to enact some sort of protections for the immigrants, negotiations have often broken down over in debates about border security and whether an expansion of protections might induce others to try to enter the U.S. without permission. Biden, a Democrat, has repeatedly called on Congress to provide a pathway to citizenship for immigrants brought to the U.S. illegally as children.

    Other classes of immigrants — including asylum seekers and people with temporary protected status — are already eligible to purchase insurance through the marketplaces of the ACA, Obama’s 2010 health care law, often called “Obamacare.”

    Source link

  • Indiana, Idaho governors sign bans on gender-affirming care

    Indiana, Idaho governors sign bans on gender-affirming care

    INDIANAPOLIS — Republican governors in Indiana and Idaho have signed into law bills banning gender-affirming care for minors, making those states the latest to restrict transgender health care as Republican-led legislatures continue to curb LGBTQ+ rights this year.

    Indiana Gov. Eric Holcomb signed legislation Wednesday that will prohibit transgender youth from accessing medication or surgeries that aid in transition and mandate those currently taking medication to stop by the end of the year.

    Idaho Gov. Brad Little had signed legislation Tuesday evening that criminalizes gender-affirming care for youth.

    More than a dozen other states are considering bills that would prohibit transgender youth from accessing hormone therapies, puberty blockers and transition surgeries, even after the approval of parents and the advice of doctors. Other proposals target transgender individuals’ everyday life — including sports, workplaces and schools.

    “Permanent gender-changing surgeries with lifelong impacts and medically prescribed preparation for such a transition should occur as an adult, not as a minor,” Holcomb said in a statement about the Indiana bill.

    The American Civil Liberties Union of Indiana filed a lawsuit rapidly after Holcomb signed the Indiana legislation — something the group had promised to do after Republican supermajorities advanced the ban this session. The American Civil Liberties Union of Idaho announced Wednesday it also planned to sue over that state’s new law.

    The Indiana ACLU filed the lawsuit on behalf of four transgender youth and an Indiana doctor who provides transgender medical treatment. It argues the ban violates the U.S. Constitution’s equal protection guarantees as well as federal laws regarding essential medical services.

    “The legislature did not ban the various treatments that are outlined,” said Ken Falk, the ACLU of Indiana legal director. “It only banned it for transgender persons.”

    Under the Indiana law that takes effect July 1, doctors who offer gender-affirming care to minors would be disciplined by a licensing board. And under the Idaho law set to go into effect next January, providing hormones, puberty blockers or other gender-affirming care to people under age 18 would be a felony crime.

    “In signing this bill, I recognize our society plays a role in protecting minors from surgeries or treatments that can irreversibly damage their healthy bodies,” Little wrote. “However, as policymakers we should take great caution whenever we consider allowing the government to interfere with loving parents and their decisions about what is best for their children.”

    Supporters of the legislation have contended the banned care is irreversible or carries side effects. They argue that only an adult — and not a minor’s parent — can consent to the treatments.

    But opponents say such care is vital and often life-saving for trans kids, and medical providers say most of the procedures are reversible and safe. Transgender medical treatments for children and teens have also been available in the U.S. for more than a decade and are endorsed by major medical associations.

    “When I started hormone therapy, it made me feel so much better about myself,” said Jessica Wayner, 16, at an Indiana House public health committee hearing last month.

    At least 13 states have laws banning gender-affirming care for minors: Alabama, Arkansas, Arizona, Georgia, Idaho, Indiana, Iowa, Kentucky, Mississippi, Tennessee, Utah, South Dakota and West Virginia. Federal judges have blocked enforcement of Alabama and Arkansas’ laws.

    The GOP-led Kansas Legislature on Wednesday also overrode Democratic Gov. Laura Kelly’s veto of a bill to ban transgender athletes from girls’ and women’s sports from kindergarten through college.

    Nineteen other states have imposed restrictions on transgender athletes, most recently Wyoming.

    The Arkansas Senate also sent a bill Wednesday to Republican Gov. Sarah Huckabee Sanders that would not allow schools to mandate its employees call transgender students by their preferred name or pronouns.

    In some states where Democrats control the legislature, lawmakers are enshrining access to gender-affirming health care. Democratic New Mexico Gov. Michelle Lujan Grisham signed a bill Wednesday that protects providers of gender-affirming health care against potential civil and criminal prosecution.

    Dr. Molly McClain, who provides gender-affirming health care to patients of all ages, said the new legislation sends a message to people exploring their identity in ways that may not conform to gender norms.

    “It says you are seen, you are safe, you are precious, and your access to health care will be protected here,” said McClain, who teaches medicine at the University of New Mexico. “I think that that sends a huge message to trainees” in the medical field.

    ___

    Associated Press writers contributed to this report — Tom Davies in Indianapolis; John Hanna in Topeka, Kansas; Morgan Lee in Santa Fe, New Mexico; and Rebecca Boone in Boise, Idaho.

    ___

    Arleigh Rodgers is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues. Follow her on Twitter at https://twitter.com/arleighrodgers

    Source link

  • Missouri Planned Parenthood sues over transgender inquiry

    Missouri Planned Parenthood sues over transgender inquiry

    Associated Press — Missouri’s state attorney general is investigating gender-affirming care provided by Planned Parenthood, according to a lawsuit filed Friday by the St. Louis health provider.

    Republican Attorney General Andrew Bailey demanded documents from Planned Parenthood after finding out that the clinic provides “life-altering gender transition drugs to children with any therapy assessment,” spokeswoman Madeline Sieren said in a statement. She described that as a departure from standard care.

    Planned Parenthood of the St. Louis Region and Southwest Missouri sued in response, trying to block access to its records. In court filings, the healthcare provider argued Bailey has no authority to investigate the clinic, which is inspected by the state health department.

    A Planned Parenthood doctor described Bailey’s investigation as a “fishing expedition” targeting the clinic, which provides gender-affirming care to adults, and teens ages 16 and older. Dr. Colleen McNicholas, the health center’s chief medical officer, told The Associated Press that the attorney general’s investigation is “an attempt to help him work outside of the legislative process and eliminate access to transgender care for Missourians.”

    The Attorney General’s Office cited its ongoing investigation into a transgender youth clinic run by Washington University, “or others in the state providing similar services,” as the reason for the document request, according to a letter to Planned Parenthood dated March 10.

    Sieren criticized Planned Parenthood for withholding its records.

    “We look forward to prevailing in this request for information and learning what is truly going on with Planned Parenthood in connection with gender transition issues,” Sieren said in a Friday statement.

    In February, Bailey launched an investigation into the Washington University Transgender Center at St. Louis Children’s Hospital following allegations of mistreatment by a former employee. The ex-staffer alleged that physicians there did not warn patients and parents enough about potential side effects of puberty blockers and hormones, and that doctors pressured parents to consent to treatment.

    Planned Parenthood argues in its lawsuit that its clinic has nothing to do with the Washington University center.

    The lawsuit comes amid a national push to restrict transgender health care, drag shows, bathroom access and how LGBTQ+ topics are discussed in schools. The lawsuit was filed Friday as rallies were scheduled in cities nationwide as part of Transgender Day of Visibility.

    As the state’s top prosecutor, Bailey is following his predecessor’s lead in using the office to take a stand on social issues. Last week, he announced plans to file an emergency rule to restrict healthcare for transgender children. It would require an 18-month waiting period, 15 therapy sessions and additional mental health treatment before Missouri doctors can provide gender-affirming care to minors.

    “I am dedicated to using every legal tool at my disposal to stand in the gap and protect children from being subject to inhumane science experiments,” Bailey said in a statement announcing the planned rule.

    His office has not yet filed the rule.

    Transgender medical treatment for children has been available in the U.S. for over a decade and is endorsed by major medical associations. Many clinics use treatment plans pioneered in Amsterdam 30 years ago, according to a recent review in the British Psych Bulletin. Since 2005, the number of youth referred to gender clinics has increased as much as tenfold in the U.S., U.K, Canada and Finland, the review said.

    McNicholas, of Planned Parenthood, said Bailey is using the “same playbook” that anti-abortion activists and elected officials have used to restrict abortions.

    Missouri banned almost all abortions in 2022, after the U.S. Supreme Court overturned Roe v. Wade.

    Before that, Republicans fought for years to regulate abortion out of existence in the state. The GOP-led state legislature proposed anti-abortion bills yearly. When increasingly restrictive bans on the procedure were tossed in court, Republican governors stepped in.

    “If we are to learn anything from our past experience with the state targeting us for the provision of lawful abortion care, we know that other folks who are providing this care are certainly going to be targets,” McNicholas said. “If not now, then soon.”

    Source link

  • GOP lawmakers override veto of transgender bill in Kentucky

    GOP lawmakers override veto of transgender bill in Kentucky

    FRANKFORT, Ky. — Republican lawmakers in Kentucky on Wednesday swept aside the Democratic governor’s veto of a bill regulating some of the most personal aspects of life for transgender young people — from banning access to gender-affirming health care to restricting the bathrooms they can use.

    The votes to override Gov. Andy Beshear’s veto were lopsided in both legislative chambers — where the GOP wields supermajorities — and came on the next-to-last day of this year’s legislative session.

    As emotions surged, some people protesting the bill from the House gallery were removed and arrested after their chants drowned out the voices of lawmakers. The protesters, their hands bound, chanted “there’s more of us not here” as they waited to be taken away from the Capitol. Kentucky State Police didn’t immediately say how many were arrested or on what charges.

    The debate is likely to spill over into this year’s gubernatorial campaign, with Beshear’s veto drawing GOP condemnation as he seeks reelection to a second term. A legal fight also is brewing. The American Civil Liberties Union of Kentucky reaffirmed that it intends to “take this fight to the courts” to try to preserve access to those health care options for young transgender people.

    “While we lost the battle in the legislature, our defeat is temporary. We will not lose in court,” said Chris Hartman, executive director of the Fairness Campaign, an LGBTQ+ advocacy organization.

    In praising the override, David Walls, executive director of The Family Foundation, said the bill puts “policy in alignment with the truth that every child is created as a male or female and deserves to be loved, treated with dignity and accepted for who they really are.”

    Activists on both sides of the impassioned debate gathered at the statehouse to make competing appeals before lawmakers took up the transgender bill.

    At a rally that drew hundreds of transgender-rights supporters outside Kentucky’s Capitol, trans teenager Sun Pacyga held up a sign summing up a grim review of the Republican legislation. The sign read: “Our blood is on your hands.”

    “If it passes, the restricted access to gender-affirming health care, I think trans kids will die because of that,” the 17-year-old student said, expressing a persistent concern among the bill’s critics that the restrictions could lead to an increase in teen suicides.

    The Senate voted 29-8 to override Beshear’s veto,. A short time later, the House completed the override on a vote of 76-23. Republicans have supermajorities in both chambers.

    Bill supporters assembled to defend the measure, saying it protects trans children from undertaking gender-affirming treatments they might regret as adults. Research shows such regret is rare, however.

    “We cannot allow people to continue down the path of fantasy, to where they’re going to end up 10, 20, 30 years down the road and find themselves miserable from decisions that they made when they were young,” said Republican Rep. Shane Baker at a rally.

    The legislation in Kentucky is part of a national movement, with state lawmakers approving extensive measures that restrict the rights of LGBTQ+ people this year — from bills targeting trans athletes and drag performers to measures limiting gender-affirming care.

    At least 10 states have enacted laws restricting or banning gender-affirming care for minors: Alabama, Arkansas, Arizona, Georgia, Iowa, Kentucky, Mississippi, Tennessee, Utah and South Dakota. A proposed ban is pending before the Republican governor in West Virginia. Federal judges have blocked enforcement of laws in Alabama and Arkansas, and nearly two dozen states are considering bills this year to restrict or ban care.

    The debate in the Kentucky Senate reflected the impassioned arguments put forth at the rival rallies.

    “We are denying families, their physicians and their therapists the right to make medically informed decisions for their families,” Democratic Sen. Karen Berg said in opposing the bill.

    Berg read what her son, Henry Berg-Brousseau, wrote in advocating for transgender rights shortly before his death late last year at age 24. The cause was suicide, his mother said.

    Republican Sen. Robby Mills said he supported the bill because of his belief that “puberty blockers and cross-sex hormones, when administered to youth under 18 for the purpose of altering their appearance, is dangerous for the health of that child.”

    Transgender medical treatments have long been available in the United States and are endorsed by major medical associations.

    Mills said another reason for his support was that “parents and students should have confidence that bathrooms in their school will only be used by the same biological sex.”

    The sweeping Kentucky measure would ban gender-affirming care for minors. It would outlaw gender reassignment surgery for anyone under 18, as well as the use of puberty blockers and hormones, and inpatient and outpatient gender-affirming hospital services.

    Doctors would have to set a timeline to “detransition” children already taking puberty blockers or undergoing hormone therapy. They could continue offering care as they taper a youngster’s treatments, if removing them from the treatment immediately could harm the child.

    Parts of the bill dealing with gender-affirming medical care will take effect in about three months.

    The bill would not allow schools to discuss sexual orientation or gender identity with students of any age. It would also require school districts to devise bathroom policies that, “at a minimum,” would not allow transgender children to use the bathroom aligned with their gender identities.

    It would further allow teachers to refuse to refer to transgender students by the pronouns they use and require schools to notify parents when lessons related to human sexuality are going to be taught.

    Another trans teenager, Hazel Hardesty, said the potential discontinuation of gender-affirming health care would mean “my male puberty would continue,” which would “cause a lot of mental distress.”

    “People don’t even understand how it feels,” the 16-year-old said during a rally. “Going through the wrong puberty, every day your body is a little bit farther from what feels like you. And eventually you don’t even recognize yourself in the mirror.”

    Source link

  • NC approves Medicaid expansion, reversing long opposition

    NC approves Medicaid expansion, reversing long opposition

    The Republican-controlled North Carolina legislature has given final approval to a Medicaid expansion agreement

    ByGARY D. ROBERTSON Associated Press

    RALEIGH, N.C. — A Medicaid expansion deal in North Carolina received final legislative approval on Thursday, ending a decade of debate over whether the closely politically divided state should accept the federal government’s coverage for hundreds of thousands of low-income adults.

    North Carolina is one of several Republican-led states that have begun considering expanding Medicaid after years of steadfast opposion. Voters in South Dakota approved expansion in a referendum in November. And in Alabama, advocates are urging lawmakers to take advantage of federal incentives to expand Medicaid in order to provide health insurance to thousands of low-income people.

    When Democratic Gov. Roy Cooper, a longtime expansion advocate, signs the bill, it will leave 10 states in the U.S. that haven’t adopted expansion. North Carolina has 2.9 million enrollees in traditional Medicaid coverage. Advocates have estimated that expansion could help 600,000 adults.

    “Medicaid Expansion is a once in a generation investment that will make all North Carolina families healthier while strengthening our economy, and I look forward to signing this legislation soon,” Cooper tweeted.

    The House voted 87-24 in favor of the deal, after little debate. Some members clapped after it passed, which is usually not permitted under chamber rules. The Senate already approved the legislation last week.

    The final agreement also included provisions scaling back or eliminating regulations that require state health officials to sign off before medical providers open certain new beds or use equipment. Senate Republicans demanded the “certificate of need” changes in any deal.

    Republicans in charge of the General Assembly for years had been skeptical about expansion, which originated from the 2010 federal Affordable Care Act. But they have come around to the idea over the past year, deciding that Congress was neither likely to repeal the law nor raise the low 10% state match that coverage requires.

    And a financial sweetener contained in a COVID-19 recovery law means North Carolina also would get an estimated extra $1.75 billion in cash over two years if it expands Medicaid. Legislators hope to use much of that money on mental health services.

    There’s no set start date in the law for expansion under the legislation, but it also comes with one caveat: It can’t happen until after a state budeget is approved. This usually happens in the early summer. Cooper panned that provision, which could give GOP leaders leverage to include unrelated items he may strongly oppose.

    The state’s 10% share of expenses for Medicaid expansion recipients would be paid through hospital assessments. Hospitals also are expected to receive larger reimbursements for treating Medicaid patients through a federal program the state is requested to include in the legislation.

    Source link

  • How to shop for new insurance if you lose Medicaid coverage

    How to shop for new insurance if you lose Medicaid coverage

    Medicaid coverage will end for millions of Americans in the coming months, and it will push many into unfamiliar territory: the health insurance marketplace.

    States will start cutting people from the government-funded plans when they no longer qualify based on income, a process that has been paused since shortly after the COVID-19 pandemic hit.

    The timing of these cuts will vary. But all states have insurance markets where people who lose Medicaid can buy new coverage with help from subsidies. Some states will even connect shoppers with a potential new plan.

    Shopping for affordable insurance that covers regular doctors and prescriptions can be daunting, especially in marketplaces that offer dozens of choices and subsidies to help pay for them. Experts say it helps to start this search with a plan. Here’s a deeper look at the process.

    WHAT’S HAPPENING TO MEDICAID?

    Nearly 85 million people are covered by government-funded Medicaid, which focuses on people with low incomes.

    At the start of the pandemic, the federal government prohibited states from kicking people off Medicaid if they were no longer eligible. That ban ends this spring, and many people on Medicaid will be introduced to this so-called redetermination process for the first time.

    States are already verifying eligibility. Some, like Arizona, Arkansas and Idaho are expected to start ending coverage for ineligible people in April. Most states will be doing that in May, June and July.

    Federal officials estimate that more than 8 million people will lose eligibility and leave Medicaid mainly because their incomes have changed.

    WHERE TO GET NEW COVERAGE

    State-based health insurance marketplaces created by the Affordable Care Act are the only places where people can buy individual insurance with help from an income-based subsidy. They can be found through the federal government’s healthcare.gov website.

    Shoppers also can find coverage sold outside these marketplaces, but it may be risky. For instance, short-term plans can exclude coverage of certain things like a medical condition someone had before signing up.

    INCOME-BASED SUBSIDIES

    The cost of any new plan should be one of the first things people consider. Shoppers can get income-based subsidies to help pay monthly premiums of plans they buy on the state-based marketplaces. Those subsidies were enhanced during the pandemic.

    People often don’t realize they can get this help, said Jeremy Smith, director of West Virginia’s health insurance navigator program, which helps shoppers find coverage.

    “A very large percentage of people can qualify for a plan starting at $0 per month,” he said.

    COVERAGE DIFFERENCES

    Individual insurance differs from Medicaid in several ways. Some marketplace plans come with a big deductible that people must pay before most coverage starts.

    Shoppers should understand deductibles and other payments they will need to make before committing to a plan, Smith noted.

    Individual insurance also groups hospitals and doctors in networks. The insurance may cover much less of the bill for care received outside those networks. Shoppers should learn how any regular doctors and medications are covered before enrolling in a new plan.

    Individual insurance also can give people more care choices. Many doctors don’t accept Medicaid, and states may pay for only a limited amount of prescriptions.

    “It is possible that people will have better access to certain services in the marketplace,” said Jennifer Tolbert, a Medicaid expert at the non-profit Kaiser Family Foundation.

    IMPORTANT STEPS IF YOU’RE ON MEDICAID

    Make sure your state program has your current contact information, including a mailing address plus email and cellphone. They will send notifications if they need more information or if someone no longer qualifies for Medicaid.

    “Everyone should do that before April,” said said Joshua Brooker, an independent broker based in Lancaster, Pennsylvania. “It’s going to make a smoother transition.”

    Start shopping for new insurance before Medicaid ends. Shoppers should allow plenty of time to sort through options.

    The goal should be to have new insurance that starts the day after Medicaid ends. That would cut down on temporary coverage losses for regular doctors or important medicines.

    Once shoppers register to shop in the insurance marketplace, they have 60 days to find a plan.

    GETTING HELP

    Seeking assistance may be a good idea, especially for people who need help figuring out their income for the coming year. That’s needed to calculate subsidies.

    There are several ways people can get help.

    States will transfer the names and contact information of those who no longer qualify for Medicaid to their marketplaces. They also will send a letter to Medicaid beneficiaries telling them how to connect to the marketplace, said Kate McEvoy, executive director of the nonprofit National Association of Medicaid Directors.

    Some states will go further. California’s marketplace, Covered California, will enroll people in a qualified health plan and send them the information. Those people then must confirm enrollment and pay the first premium to remain covered.

    State marketplaces have navigators like Smith who can help people sort through options and understand potential plans. The government-funded navigators are free to use but they cannot recommend any specific choices.

    Federally qualified health centers also have counselors who can help people apply.

    Independent brokers also help people sort through options. They will get a fee that usually comes out of the premium you wind up paying.

    ___

    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.

    Source link

  • UK: Tens of thousands of doctors kick off 3-day strike

    UK: Tens of thousands of doctors kick off 3-day strike

    LONDON — Tens of thousands of junior doctors went on strike across England on Monday to demand better pay, kicking off three days of widespread disruption at the U.K.’s state-funded hospitals and health clinics.

    Junior doctors — who are qualified but in the earlier years of their career — make up 45% of all doctors in the National Health Service. Their walkout means that operations and appointments will be canceled for thousands of patients, and senior doctors and other medics have had to be drafted in to cover for emergency services, critical care and maternity services.

    The British Medical Association, the doctors’ trade union, says pay for junior doctors has fallen 26% in real terms since 2008, while workload and patient waiting lists are at record highs. The union says burnout and the U.K.’s cost-of-living crisis are driving scores of doctors away from the public health service.

    The union said newly qualified medics earn just 14.09 pounds ($17) an hour.

    “All that junior doctors are asking is to be paid a wage that matches our skill set,” said Rebecca Lissman, 29, a trainee in obstetrics and gynaecology. “We love the NHS, and I don’t want to work in private practice, but I think we are seeing the erosion of public services.”

    “I want to be in work, looking after people, getting trained. I don’t want to be out here striking, but I feel that I have to,” she added.

    Other health workers, including nurses and paramedics, have also staged strikes in recent months to demand better pay and conditions. NHS figures show that more than 100,000 appointments have already been postponed this winter as a result of the nurses’ walkouts.

    Stephen Powis, medical director of NHS England, said the 72-hour strike this week is expected to have the most serious impact and will cause “extensive disruption.”

    He said some cancer care will likely be affected, alongside routine appointments and some operations.

    Prime Minister Rishi Sunak told reporters on Sunday it was “disappointing that the junior doctors’ union are not engaging with the government.” The doctors’ union said officials have refused to engage with their demands for months, and that a recent invitation to talks came with “unacceptable” preconditions.

    The doctors’ strike this week will coincide with mass walkouts by tens of thousands of teachers and civil servants on Wednesday, the day the government unveils its latest budget statement.

    A wave of strikes has disrupted Britons’ lives for months, as workers demand pay raises to keep pace with soaring inflation, which stood at 10.1% in January. That was down from a November peak of 11.1%, but is still the highest in 40 years.

    Scores of others in the public sector, including train drivers, airport baggage handlers, border staff, driving examiners, bus drivers and postal workers have all walked off their jobs to demand higher pay.

    Unions say wages, especially in the public sector, have fallen in real terms over the past decade, and a cost-of-living crisis fueled by sharply rising food and energy prices has left many struggling to pay their bills.

    Source link

  • Congress members warned of significant health data breach

    Congress members warned of significant health data breach

    WASHINGTON — Members of the House and Senate were informed Wednesday that hackers may have gained access to their sensitive personal data in a breach of a Washington, D.C., health insurance marketplace. Employees of the lawmakers and their families were also affected.

    DC Health Link confirmed that data on an unspecified number of customers was affected and said it was notifying them and working with law enforcement. It said it was offering identity theft service to those affected and extending credit monitoring to all customers.

    The FBI said it was aware of the incident and was assisting the investigation.

    A broker on an online crime forum claimed to have records on 170,000 DC Health Link customers and was offering them for sale for an unspecified amount. The broker claimed they were stolen Monday. Reached by The Associated Press on an encrypted chat site, the broker did no say whether the data had been purchased and said they could not provide additional data to back the claim. They said they were acting on behalf of the seller, who they identified as “thekilob.”

    Sample stolen data was posted on the site for a dozen apparent customers. It included Social Security numbers, addresses, names of employers, phone numbers, emails and addresses. The AP reached one of the dozen by dialing a listed number.

    “Oh my God,” the man said when informed the information was public. All 12 people listed work for the same company or are family members.

    In an email to all Senate email account holders, the sergeant at arms said it was informed that the stolen data included full names of the insured and family members. An email sent out by the office of the Chief Administrative Office of the House on behalf of House Speaker Kevin McCarthy and Minority Leader Hakeem Jeffries called the breach “egregious” and promised to provide updates. It urged members to use credit and identity theft monitoring resources.

    The Senate email recommended that anyone registered on the health insurance exchange freeze their credit to prevent identity theft.

    In an emailed statement, Rep. Joe Morelle of New York said House leadership was informed by Capitol Police that DC Health Link “suffered an extraordinarily large data breach of enrollee information” that posed a “great risk” to members, employees and their family members. “At this time the cause, size, and scope of the data breach impacting the DC Health Link still needs to be determined by the FBI,” Morelle said.

    The hack follows several recent breaches affecting U.S. agencies. Hackers broke into a U.S. Marshals Service computer system and activated ransomware on Feb. 17 after stealing personally identifiable data about agency employees and targets of investigations.

    An FBI computer system was recently breached at the bureau’s New York field office, CNN reported in mid-February. Asked about that intrusion, the FBI issued a statement calling it “an isolated incident that has been contained.” It declined further comment, including when it occurred and whether ransomware was involved.

    There was no indication the Health breach was ransomware-related.

    ___

    AP Technology Writer Frank Bajak in Boston contributed to this report.

    Source link

  • Humana lays out exit from employer-sponsored coverage

    Humana lays out exit from employer-sponsored coverage

    The health insurer Humana will stop providing employer-sponsored coverage as it stays focused on bigger parts of its business, like Medicare Advantage

    ByTOM MURPHY AP Health Writer

    February 23, 2023, 12:00 PM

    The health insurer Humana will stop providing employer-sponsored coverage as it focuses on bigger parts of its business, like Medicare Advantage.

    The insurer said Thursday it will leave the employer-sponsored business over the next 18 to 24 months. That includes coverage provided through private companies and for federal government employees.

    Employer-sponsored health insurance is one of the most common ways for Americans to get coverage, but it amounts to a small part of Humana’s enrollment. That is centered largely on Medicare Advantage, the privately run version of the federal government’s Medicare program for people age 65 and older.

    Humana also will continue to provide coverage to nearly 6 million military service members and their families.

    Humana also runs Medicaid coverage for states and provides stand-alone Medicare prescription drug coverage. The insurer covered about 13.5 million people last year, not counting the stand-alone prescription drug plans.

    Employer-sponsored coverage made up around 7% of that total.

    Humana CEO Bruce Broussard said in a prepared statement that the exit from employer-sponsored coverage lets Humana focus its “greatest opportunities for growth.”

    The company also said its employer-sponsored business “was no longer positioned to sustainably meet the needs of commercial members over the long term or support the company’s long-term strategic plans.”

    Enrollment growth in employer-sponsored insurance has stagnated for many years for insurers, including market leaders like UnitedHealthcare. Insurers have turned more to government-backed coverage like Medicare Advantage or managing state Medicaid coverage for enrollment growth.

    They also have pushed deeper into managing prescription drug plans and buying care providers in order to control health care costs.

    Humana does not expect that the changes will affect adjusted profits this year, which the company earlier this year projected to be at least $28 per share.

    Analysts forecast $28.06 per share, according to FactSet.

    Shares of Humana Inc., based in Louisville, Kentucky, climbed about $1 to $504.60 Thursday.

    Source link

  • Ukraine’s health care on the brink after hundreds of attacks

    Ukraine’s health care on the brink after hundreds of attacks

    KRASNOHORIVKA, Ukraine — Valentyna Mozgova sweeps shattered glass and other debris from the vacant halls of the bombed-out hospital where she began her career. Living in the basement, the 55-year-old lab technician now works as its solitary guard.

    Russian artillery strikes targeted Marinskaya Central District Hospital in 2017 and again in 2021. But numerous barrages over the last seven months forced the hospital’s medical staff to flee, destroying key departments such as neurology and gynecology, as well as a general medical clinic in the process.

    Mozgova chose to stay. Having worked in the hospital’s laboratories since graduating from medical school in the late 1980s, she agreed to act as the hospital’s security guard for 10,000 hryvnia ($250) a month. She and her husband were soon joined in the basement shelter by five others who had lost their homes to bombing, a dog and a cat.

    Mozgova picks up the broom at 8 a.m. sharp every three days to inspect the hallways, carefully avoiding the fragments of Russian Grad rockets strewn across the floors for fear of yet another explosion.

    “Everything is decaying and falling apart,” she told The Associated Press. “But I’m so sick of it. I want to live my life normally, sleep in my bed, watch my TV, not jump at the sound of an explosion, go to work calmly and do my job.”

    A year into Russia’s war in Ukraine, hundreds of attacks against the health care system have begun to take a toll. More than 700 attacks have targeted health care facilities and staff since the Feb. 24 Russian invasion , according to data verified by five organizations working inside Ukraine.

    The World Health Organization has similarly documented more than 750 attacks and 101 deaths, and Ukraine’s health minister said recently that more than 1,200 facilities have been damaged either directly or indirectly, with 173 hospitals damaged beyond repair.

    The report released Tuesday, which was shared in advance with the AP, said Russia has targeted the Ukrainian health care system “deliberately and indiscriminately” — an allegation that the organization said amounted to a war crime.

    The attacks were at their most ferocious early in the war, according to the report, which found a total of 278 attacks in the last four days of February and all of March — an average of eight per day.

    The report defines attacks not just as weapons strikes, but also threats aimed at forcing doctors to keep working in occupied territories, and incidents of theft in areas that Russian forces failed to hold on to.

    In the city of Kherson, residents said retreating Russian forces took most of the ambulances with them. As they captured the city of Mariupol, the Russians took over the city’s last functioning hospital, days after a Russian airstrike devastated a maternity ward.

    “Russian soldiers were on all the floors. They counted the patients, counted the employees, so that no one would leave. They said that if the doctors left, they would shoot,” Maryna Gorbach, a nurse from Mariupol Hospital No. 2, told the AP in an interview in December.

    Gorbach, like most of the staff, managed to flee a few days later.

    In Izium, explosives ripped through the main hospital’s walls in March, shredding its wiring and forcing doctors and patients into the basement.

    “Before we went to the basement we covered our patients with mattresses because we thought they would protect patients from shrapnel,” said Dr. Yurii Kuznetsov, a trauma surgeon who for a time was the only doctor still at the hospital. At this point, three of the four floors are functional. Water drips from the roof. But patients have already seen how much repair has been accomplished.

    For a year, AP journalists across Ukraine have also witnessed the result of attacks on hospitals, ambulances and medical staff firsthand.

    “They follow specific patterns, and it is those patterns that are important, not even the number,” said Pavlo Kovtoniuk of the Ukrainian Health Care think tank, which was among the groups gathering data. “Because patterns mean that that most likely was a deliberate policy, not just a coincidence or separate events.”

    Russia claims Ukraine has also hit hospitals in territory it occupies. But Kovtoniuk said there’s a vast difference between the huge number of systematic attacks recorded and what he described as accidents that happen in the course of a war for survival.

    The international organization Physicians for Human Rights long documented Russian attacks on medical facilities in Syria and said the war in Ukraine indicated a continuation of that policy. The U.K. defense mnistry said that Russian attacks on medical and educational facilities intensified in January.

    The attacks show keen awareness of “the cascading effects that attacks on health have on the civilian population,” said Christian De Vos, director of research and investigation for Physicians for Human Rights, who contributed to the report. “It’s part of a destabilizing tactic to sow fear in the wider population.”

    In the short term, attacks have forced many hospitals to shut down or sharply reduce services. In Izium, which was liberated by Ukrainian troops last fall, around 200 people from a staff of 500 have returned to work, and one of the damaged wings is operating again after repairs. At least one pharmacy has reopened as well, enabling people whose medication ran out during six months of occupation to be resupplied.

    Ukraine had the second-highest number of HIV infections in Europe and Central Asia and one of the highest rates of drug-resistant tuberculosis. But since the invasion, the number of people being treated for these ailments has dropped precipitously. Drug quantities aren’t an issue thanks to a steady supply from donations. But it’s harder to follow-up or track new infections because of the mass displacement of Ukrainians within the country and across Europe.

    Andriy Klepikov runs the Alliance for Public Health, an organization whose mobile clinics reach towns near the front lines. He worries about cases of tuberculosis or HIV that are going undiagnosed, but remains optimistic about his country’s capacity to overcome.

    “The health system is (not about) walls or buildings or even equipment. It is about people,” he said. “The Ukrainian military are known for their strength and resilience, but in the area of public health, we are equally strong and resilient.”

    Back in Krasnohorivka, a tank shell took out the signal for a Russian television show about the lives of doctors that Mozgova enjoyed. Despite the loss of what little made life comfortable for her, Mozgova said neither she nor her husband have any plans of permanently rejoining their adult children in the western city of Lviv, considered among the safest in Ukraine.

    “They tell us to come and they have space, but what will I do? I’ll be a guest there. So I’ll be here as long as I have work. I’m trying to be useful here,” she said. “However good it was with my children and grandchildren I still think about this place because it’s my home.”

    ___

    Lori Hinnant reported from Paris. Vasilisa Stepanenko reported from Izium. Inna Varenytsia contributed to this report from Kyiv.

    ___

    Follow the AP’s coverage of the war at https://apnews.com/hub/russia-ukraine

    Source link

  • LGBTQ people, allies dodge $1,500 fines in North Dakota

    LGBTQ people, allies dodge $1,500 fines in North Dakota

    As more than a dozen states consider passing anti-transgender legislation this year, North Dakota lawmakers rejected a bill Friday that would have made people pay $1,500 each time they refer to themselves or others with gender pronouns different from the ones they were assigned at birth.

    “The main purpose of the bill was to eliminate state funding for entities including education that would promote, allow or support the ideology of transgenderism,” said Republican sponsor Sen. David Clemens, of West Fargo. Others testified at a Wednesday Senate Judiciary Committee hearing that the bill is designed to discriminate, and could impact the state’s behavioral health providers.

    The vote tally came to 39 senators against the bill and eight in favor.

    Members of the Senate Judiciary Committee had said they agreed with the bill’s purpose, but that it was poorly written and would be difficult to enforce. It would also have harmed people who do not identify as transgender and would possibly violate First Amendment rights, they said.

    Christina Sambor of the North Dakota Human Rights Coalition testified against the bill Wednesday. “Its very purpose is gender-based discrimination,” Sambor said.

    Reed Eliot Rahrich, who identifies as transgender, added that the bill is “a poorly thought out affront to human rights.”

    Dan Cramer, a psychologist and clinical director at the state Department of Health and Human Services, said it would create “significant problems” for human service centers in meeting basic accreditation standards and funding requirements. Those standards prohibit discrimination against a client’s sexual orientation and gender identity.

    Republican Sen. Janne Myrdal, of Edinburg, voted against the bill, but said she plans to support others that align with her belief “that God gives you your identity and your sex at conception.”

    North Dakota lawmakers will consider other bills this session that would obstruct transgender and non-binary people from using their preferred pronouns, criminalize doctors providing gender-affirming care, deter transgender youth from joining school sports teams, penalize drag-show performers and more.

    More than two dozen bills seeking to restrict transgender health care access have been introduced in at least 11 other states — Kansas, Kentucky, Missouri, Montana, New Hampshire, Oklahoma, South Carolina, Tennessee, Texas, Utah and Virginia — for the legislative sessions beginning in early 2023. Bills targeting other transgender issues have been filed in many of the same states and are expected in several others with GOP majorities.

    Rahrich, who testified against the bill, said he lived in North Dakota until he was 25 but moved away in 2016 after “a series of escalating brushes” with anti-LGBTQ violence.

    “I could wax poetic about the rolling prairie, or how much I miss the enormity of the sky,” he said about North Dakota. “But what I can’t do is compel you to see me as a human being.”

    ___

    Trisha Ahmed is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues. Follow her on Twitter: @TrishaAhmed15

    Source link

  • Japan steps up push to get public buy-in to digital IDs

    Japan steps up push to get public buy-in to digital IDs

    TOKYO — Japan has stepped up its push to catch up on digitization by telling a reluctant public they have to sign up for digital IDs or possibly lose access to their public health insurance.

    As the naming implies, the initiative is about assigning numbers to people, similar to Social Security numbers in the U.S. Many Japanese worry the information might be misused or that their personal information might be stolen. Some view the My Number effort as a violation of their right to privacy.

    So the system that kicked off in 2016 has never fully caught on. Fax machines are still commonplace, and many Japanese conduct much of their business in person, with cash. Some bureaucratic procedures can be done online, but many Japanese offices still require “inkan,” or seals for stamping, for identification, and insist on people bringing paper forms to offices.

    Now the government is asking people to apply for plastic My Number cards equipped with microchips and photos, to be linked to drivers licenses and the public health insurance plans. Health insurance cards now in use, which lack photos, will be discontinued in late 2024. People will be required to use My Number cards instead.

    That has drawn a backlash, with an online petition demanding a continuation of the current health cards drawing more than 100,000 signatures in a few days.

    Opponents of the change say the current system has been working for decades and going digital would require extra work at a time when the pandemic is still straining the medical system.

    But the reluctance to go digital extends beyond the health care system. After numerous scandals over leaks and other mistakes, many Japanese distrust the government’s handling of data. They’re also wary about government overreach, partly a legacy of authoritarian regimes before and during World War II.

    Saeko Fujimori, who works in the music copyright business, said she’s supposed to get My Number information from the people she deals with, but many balk at giving it out. And no one is all that surprised she has trouble getting that information, given how unpopular it is.

    “There is a microchip in it, and that means there could be fraud,” said Fujimori, who has a My Number but doesn’t intend to get the new card. “If a machine is reading all the information, that can lead to mistakes in the medical sector, too.”

    “If this was coming from a trustworthy leadership and the economy was thriving, maybe we would think about it, but not now,” Fujimori said.

    Something drastic may have to happen for people to accept such changes, just as it took a devastating defeat in World War II for Japan to transform itself into an economic powerhouse, said Hidenori Watanave, a professor at the University of Tokyo.

    “There’s resistance playing out everywhere,” he said.

    Japanese traditionally take pride in meticulous, handcraft-quality workmanship and many also devote themselves to carefully keeping track of documents and neatly filing them away.

    “There are too many people worried their jobs are going to disappear. These people see digitization as a negation of their past work,” said Watanave, who spells his last name with a “v” instead of the usual “b.”

    The process of getting an existing My Number digitized is time consuming and very analog, it turns out. One must fill out and mail back forms sent by mail. Last month’s initial deadline was extended, but only about half of the Japanese population have a My Number, according to the government.

    “They keep failing in anything digital and we have no memories of successful digital transformation by the government,” said Nobi Hayashi, a consultant and technology expert.

    Hayashi cited as a recent example Cocoa, the government’s tracing app for COVID-19, which proved unpopular and often ineffectual. He says the digital promotion effort needs to be more “vision-driven.”

    “They don’t show a bigger picture, or they don’t have one,” Hayashi said.

    Koichi Kurosawa, secretary-general at the National Confederation of Trade Unions, a 1 million-member grouping of labor unions, said people would be happier with digitization if it made their work easier and shorter, but it was doing just the opposite at many Japanese work places.

    “People feel this is about allocating numbers to people the way teams have numbers on their uniforms,” he said. “They are worried it will lead to tighter surveillance.”

    That’s why people are saying No to My Number, he said in a phone interview with The Associated Press.

    Yojiro Maeda, a cooperative research fellow at Nagasaki University who studies local governments, thinks digitization is needed, and My Number is a step in the right direction.

    “You just have to do it,” Maeda said.

    On Monday, Prime Minister Fumio Kishida acknowledged concerns about My Number cards. He told lawmakers in Parliament that the old health insurance cards will be phased out but the government will arrange for people to continue to use their public health insurance if they are paying into a health plan.

    Japan’s Minister of Digital Affairs, Taro Kono, acknowledged in a recent interview with The Associated Press that more is needed to persuade people of the benefits of going digital.

    “To create a digitized society, we need to work on developing new infrastructure. My Number cards could serve as a passport that will open such doors,” Kono said. “We need to win people’s understanding so that My Number cards get used in all kinds of situations.”

    ———

    Yuri Kageyama is on Twitter at https://twitter.com/yurikageyama

    Source link

  • Pfizer says COVID-19 vaccine will cost $110-$130 per dose

    Pfizer says COVID-19 vaccine will cost $110-$130 per dose

    Pfizer will charge $110 to $130 for a dose of its COVID-19 vaccine once the U.S. government stops buying the shots, but the drugmaker says it expects many people will continue receiving it for free.

    Pfizer executives said the commercial pricing for adult doses could start early next year, depending on when the government phases out its program of buying and distributing the shots.

    The drugmaker said it expects that people with private health insurance or coverage through public programs like Medicare or Medicaid will pay nothing. The Affordable Care Act requires insurers to cover many recommended vaccines without charging any out-of-pocket expenses.

    A spokesman said the company also has an income-based assistance program that helps eligible U.S. residents with no insurance get the shots.

    The price would make the two-dose vaccine more expensive for cash-paying customers than annual flu shots. Those can range in price from around $50 to $95, depending on the type, according to CVS Health, which runs one of the nation’s biggest drugstore chains.

    A Pfizer executive said Thursday that the price reflects increased costs for switching to single-dose vials and commercial distribution. The executive, Angela Lukin, said the price was well below the thresholds “for what would be considered a highly effective vaccine.”

    The drugmaker said last year that it was charging the U.S. $19.50 per dose, and that it had three tiers of pricing globally, depending on each country’s financial situation. In June, the company said the U.S. government would buy an additional 105 million doses in a deal that amounted to roughly $30 per shot. The government has the option to purchase more doses after that.

    Pfizer’s two-shot vaccine debuted in late 2020 and has been the most common preventive shot used to fight COVID-19 in the U.S.

    More than 375 million doses of the original vaccine, which Pfizer developed with the German drugmaker BioNTech, have been distributed in the U.S., according to the Centers for Disease Control and Prevention.

    That doesn’t count another 12 million doses of an updated booster that was approved earlier this year.

    The vaccine brought in $36.78 billion in revenue last year for Pfizer and was the drugmaker’s top-selling product.

    Analysts predict that it will rack up another $32 billion this year, according to FactSet. But they also expect sales to fall rapidly after that.

    More than 90% of the adult U.S. population has already received at least one dose of COVID-19 vaccine, according to the CDC. But only about half that population has also received a booster dose.

    ———

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

    Source link