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Tag: Health care costs

  • With an election looming, New Zealand lawmakers wrap up rowdy final session

    With an election looming, New Zealand lawmakers wrap up rowdy final session

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    New Zealand lawmakers rushed to pass legislation and criticize opponents during a rowdy final day of the nation’s 53rd Parliament

    ByNICK PERRY Associated Press

    WELLINGTON, New Zealand — New Zealand lawmakers rushed Thursday to pass legislation and criticize opponents during a rowdy final day of the nation’s 53rd Parliament.

    With an election looming in six weeks, lawmakers will now switch focus to the campaign trail. Opinion polls indicate the opposition conservatives hold a slight edge over the incumbent liberals.

    Lawmakers took just two hours to introduce and pass a new bill to ensure some violent sexual offenders will be kept under long-term supervision. Then a fiery debate session began, with loud cheers, laughter and groans. At one point, environmental protesters interrupted by unfurling a banner saying there were too many cows, before security guards escorted them out.

    Nicola Willis, deputy leader of the opposition, took aim at Grant Robertson, the finance minister.

    “Does he think he has been a good steward of taxpayers’ money when government spending is up 80%, our hospitals are in crisis, educational achievement is in decline, and many New Zealanders feel worse off?” Willis asked.

    Robertson replied that the government was getting high marks from ratings agencies and had helped low-income families and beneficiaries.

    “Confidence is rising, spring is coming, the member should cheer up,” he said.

    Former Prime Minister Jacinda Ardern won the last election in a landslide. But the Labour Party’s fortunes have turned since then as many people wearied of COVID-19 restrictions and felt the impacts of high inflation.

    Ardern stepped down earlier this year and Chris Hipkins took over as prime minister. Hipkins axed many contentious polices to focus on the rising cost of living.

    Tax has become a major election issue, with both parties promising cuts.

    Hipkins says his party will remove the sales tax from fruit and vegetables and cut taxes for lower-income families. The opposition National Party, led by Christopher Luxon, promises to cut income taxes, with relief aimed at the “squeezed middle.”

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  • See which drugs President Biden is targeting first for Medicare price-lowering talks

    See which drugs President Biden is targeting first for Medicare price-lowering talks

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    WASHINGTON — The Biden administration is targeting the blood thinner Eliquis, diabetes treatment Jardiance and eight other medications for Medicare’s first-ever drug price negotiations as it seeks to lower medical costs for Americans.

    The administration on Tuesday released a list of the 10 drugs for which prices will be negotiated directly with the manufacturer. The move is expected to cut costs for many patients, but it faces litigation from drugmakers and heavy criticism from Republican lawmakers, and it will be years before consumers notice any savings.

    The effort is a centerpiece of President Joe Biden’s reelection pitch as the Democrat seeks to show Americans he’s deserving of a second term because of the work he’s doing to lower costs for them while the country is struggling with inflation. But like the drug negotiations, many of Biden’s biggest policy moves take time to roll out, and his challenge is to persuade the public to be patient.

    “For many Americans, the cost of one drug is the difference between life and death, dignity and dependence, hope and fear,” Biden said in a statement. “That is why we will continue the fight to lower healthcare costs — and we will not stop until we finish the job.”

    Biden plans to deliver a speech on health care costs from the White House later Tuesday. He’ll be joined by Vice President Kamala Harris.

    The drugs on the list announced Tuesday accounted for more than $50 billion in Medicare prescription drug costs between June 1, 2022, and May 31, according to the Centers for Medicare and Medicaid Services, or CMS.

    That includes more than $16 billion on Eliquis. The drug from Pfizer and Bristol-Myers Squibb treats blood clots in the legs and lungs and reduces the risk of stroke in people with an irregular heartbeat called atrial fibrillation.

    Senior administration officials said Tuesday that the 10 drugs selected for negotiation are among the most costly to the Medicare program. They said 8.2 million people with Medicare Part D prescription drug coverage take them.

    The diabetes treatments Jardiance from Eli Lilly and Co. and Boehringer Ingelheim and Januvia from Merck made the list. It also included Amgen’s autoimmune disease treatment Enbrel and Entresto from Novartis, which is used to treat heart failure.

    Other drugs on the list include AstraZeneca’s diabetes and heart failure treatment Farxiga and three drugs from Johnson & Johnson: the blood thinner Xarelto, the blood cancer treatment Imbruvica and it’s biggest seller, Stelara, an IV treatment for psoriasis and other inflammatory disorders.

    The list also includes several versions of Novo Nordisk’s Fiasp, a fast-acting insulin taken around meals.

    The Inflation Reduction Act already caps Medicare patient out-of-pocket costs for insulin at $35 a month. An administration official said Tuesday that upper limit will hold but there could be further changes in those costs.

    The announcement Tuesday is another significant step toward taming drug pricing under the Inflation Reduction Act, which was signed by Biden last year. The law also calls for a $2,000 annual cap on how much people with Medicare have to pay out of pocket for drugs starting in 2025.

    For drugs on the list released Tuesday, the government aims to negotiate the lowest maximum fair price. That could help some patients who have coverage but still face big bills like coinsurance payments when they get a prescription.

    About 9% of Medicare beneficiaries age 65 and older said in 2021 that they did not fill a prescription or skipped a drug dose due to cost, according to research by the Commonwealth Fund, which studies health care issues.

    Currently, pharmacy benefit managers that run Medicare prescription plans negotiate rebates off a drug’s price. Those rebates sometimes help reduce premiums customers pay for coverage. But they may not directly change what a patient spends at the pharmacy counter.

    The new drug price negotiations aim “to basically make drugs more affordable while also still allowing for profits to be made,” said Gretchen Jacobson, who researches Medicare issues at Commonwealth.

    The federal government will benefit most from any lowered drug prices, noted Larry Levitt, an executive vice president for health policy at KFF, another non-profit that studies health care. But he said that if Medicare spends less on prescription drugs, then premiums for everyone with its drug coverage also should fall.

    Drug companies that refuse to be a part of the new negotiation process will be heavily taxed.

    The pharmaceutical industry has been gearing up for months to fight these rules. The lobbying group Pharmaceutical Research and Manufacturers of America said Tuesday that the drug list announcement stemmed from “a rushed process focused on short-term political gain rather than what is best for patients.”

    “Many of the medicines selected for price setting already have significant rebates and discounts due to the robust private market negotiation that occurs in the Part D program today,” PhRMA CEO Stephen J. Ubl said in a statement.

    PhRMA representatives also have said pharmacy benefit managers can still restrict access to drugs with negotiated prices by moving the drugs to a tier of their formulary — a list of covered drugs — that would require higher out-of-pocket payments. Pharmacy benefit managers also could require patients to try other drugs first or seek approval before a prescription can be covered.

    PhRMA and several drugmakers have filed lawsuits over the administration’s plan.

    Republican lawmakers also have blasted the Biden administration, saying companies might pull back on introducing new drugs that could be subjected to future haggling. They’ve also questioned whether the government knows enough to suggest prices for drugs.

    CMS plans to meet this fall with drugmakers that have a drug on its list, and government officials say they also plan to hold patient-focused listening sessions. By February 2024, the government will make its first offer on a maximum fair price and then give drugmakers time to respond.

    Any negotiated prices won’t take hold until 2026.

    CMS aims to add 15 more drugs to its negotiation list for 2027 and another 15 for 2028. It then plans to add up to 20 more for each year after that.

    ___

    Murphy reported from Indianapolis.

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  • Biden targets diabetes drug Jardiance, blood thinner Eliquis and 8 others for Medicare price talks

    Biden targets diabetes drug Jardiance, blood thinner Eliquis and 8 others for Medicare price talks

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    WASHINGTON — The blood thinner Eliquis and popular diabetes treatments including Jardiance are among the first drugs that will be targeted for price negotiations in an effort to cut Medicare costs.

    President Joe Biden’s administration on Tuesday released a list of 10 drugs for which the federal government will take a first-ever step: negotiating drug prices directly with the manufacturer.

    The move is expected to cut costs for some patients but faces litigation from the drugmakers and heavy criticism from Republican lawmakers. It’s also a centerpiece of the Democratic president’s reelection pitch as he seeks a second term in office by touting his work to lower costs for Americans at a time when the country has struggled with inflation.

    The diabetes treatments Jardiance from Eli Lilly and Co. and Merck’s Januvia made the list, along with Amgen’s autoimmune disease treatment Enbrel. Other drugs include Entresto from Novartis, which is used to treat heart failure.

    “For many Americans, the cost of one drug is the difference between life and death, dignity and dependence, hope and fear,” Biden said in a statement. “That is why we will continue the fight to lower healthcare costs — and we will not stop until we finish the job.”

    Biden plans to deliver a speech on health care costs from the White House later Tuesday. He’ll be joined by Vice President Kamala Harris.

    The drugs on the list announced Tuesday accounted for more than $50 billion in Medicare prescription drug costs between June 1, 2022, and May 31, according to the Centers for Medicare and Medicaid Services, or CMS.

    Medicare spent about $10 billion in 2020 on Eliquis, according to AARP research. The drug treats blood clots in the legs and lungs and reduces the risk of stroke in people with an irregular heartbeat called atrial fibrillation.

    The announcement is a significant step under the Inflation Reduction Act, which was signed by Biden last year. The law requires the federal government for the first time to start negotiating directly with companies about the prices they charge for some of Medicare’s most expensive drugs.

    More than 52 million people who either are 65 or older or have certain severe disabilities or illnesses get prescription drug coverage through Medicare’s Part D program, according to CMS.

    About 9% of Medicare beneficiaries age 65 and older said in 2021 that they did not fill a prescription or skipped a drug dose due to cost, according to research by the Commonwealth Fund, which studies health care issues.

    The agency aims to negotiate the lowest maximum fair price for drugs on the list released Tuesday. That could help some patients who have coverage but still face big bills like high deductible payments when they get a prescription.

    Currently, pharmacy benefit managers that run Medicare prescription plans negotiate rebates off a drug’s price. Those rebates sometimes help reduce premiums customers pay for coverage. But they may not change what a patient spends at the pharmacy counter.

    The new drug price negotiations aim “to basically make drugs more affordable while also still allowing for profits to be made,” said Gretchen Jacobson, who researches Medicare issues at Commonwealth.

    Drug companies that refuse to be a part of the new negotiation process will be heavily taxed.

    The pharmaceutical industry has been gearing up for months to fight these rules. Already, the plan faces several lawsuits, including complaints filed by drugmakers Merck and Bristol-Myers Squibb and a key lobbying group, the Pharmaceutical Research and Manufacturers of America, or PhRMA.

    PhRMA said in a federal court complaint filed earlier this year that the act forces drugmakers to agree to a “government-dictated price” under the threat of a heavy tax and gives too much price-setting authority to the U.S. Department of Health and Human Services.

    PhRMA representatives also have said pharmacy benefit managers can still restrict access to drugs with negotiated prices by moving the drugs to a tier of their formulary — a list of covered drugs — that would require higher out-of-pocket payments. Pharmacy benefit managers also could require patients to try other drugs first or seek approval before a prescription can be covered.

    Republican lawmakers also have blasted the Biden administration for its plan, saying companies might pull back on introducing new drugs that could be subjected to future haggling. They’ve also questioned whether the government knows enough to suggest prices for drugs.

    CMS will start its negotiations on drugs for which it spends the most money. The drugs also must be ones that don’t have generic competitors and are approved by the Food and Drug Administration.

    CMS plans to meet this fall with drugmakers that have a drug on its list, and government officials say they also plan to hold patient-focused listening sessions. By February 2024, the government will make its first offer on a maximum fair price and then give drugmakers time to respond.

    Any negotiated prices won’t take hold until 2026. More drugs could be added to the program in the coming years.

    ___

    Murphy reported from Indianapolis.

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  • Liz Weston: Create a care plan for older parents (or yourself)

    Liz Weston: Create a care plan for older parents (or yourself)

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    At some point, most older people will need help getting through the day. Someone turning 65 today has a 70% chance of eventually requiring assistance with basic living activities, such as bathing, dressing and using the toilet, according to the U.S. Department of Health and Human Services.

    That’s the grim reality. Even grimmer is that Medicare typically doesn’t pay for such help. Plus, families often don’t try to figure out how to provide this care until there is a health crisis, which can lead to unnecessary stress, conflicts and escalating costs, says certified financial planner and physician Carolyn McClanahan of Life Planning Partners in Jacksonville, Florida.

    Making a care plan well in advance allows families to get organized, locate appropriate resources and figure out ways to pay for care before a crisis hits.

    “A care plan is thinking through the logistics of what you’re going to need as you age, so that when the poop hits the fan with aging, then you are prepared,” McClanahan says.

    DEAL WITH DENIAL FIRST

    The biggest barrier can be our own wishful thinking, says Katy Butler, author of the books “The Art of Dying Well” and “Knocking on Heaven’s Door.” We want to picture a perfectly healthy life followed, if absolutely necessary, by a quick and painless death.

    The reality may be quite different, and that can be awful to contemplate, Butler acknowledges.

    One way to cope is to plan for temporary rather than permanent disability. For example, what kind of help might you or your loved one need after a hip or knee replacement? How well is the home set up for recovery? Who would help with household tasks? Contemplating a two- or three-month disability with an eventual return to health is less daunting, but involves much of the same planning as a more lasting decline, says Butler, who lives in Mill Valley, California.

    “I think that really would help people visualize without terrifying them,” Butler says.

    THINK ABOUT WHERE YOU’LL GET CARE

    Many people want to remain in their current homes as they age, something called “aging in place.” That typically means relying on family members for care, or using paid workers, or both.

    If family members will be tapped, discuss the logistics, including whether and how much they will be paid. If home health aides will be hired, consider who will supervise the process.

    Costs can mount quickly. Nationally, a full-time home health aide costs an average of $5,148 a month, according to long-term care insurer Genworth. (You can use Genworth’s cost of care calculator to estimate costs in your area.)

    EXPLORE WAYS TO COVER COSTS

    Are there savings that can be tapped? Does the older person have long-term care insurance or can they get a reverse mortgage? Will other family members chip in? Does the older person qualify for government help, such as veterans benefits, Medicaid or state programs? Benefitscheckup.org, a site run by the nonprofit National Council on Aging, can help you search for resources that help people age in place. Families may want to consult an elder law attorney for personalized advice. (You can get a referral from the National Academy of Elder Law Attorneys at www.naela.org.)

    Also consider whether the current home is “aging friendly,” McClanahan says. An occupational therapist can suggest adaptations that could allow the older person to remain in the home if they’re disabled. Some changes might be simple, such as removing throw rugs that could cause falls, while others — like widening doorways or constructing a walk-in shower — might be part of a larger remodel. The sooner you get this evaluation, the more time you will have to plan and pay for it, McClanahan says.

    “I recommend everybody do this when they hit their 50s if they’re planning on staying in their home,” she says.

    CONSIDER THE COMMUNITY

    Even if the home supports aging in place, the neighborhood might not, Butler says. Consider how the older person will socialize, get groceries and make it to health appointments if they can no longer drive.

    An independent living or senior living facility could provide more amenities, but these typically don’t provide long-term care, Butler says. Is the older person OK with moving again later, or should they start with an assisted living or continuing care facility that can provide more help?

    Once you have a plan, write down the details and consider sharing it with family members or other people who may be involved, McClanahan suggests. Revisit the document periodically as circumstances change.

    “Aging planning is not a one and done thing. It’s an ongoing process,” she says.

    __________________________

    This column was provided to The Associated Press by the personal finance website NerdWallet. Liz Weston is a columnist at NerdWallet, a certified financial planner and author of “Your Credit Score.” Email: lweston@nerdwallet.com. Twitter: @lizweston.

    RELATED LINK:

    NerdWallet: What If You Can’t Afford Long-Term Care?

    https://bit.ly/nerdwallet-afford-long-term-care

    METHODOLOGY

    Genworth Cost of Care Survey

    From June through November 2021, CareScout, a Genworth company, contacted 67,742 providers by phone to complete 14,698 surveys of nursing homes, assisted living facilities, adult day health facilities and home care providers. Potential respondents were selected randomly from the CareScout nationwide database of providers in each category of long-term care services. Survey respondents represent all 50 states and the District of Columbia.

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  • Cyprus allows human COVID-19 medications to be used on cats to fight deadly virus mutation

    Cyprus allows human COVID-19 medications to be used on cats to fight deadly virus mutation

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    Veterinarians in Cyprus are lauding a government decision to allow its stock of human COVID-19 medication to be used against a feline virus that has killed thousands of cats on the Mediterranean island

    FILE – A cat crosses a pedestrian road at the main linear park, in the capital Nicosia, Cyprus, on July 19, 2023. Cyprus’ veterinarians association on Friday Aug. 4, 2023 lauded a government decision to allow its stock of human coronavirus medication to be used on cats to fight a local mutation of a feline virus that has killed thousands of animals on the Mediterranean island. (AP Photo/Petros Karadjias, File)

    The Associated Press

    NICOSIA, Cyprus — Cyprus’ veterinarians association on Friday lauded a government decision to allow its stock of human coronavirus medication to be used on cats to fight a local mutation of a feline virus that has killed thousands of animals on the Mediterranean island.

    The association said in a statement that it had petitioned the government for access to the medication at “reasonable prices” from the beginning of this year, when the mutation that causes lethal Feline Infectious Peritonitis (FIP) began to noticeably crop up in the island’s cat population.

    “We want to assure that we will continue to investigate and control the rise in case of FCov-2023,” the association said.

    Local animal activists had claimed that the mutation had killed as many as 300,000 cats, but Association President Nektaria Ioannou Arsenoglou says that’s an exaggeration.

    Arsenoglou had told The Associated Press that an association survey of 35 veterinary clinics indicated an island-wide total of about 8,000 deaths.

    According to Arsenoglou, FIP is nearly always lethal if left untreated, but medication can nurse cats back to health in approximately 85% of cases in both the “wet” and “dry” forms of the illness.

    What made FIP treatment difficult was the high price of the medication that activists said put it out of reach of many cat care givers.

    Spread through contact with cat feces, neither the virus or its mutation can be passed on to humans. The feline coronavirus has been around since 1963. Previous epidemics eventually fizzled out without the use of any medication, Arsenoglou said.

    Measures have already been enacted to prevent the export of the mutation through mandatory medical check-ups of all felines destined for adoption abroad.

    It’s unclear how many feral cats live in Cyprus, where they are generally beloved and have a long history dating back thousands of years.

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  • Members of Congress break for August with no clear path to avoiding a shutdown this fall

    Members of Congress break for August with no clear path to avoiding a shutdown this fall

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    WASHINGTON — Lawmakers broke for their August recess this week with work on funding the government largely incomplete, fueling worries about whether Congress will be able to avoid a partial government shutdown this fall.

    Congress has until Oct. 1, the start of the new fiscal year, to act on government funding. They could pass spending bills to fund government agencies into next year, or simply pass a stopgap measure that keeps agencies running until they strike a longer-term agreement. No matter which route they take, it won’t be easy.

    “We’re going to scare the hell out of the American people before we get this done,” said Sen. Chris Coons, D-Del.

    Coons’ assessment is widely shared in Congress, reflecting the gulf between the Republican-led House and the Democratic-led Senate, which are charting vastly different — and mostly incompatible — paths on spending.

    The Senate is adhering mostly to the top-line spending levels that President Joe Biden negotiated with House Republicans in late May as part of the debt-ceiling deal that extended the government’s borrowing authority and avoided an economically devastating default.

    That agreement holds discretionary spending generally flat for the coming year while allowing increases for military and veterans accounts. On top of that, the Senate is looking to add $13.7 billion in additional emergency appropriations, including $8 billion for defense and $5.7 billion for nondefense.

    House Republicans, many of whom opposed the debt-ceiling deal and refused to vote for it, are going a different way.

    GOP leaders have teed up bills with far less spending than the agreement allows in an effort to win over members who insist on rolling back spending to fiscal year 2022 levels. They are also adding scores of policy add-ons broadly opposed by Democrats. There are proposals to reduce access to abortion pills, bans on the funding of hormone therapy and certain surgeries for transgender veterans, and a prohibition on training programs promoting diversity in the federal workplace, among many others.

    At a press conference at the Capitol this past week, some members of the House Freedom Caucus, a conservative faction within the House GOP, said that voters elected a Republican majority in that chamber to rein in government spending and it was time for House Republicans to use every tool available to get the spending cuts they want.

    “We should not fear a government shutdown,” said Rep. Bob Good, R-Va. “Most of the American people won’t even miss if the government is shut down temporarily.”

    Many House Republicans disagree with that assessment. Rep. Mike Simpson, R-Idaho, called it an oversimplification to say most Americans wouldn’t feel an impact. And he warned Republicans would take the blame for a shutdown.

    “We always get blamed for it, no matter what,” Simpson said. ”So it’s bad policy, it’s bad politics.”

    But the slim five-seat majority Republicans hold amplifies the power that a small group can wield. Even though the debt ceiling agreement passed with a significant majority of both Republicans and Democrats, conservatives opponents were so unhappy in the aftermath that they shut down House votes for a few days, stalling the entire GOP agenda.

    Shortly thereafter, McCarthy argued the numbers he negotiated with the White House amounted to a cap and “you can always do less.” GOP Rep. Kay Granger of Texas, who chairs the House Appropriations Committee, followed that she would seek to limit nondefense spending at 2022 budget levels, saying the debt agreement “set a top-line spending cap — a ceiling, not a floor.”

    The decision to cut spending below levels in the the debt ceiling deal helped get the House moving again, but put them on a collision course with the Senate, where the spending bills hew much closer to the agreement.

    “What the House has done is they essentially tore up that agreement as soon as it was signed,” said Sen. Chris Van Hollen, D-Md. “And so we are in for a bumpy ride.”

    Even as House Republicans have been moving their spending bills out of committee on party-line votes, the key committee in the Senate has been operating in a bipartisan fashion, drafting spending bills with sometimes unanimous support.

    “The way to make this work is do it in a bipartisan way like we are doing in the Senate. If you do it in a partisan way, you’re heading to a shutdown. And I am really worried that that’s where the House Republicans are headed,” Senate Majority Leader Chuck Schumer, D-N.Y., told reporters this week.

    McCarthy countered that people had the same doubts about whether House Republicans and the White House could reach an agreement to pass a debt ceiling extension and avoid a default.

    “We’ve got ’til Sept. 30. I think we can get this all done,” McCarthy said.

    In a subsequent press conference, McCarthy said he had just met with Schumer to talk about the road ahead on an array of bills, including the spending bills.

    “I don’t want the government to shut down,” McCarthy said. “I want to find that we can find common ground.”

    In all, there are 12 spending bills. The House has passed one so far, and moved others out of committee. The Senate has passed none, though it has advanced all 12 out of committee, something that hasn’t happened since 2018.

    Still, the difficulty ahead was evident on the House side, where Republicans gave up until after the recess on trying to pass a spending measure to fund federal agriculture and rural programs and the Food and Drug Administration, amid disagreements over its contents. They began their August recess a day early instead of holding votes Friday.

    Simpson said some of his Republican colleagues don’t want to take money approved already outside the appropriations process to cover some of this year’s spending and avoid deeper cuts. For example, the House bills would take almost all of the money approved last year for the Internal Revenue Service in Biden’s Inflation Reduction Act and use the savings to avoid deeper spending cuts elsewhere.

    Simpson said that without such rescissions, as they are called in Washington, he couldn’t vote for the agriculture spending bill because the cuts “would have just been devastating.”

    “That’s the challenge we’re going to have when we get back in September,” he said.

    Further complicating things in the House, a few Republicans are opposed to some of the policy riders being included in the spending bills. For example, the agriculture spending bill would reverse the FDA’s decision to allow abortion pills to be dispensed in certified pharmacies, instead of only by prescribers in hospitals, clinics, and medical offices.

    “I had a problem with abortion being put inside an ag bill,” said Rep. Brian Fitzpatrick, R-Pa. “I think that’s ridiculous.”

    It’s a strong possibility that Congress will have to pass a stopgap spending bill before the new fiscal year begins Oct. 1. The Senate can vote first on the measure, which would put the onus on House Republicans to bring it up for a vote or allow for a shutdown.

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  • Biden takes aim at ‘junk’ insurance, vowing to save money for consumers being played as ‘suckers’

    Biden takes aim at ‘junk’ insurance, vowing to save money for consumers being played as ‘suckers’

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    WASHINGTON — President Joe Biden on Friday rolled out a new set of initiatives to reduce health care costs: a crackdown on what he called “junk” insurance plans that play consumers as ‘suckers,’ new guidance to prevent surprise medical bills and an effort to reduce medical debt tied to credit cards.

    Biden is building on previous initiatives to limit health care costs, with the Department of Health and Human Services releasing new estimates showing 18.7 million older adults and other Medicare beneficiaries will save an estimated $400 per year in prescription drug costs in 2025 because of the president placing a cap on out-of-pocket spending as part of last year’s Inflation Reduction Act.

    Gearing up for his 2024 reelection campaign as inflation remains a dominant concern for voters, the Democratic president has emphasized his policies to help families manage their expenses, as well as a spate of government incentives to encourage private sector development of electric vehicles, clean energy and advanced computer chips.

    Republican lawmakers have criticized Biden’s policies by saying they have spurred higher prices that hurt the well-being of families.

    Biden said his administration was taking aim at what he called “junk” insurance plans, such as short-term policies that can deny basic coverage as people transition between employers and still need temporary health care coverage.

    The new proposed rules aims to close loopholes that allow insurers to offer products that can discriminate based on pre-existing conditions and market to consumers coverage that provides little or no coverage.

    “In America, it sounds corny, but fairness is something we kind of expect,” Biden said. “And I don’t know anybody who likes to be viewed as having been played for a sucker.”

    Biden invited Cory Dowd to tell his story at the White House event to spotlight the initiative. Dowd in 2019 purchased a high-deductible health care plan when he returned stateside after serving in the Peace Corps in Ghana but before he started graduate school and was able to get on a student health plan. He thought the plan would protect him in the case of a medical emergency.

    But just weeks before he started school, he had to have emergency surgery to remove his appendix. Months later, the hospital called him to tell him his insurer would only cover a small portion of his bill and that he would have to pay more than $37,000 out of pocket.

    “For me, there was both a financial and emotional cost,” said Dowd, who added that the insurer relented after news coverage about his situation. “I’ve always considered myself a very responsible person. But this really took a toll on my self-esteem and my identity.”

    Biden also announced new guidance on medical billing stemming from 2020’s No Surprises Act. The guidance would limit the ability of insurers that contract with hospitals to claim provided care was not in network and have customers pay more money. Health plans also would need to disclose facility fees that are increasingly charged to patients and can surface as an unexpected cost in a medical bill.

    “Folks, that’s not health insurance,” Biden said. “That’s a scam. It has to end.”

    The Consumer Financial Protection Bureau and Treasury Department also are seeking information on third-party credit cards and loans that are specifically used to pay for health care. The higher costs and interest charges can discourage people in need of treatment from seeking care.

    The president in his remarks also highlighted previous efforts to reduce health care costs, including a plan allowing Medicare to negotiate lower prices for prescription drugs and a $35 monthly price cap on insulin for people in Medicare Part B.

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  • The aftermath of mass shootings infiltrates every corner of survivors’ lives

    The aftermath of mass shootings infiltrates every corner of survivors’ lives

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    CHICAGO (AP) — More than a year after 11-year-old Mayah Zamora was airlifted out of Uvalde, Texas, after being critically injured in the Robb Elementary school shooting that killed 19 children and two teachers, the family is still reeling.

    Knocks on the door startle Mayah into a panic. The family is skipping Fourth of July celebrations to avoid booming fireworks. An outing to the Little Mermaid movie requires noise-canceling headphones.

    Since 2016, thousands of Americans have been wounded in mass shootings, and tens of thousands by gun violence, with that number continuing to grow, according to the Gun Violence Archive. Beyond the colossal medical bills and the weight of trauma and grief, mass shooting survivors and family members contend with scores of other changes that upend their lives.

    A French far-right figure behind a divisive, and hugely successful, crowdfunding campaign for the family of a police officer jailed in the killing of a 17-year-old that triggered riots around France announced on Tuesday that he’s closing the account which topped more than 1.5 million euros.

    People participate in a community walk in Highland Park, Ill., Tuesday, July 4, 2023. One year after a shooter took seven lives at the city's annual parade, community members are planning to honor the victims and reclaim the space to move forward. (AP Photo/Nam Y. Huh)

    The holiday takes on a different meaning for the Illinois community this year.

    Police on the scene of a shooting Monday, July 3, 2023 in Philadelphia. Police say a gunman in a bulletproof vest has opened fire on the streets of Philadelphia, killing several people and wounding two boys before he surrendered to responding officers. (Steven M. Falk/The Philadelphia Inquirer via AP)

    A 40-year-old killed one man in a house before fatally shooting four others on the streets of a Philadelphia neighborhood, then surrendering along with a rifle, a pistol, extra magazines, a police scanner and a bulletproof vest, police said.

    A shooting early Sunday morning, July 2, 2023, at City Nightz nightclub in Wichita, Kan., left multiple people with gunshot wounds and a few more people hospitalized after being trampled in a rush for the exits, police said. Wichita Police Lt. Aaron Moses said investigators believe several shooters opened fire inside the club just before 1 a.m. (Travis Heying/The Wichita Eagle via AP)

    Police in Kansas now say 11 people were hurt over the weekend when a gunman opened fire inside a Wichita nightclub. Meanwhile, a St.

    Survivors talked to The Associated Press about the mental and physical wounds that endure in the aftermath of shootings in Uvalde; Las Vegas; Colorado Springs, Colorado; and the Chicago suburb of Highland Park, Illinois, during a July Fourth parade last year.

    UVALDE

    Mayah suffered wounds to her chest, back, both hands, face and ear, and needed so many surgeries her parents said they stopped counting. The family relocated to San Antonio, where Mayah spent 66 days in the hospital and still needs care.

    “Her hospital bill is insane,” said Mayah’s mother, Christina Zamora. “It reaches close to $1,000,000, maybe over,” not including rehabilitation, follow-up visits and counseling.

    A year later, Christina and Mayah’s father, Ruben, said they don’t know what bills will be covered by insurance. When Mayah was discharged, they realized one parent needed to stay home to care for her.

    Christina quit her job. The relocation separated the family: Ruben works seven days on, seven off in Uvalde. Mayah is terrified to return to Uvalde.

    “It’s heartbreaking when your little one can’t enjoy the things that she did before, and all these other kids are able to do,” the elder Ruben said. “It tears you up.”

    COLORADO SPRINGS

    Ashtin Gamblin was working the front door at Club Q in Colorado Springs on Nov. 19 when a person armed with a semiautomatic rifle shot and killed five people and injured 17 more, including Gamblin.

    “I was shot nine times. Five to my left arm. Twice to my right arm. Twice to my left breast. Both of my humerus were shattered. So two broken arms,” the 30-year-old said. Six months later, “my right arm is still fractured. My left hand, we’re still working on function.”

    She has battled with health insurance, the hospital and worker’s compensation officials to figure out who would foot the $300,000 medical bill.

    Gamblin also no longer felt safe in her apartment, where she could sometimes hear gunshots outside. She bought a house in a quieter neighborhood: “a house I wasn’t prepared to buy,” she said. “I bought a $380,000 safe space.”

    Half a year later she is not mentally recovered enough to return to work.

    “I just can’t be there… I don’t feel safe going to the grocery store. I don’t feel safe being in public,” she said.

    So far in 2023, nearly 400 people in the U.S. have been wounded in mass shootings, according to the Gun Violence Archive. And 140 people have died in mass killings this year, which is on track to surpass 2019, the deadliest year on record for mass killings since 2006, according to a database maintained by The Associated Press and USA Today in a partnership with Northeastern University.

    LAS VEGAS

    Tia Christiansen had worked in the music industry for more than 20 years when a gunman unleashed the deadliest mass shooting in modern U.S. history at a Las Vegas music festival she helped organize in October 2017.

    The shooter rained gunfire from the windows of a high-rise casino hotel into an outdoor concert crowd, killing 58 people and wounding more than 850.

    Christiansen was scheduled to be at the festival that day. But she felt ill and stayed in her room, two doors down from where the gunman fired.

    “There was actually a moment when the gunfire was so loud that I literally instinctively ducked and put my hands over my head because I thought that the walls or the ceiling would come crumbling down,” Christiansen said. “I completely reconciled my life and thought, ‘Am I ready to die?’”

    She was physically unscathed. But her life turned upside down. After the shooting, she worked a few more festivals, until she “had a complete, total breakdown on site crying.”

    Christiansen, who is based in South Deerfield, Massachusetts, turned to spending. She bought a new bed to try to find more comfort and relied on delivered meals to avoid leaving her home.

    “The financial aspect of it is crushing, absolutely crushing,” she said.

    Now Christiansen is part of a mentorship program for the Everytown Survivors Network, which connects thousands of gun violence survivors to resources and aims to end gun violence.

    HIGHLAND PARK

    Leah Sundheim, 29, was a night manager at a hotel in Las Vegas when she got “the worst phone call you can ever receive.”

    Her mother, Jacquelyn Sundheim, had been killed at a shooting during Highland Park’s 2022 Fourth of July parade, along with six other people.

    “That flight home broke me,” Sundheim said.

    She then moved back to Highland Park to be close to her father.

    Mass shootings cause a variety of trauma, she said. Her experience is different from that of her aunt and cousins, who were sitting next to Jacquelyn Sundheim when she died.

    Whichever type of trauma survivors experience, she said, “it shatters the sense of security that you have in the world.”

    ___

    Savage 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.

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  • The aftermath of mass shootings infiltrates every corner of survivors’ lives

    The aftermath of mass shootings infiltrates every corner of survivors’ lives

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    CHICAGO — More than a year after 11-year-old Mayah Zamora was airlifted out of Uvalde, Texas, after being critically injured in the Robb Elementary school shooting that killed 19 children and two teachers, the family is still reeling.

    Knocks on the door startle Mayah into a panic. The family is skipping Fourth of July celebrations to avoid booming fireworks. An outing to the Little Mermaid movie requires noise-canceling headphones.

    Since 2016, thousands of Americans have been wounded in mass shootings, and tens of thousands by gun violence, with that number continuing to grow, according to the Gun Violence Archive. Beyond the colossal medical bills and the weight of trauma and grief, mass shooting survivors and family members contend with scores of other changes that upend their lives.

    Survivors talked to The Associated Press about the mental and physical wounds that endure in the aftermath of shootings in Uvalde, Las Vegas, Colorado Springs, Colorado, and the Chicago suburb of Highland Park, Illinois, during a July Fourth parade last year.

    UVALDE

    Mayah suffered wounds to her chest, back, both hands, face and ear, and needed so many surgeries her parents said they stopped counting. The family relocated to San Antonio, where Mayah spent 66 days in the hospital and still needs care.

    ”Her hospital bill is insane,” said Mayah’s mother, Christina Zamora. “It reaches close to $1,000,000, maybe over,” not including rehabilitation, follow-up visits and counseling.

    A year later, Christina and Mayah’s father, Ruben, said they don’t know what bills will be covered by insurance and how much they will need to pay. When Mayah was discharged, they realized one parent needed to stay home to care for her.

    Christina quit her job. Facing daunting bills with one income instead of two is scary, she said. The relocation also has separated the family: Ruben works seven days on, seven off in Uvalde. The couple’s oldest son, Ruben Jr., stayed in Uvalde to attend college and work. Zach, 12, “misses him. He misses our old normal life.”

    Mayah is terrified to return to Uvalde.

    “It’s heartbreaking when your little one can’t enjoy the things that she did before, and all these other kids are able to do,” the elder Ruben said. “It tears you up.”

    COLORADO SPRINGS

    Ashtin Gamblin was working the front door at Club Q in Colorado Springs on Nov. 19 when a person armed with a semiautomatic rifle shot and killed five people and injured 17 more, including Gamblin.

    “I was shot nine times. Five to my left arm. Twice to my right arm. Twice to my left breast. Both of my humerus were shattered. So two broken arms,” the 30-year-old said. Six months later, “my right arm is still fractured. My left hand, we’re still working on function.”

    Tasks that were once simple, such as walking her dogs, are now challenging and the loss of autonomy has been difficult, Gamblin said.

    She has battled with health insurance, the hospital and worker’s compensation officials to figure out who would foot the $300,000 medical bill.

    Gamblin also no longer felt safe in her apartment, where she could sometimes hear gunshots outside. She bought a house in a quieter neighborhood: “a house I wasn’t prepared to buy,” she said. “I bought a $380,000 safe space.”

    She lists other unexpected post-shooting costs: a flooded basement, a service animal, a new car to get to doctor’s appointments.

    Half a year later she is not mentally recovered enough to return to work.

    ”I just can’t be there… I don’t feel safe going to the grocery store. I don’t feel safe being in public,” she said. “I have no idea what I’m doing with my life currently.”

    So far in 2023, nearly 400 people in the U.S. have been wounded in mass shootings, according to the Gun Violence Archive. And 140 people have died in mass killings this year, which is on track to surpass 2019, the deadliest year on record for mass killings since 2006, according to a database maintained by The Associated Press and USA Today in a partnership with Northeastern University.

    “There is a lot of focus on the people that are killed. And I’m grateful for that. Those are my friends and they deserved all of the attention and more,” Gamblin said. “The downfall is the rest of us are still suffering.”

    LAS VEGAS

    Tia Christiansen had worked in the music industry for more than 20 years when a gunman unleashed the deadliest mass shooting in modern U.S. history at a Las Vegas music festival she helped organize in October 2017.

    The shooter rained gunfire from the windows of a high-rise casino hotel into an outdoor concert crowd, killing 58 people and injuring more than 850.

    Christiansen was scheduled to be at the festival that day. But she felt ill and stayed in her room, two doors down from where the gunman fired.

    “The room was shaking. It was incredibly loud. There was actually a moment when the gunfire was so loud that I literally instinctively ducked and put my hands over my head because I thought that the walls or the ceiling would come crumbling down,” Christiansen said. “I completely reconciled my life and thought, ‘Am I ready to die?’”

    She was physically unscathed. But her life turned upside down. After the shooting, she worked a few more festivals, until she “had a complete, total breakdown on site crying.”

    “What I came to understand about myself in that moment was, I don’t know if I can do this anymore,” she said.

    At concerts, Christiansen no longer focused on fans’ joy, instead fixating on emergency exits and whether people could get to safety. She has since given up her career in the music industry, letting go of her dreams.

    Her lingering PTSD and need to control her environment also has affected Christiansen’s relationships with her friends and family.

    “My personality changes. I get very short tempered, and I get very judgmental. I’m quick to be snippy,” she said. “That is heavy energy to be around.”

    Christiansen, who is based in South Deerfield, Massachusetts, turned to spending. She bought a new bed to try to find more comfort and relied on delivered meals to avoid leaving her home.

    “The financial aspect of it is crushing, absolutely crushing,” she said. “I don’t know how many years it’s gonna take to pay that off.”

    Now Christiansen is part of a mentorship program for the Everytown Survivors Network, which connects thousands of gun violence survivors to resources and aims to end gun violence.

    “The trauma doesn’t go away,” she said. “Even if you’re not wounded in the moment, there is injury.”

    HIGHLAND PARK

    Leah Sundheim, 29, was a night manager at a hotel in Las Vegas when she got “the worst phone call you can ever receive.”

    Her mother, Jacquelyn Sundheim, had been killed at a shooting during Highland Park’s 2022 Fourth of July parade, along with six other people.

    “That flight home broke me,” Sundheim said.

    She then moved back to Highland Park to be close to her father.

    “I couldn’t be away from my family,” Sundheim said. “I can’t do another flight like that ever.”

    Mass shootings cause a variety of trauma, she said. Her experience is different from that of her aunt and cousins, who were sitting next to Jacquelyn Sundheim when she died.

    “They have the visual and sound… of watching her be murdered, and my dad has the trauma of receiving the phone call and then subsequent hours trying to get to her body. My trauma is waking up to my phone ringing and hearing that my mom was killed,” she said.

    Whichever type of trauma survivors experience, she said, “it shatters the sense of security that you have in the world.”

    ___

    Savage 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.

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  • Australia is the first country to let patients with depression or PTSD be prescribed psychedelics

    Australia is the first country to let patients with depression or PTSD be prescribed psychedelics

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    SYDNEY — Australia is now the first country to allow psychiatrists to prescribe certain psychedelic substances to patients with depression or post-traumatic stress disorder.

    Beginning Saturday, Australian physicians can prescribe doses of MDMA, also known as ecstasy, for PTSD. Psilocybin, the psychoactive ingredient in psychedelic mushrooms, can be given to people who have hard-to-treat depression. The country put the two drugs on the list of approved medicines by the Therapeutic Goods Administration.

    Scientists in Australia were surprised by the move, which was announced in February but took effect July 1. One scientist said it puts Australia “at the forefront of research in this field.”

    Chris Langmead, deputy director of the Neuromedicines Discovery Centre at the Monash Institute of Pharmaceutical Sciences, said there have been very few advancements on treatment of persistent mental health issues in the last 50 years.

    The growing cultural acceptance has led two U.S. states to approve measures for their use: Oregon was the first to legalize the adult use of psilocybin, and Colorado’s voters decriminalized psilocybin in 2022. Days ago, President Joe Biden’s youngest brother said in a radio interview that the president has been “very open-minded” in conversations the two have had about the benefits of psychedelics as a form of medical treatment.

    The U.S. Food and Drug Administration designated psilocybin as a “breakthrough therapy” in 2018, a label that’s designed to speed the development and review of drugs to treat a serious condition. Psychedelics researchers have benefited from federal grants, including Johns Hopkins, and the FDA released draft guidance late last month for researchers designing clinical trials testing psychedelic drugs as potential treatments for a variety of medical conditions.

    Still, the American Psychiatric Association has not endorsed the use of psychedelics in treatment, noting the FDA has yet to offer a final determination.

    And medical experts in the U.S. and elsewhere, Australia included, have cautioned that more research is needed on the drugs’ efficacy and the extent of the risks of psychedelics, which can cause hallucinations.

    “There are concerns that evidence remains inadequate and moving to clinical service is premature; that incompetent or poorly equipped clinicians could flood the space; that treatment will be unaffordable for most; that formal oversight of training, treatment, and patient outcomes will be minimal or ill-informed,” said Dr. Paul Liknaitzky, head of Monash University’s Clinical Psychedelic Lab.

    Plus, the drugs will be expensive in Australia — about $10,000 (roughly $6,600 U.S. dollars) per patient for treatment.

    Litnaitzky said the opportunity for Australians to access the drugs for specific conditions is unique.

    “There’s excitement about drug policy progress,” he said, “… about the prospect of being able to offer patients more suitable and tailored treatment without the constraints imposed by clinical trials and rigid protocols.”

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  • Georgia launches Medicaid expansion in closely watched test of work requirements

    Georgia launches Medicaid expansion in closely watched test of work requirements

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    ATLANTA — Georgia is offering a new bargain to some adults without health insurance beginning Saturday: Go to work or school and the state will cover you.

    But advocates decry the plan, which will insure far fewer people than a full expansion of the state-federal Medicaid program, as needlessly restrictive and expensive.

    The program is likely to be closely watched as Republicans in Congress push to let states require work from some current Medicaid enrollees.

    Madeline Guth, a senior policy analyst with the Kaiser Family Foundation, said Democratic President Joe Biden’s administration is unlikely to approve work requirements, but a future Republican president could.

    “I think there will be a lot of eyes on Georgia,” Guth said.

    Georgia is one of 10 remaining states that hasn’t expanded Medicaid eligibility to include individuals and families earning up to 138% of the federal poverty line, or $20,120 annually for a single person and $41,400 for a family of four.

    Medicaid expansion was a key part of President Barack Obama’s health care overhaul in 2010, but many Republicans have fought it, including Georgia Gov. Brian Kemp, a Republican.

    Instead, Kemp is limiting expanded coverage to adults earning up to 100% of the poverty line — $14,580 for a single person or $30,000 for a family of four. And coverage is only available if able-bodied adults document they are working, volunteering, studying or in vocational rehabilitation for 80 hours per month.

    It fits Kemp’s argument, as he tries to drag his party away from former President Donald Trump, that the GOP needs to show tangible conservative achievements for everyday people

    “In our state, we want more people to be covered at a lower cost with more options for patients,” Kemp said in his State of the State speech in January.

    Those who earn more will remain eligible for subsidized coverage, often with no premium cost, on the federal marketplace. Kemp’s administration argues commercial coverage is better because it pays providers more than state-set Medicaid rates.

    The Trump administration ultimately gave permission to 13 states to impose work requirements on some Medicaid recipients. The Biden administration revoked all those waivers in 2021, ruling work isn’t a primary purpose of Medicaid. But Kemp’s administration won a federal court fight last year to preserve Georgia’s plan, in part because it applies to new enrollees and not current Medicaid recipients.

    Caylee Noggle, commissioner of the Department of Community Health, told The Associated Press this week that Pathways to Coverage is a “Georgia-specific approach” that could insure up to 100,000 people in its first year.

    But 100,000 is far less than the nearly 450,000 uninsured Georgians that the Urban Institute estimates could gain coverage with a full Medicaid expansion.

    Others say the nearly $118 million in state money, combined with another $229 million in federal money, isn’t nearly enough to reach that goal. The liberal-leaning Georgia Budget & Policy Institute estimates the funds will cover fewer than 50,000 people.

    And state taxpayers will pay much more per person. Partly at the behest of Democratic Georgia Sen. Raphael Warnock, the federal government is offering to pay 95% of any Medicaid expansion for two years and 90% afterward. Instead, refusing federal largesse, Georgia will continuing paying the same 34.2% share the state foots for its existing Medicaid program and spurn extra federal funding that has been pledged.

    “The inappropriately named ‘Pathways to Coverage’ will cost Georgia more money and cover fewer people than if the state simply joined 40 other states in expanding Medicaid,” Warnock said in a statement to the AP.

    “While state politicians continue playing games with people’s lives, Georgians are dying because they can’t afford the health care they need,” he said.

    Noggle and other Georgia officials say working, studying or volunteering leads to improved health, a key argument for why those requirements should be part of a health insurance program.

    But those who treat uninsured people say many can’t work because they are in poor health.

    “The reason they have their challenges, that they can’t work, is because they’ve got a mental illness or they’ve got a medical illness that is affecting their ability to do that,” said Dr. Reed Pitre, an addiction psychiatrist and interim chief medical officer at Mercy Care, a federally subsidized nonprofit in Atlanta.

    Enrolling people in the new program is a priority for Mercy Care, Pitre said, while noting that no one will qualify until a month after they establish compliance with the work requirement.

    The Kemp administration anticipates the program will serve people in low-wage jobs who can’t afford employer insurance, as well as students. The state also is redetermining eligibility for 2.4 million adults and children now covered by Medicaid.

    Georgia has delayed decisions on people it thinks are ineligible for regular Medicaid but could transfer to the Pathways program, Noggle said.

    Either way, once on the new program, people will have to meet activity requirements or lose coverage beginning the following month, which could impact thousands. When Arkansas imposed work requirements in 2018 for some adults, more than 18,000 people lost coverage in less than a year.

    Georgia will be different, Noggle argued, saying recipients will only have to certify for the first three months of the year.

    “I think we are going to make it as easy as possible as we can for our members to verify their eligibility,” she said.

    But only time will tell. Kemp’s expansion plan in Georgia could provide a blueprint for other states and other Republicans looking to require more from those on Medicaid.

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  • Foreign companies are shifting investment out of China as confidence wanes, business group says

    Foreign companies are shifting investment out of China as confidence wanes, business group says

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    BEIJING — Foreign companies are shifting investments and their Asian headquarters out of China as confidence plunges following the expansion of an anti-spying law and other challenges, a business group said Wednesday.

    The report by the European Union Chamber of Commerce in China adds is one of many signs of growing pessimism despite the ruling Communist Party’s efforts to revive interest in the world’s No. 2 economy following the end of anti-virus controls.

    Companies are uneasy about security controls, government protection of their Chinese rivals and a lack of action on reform promises, according to the European Chamber. They also are being squeezed by slowing Chinese economic growth and rising costs.

    Business confidence in China is “pretty much the lowest we have on record,” the European Chamber president, Jens Eskelund, told reporters ahead of the report’s release.

    “There’s no expectation that the regulatory environment is really going to improve over the next five years,” Eskelund said.

    President Xi Jinping’s government, trying to shore up economic growth that sank to 3% last year, is trying to encourage foreign companies to invest and bring in technology. But they are uneasy about security rules and plans to create competitors to global suppliers of computer chips, commercial jetliners and other technology. That often involves subsidies and market barriers that Washington and the European Union say violate Beijing’s free-trade commitments.

    Two-thirds of the 570 companies that responded to the European Chamber’s survey said doing business in China has become more difficult, up from less than half before the pandemic. Three out of five said the business environment is “more political,” up from half the previous year.

    Companies are on edge after police raided offices of two consultancies, Bain & Co. and Capvision, and a due diligence firm, Mintz Group, without public explanation. Authorities say companies are obliged to obey the law but have given no indication of possible violations.

    Companies also are uneasy about Beijing’s promotion of national self-reliance. Xi’s government is pressing manufacturers, hospitals and others to use Chinese suppliers even if that raises their costs. Foreign companies worry they might be shut out of their markets.

    Last month, the government banned using products from the biggest U.S. maker of memory chips, Micron Technology Inc., in computers that handle sensitive information. It said Micron had unspecified security flaws but gave no explanation.

    One in 10 companies in the European Chamber survey said they have shifted investments out of China. Another 1 in 5 are delaying or considering shifting investments. In aviation and aerospace, 1 in 5 companies plan no future investment in China.

    China has long been a top investment destination due to its huge and growing consumer market, but companies complain about market access restrictions, pressure to hand over technology and other irritants. The ruling party has tightened control since Xi took power in 2012, pressing foreign companies to give the party board seats and a direct say in hiring and other decisions.

    The European Chamber noted it wasn’t just foreign companies that are moving: 2 out of 5 in its survey reported Chinese customers or suppliers are shifting investments out of the country.

    A separate group, the British Chamber of Commerce in China, said last month its members were waiting for “greater clarity” about anti-spying, data security and other rules before making new investments.

    The biggest concern is the ruling party’s sweeping expansion of its definition of national security to include the economy, food, energy and politics, Eskelund said.

    “What does qualify as a state secret? Where does politics begin and the commercial world stop?” Eskelund said. That “creates uncertainty” about “where we can operate as normal businesses.”

    In the European Chamber survey, the top destination for companies moving their Asian headquarters out of China was Singapore, with 43% of companies that moved, followed by Malaysia. Only 9% went or plan to go to Hong Kong.

    Leaders including Premier Li Qiang, China’s top economic official, have promised to improve operating conditions, but businesses say they see few concrete changes.

    “Our members are not really convinced that we are going to see tangible results,” Eskelund said.

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  • Biden’s rally with union workers marks first big event of his 2024 campaign

    Biden’s rally with union workers marks first big event of his 2024 campaign

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    PHILADELPHIA — PHILADELPHIA (AP) — President Joe Biden is promoting his pro-labor record Saturday at his first major political rally of his reelection campaign, appearing alongside union members to make the case that his economic agenda is boosting the middle class.

    He plans to “lay out the core principles of his economic message” during his remarks at the Philadelphia Convention Center, according to his campaign. He also intends to talk about how a sweeping climate, tax and health care package he signed into law last year has cut the cost of prescription drugs and lowered insurance premiums. It’s part of his administration’s focus on his achievements during his first two years in office — the centerpiece argument for a second term.

    The event, which organizers said included unions representing 18 million workers nationwide, recalled then-candidate Biden opening his 2020 presidential campaign at a union hall in Pittsburgh. That underscores just how important labor support will be to his winning a second term.

    The president told reporters before he left Washington that he had met with business leaders on Friday and that corporate interests and “unions are beginning to work together.”

    “I’m excited about this is the beginning of something big,” Biden said, “and we’ll begin changing the economic balance.”

    Several of the nation’s most powerful unions — including the AFL-CIO, American Federation of Teachers and the American Federation of State, County and Municipal Employees — officially endorsed Biden’s campaign on Friday. The first-of-its-kind joint endorsement among the unions and the backdrop of hundreds of workers are part of a meticulously choreographed effort to show the support of labor behind what Biden himself calls the most pro-union president in history.

    “I’m saying that my philosophy about building from the middle out and the bottom up is working,” Biden told reporters before a fundraiser in Connecticut on Friday evening.

    The Philadelphia event also comes amid some encouraging economic news for Biden, with inflation cooling last month, continuing a steady decline in consumer prices primarily driven by lower gas prices, a smaller rise in grocery costs than in previous months and less expensive furniture, air fares and appliances.

    The city and Pennsylvania have long been at the heart of Biden’s political efforts. Philadelphia was the site of his campaign headquarters in 2020 and the state was one of a handful that had voted for Donald Trump in 2016 but flipped back to Democrats four years later.

    Before addressing the union gathering, Biden took a helicopter tour over the collapsed section of Interstate 95 in Philadelphia that has complicated traffic along one of the nation’s most crowded highways.

    Michael Smith, a 62-year-old retired electrician who was attending Saturday’s rally in a T-shirt bearing the name and logo of the International Brotherhood of Electrical Workers, said he liked Biden’s chances of reelection next year because of his administration’s championing green jobs and construction nationwide as part of the bipartisan infrastructure law Biden signed in 2021.

    “You can see see how important that is with 95 going down,” Smith said of the legislation, adding “That is a big factor in creating work and jobs. Not just for unions but for the middle class.”

    Another attendee, 53-year-old Jennifer McKinnon, a grade school librarian and member of the National Education Association, said she felt that Biden had a personal commitment to education because his wife, Jill, was a teacher who continued to teach English at a Northern Virginia community college as first lady.

    “I’m very optimistic. I fear that the Republicans are going to get caught in their cycle that they did last time and people aren’t going to buy it this time, so Joe’s going to sweep right in,” McKinnon said, alluding to former President Donald Trump, who is the early front-runner for the Republican nomination in 2024.

    Many in the crowd also said they thought the criminals cases in federal and New York courts against Trump could complicate his electoral pitch even though his message of economic populism resonated with some union members in the past. AP VoteCast, a sweeping survey of the 2020 electorate, found that about 6 in 10 self-identified union members supported Biden, a margin that outpaced Trump but was not commanding.

    Randi Weingarten, president of the American Federation of Teachers, said some union members supported Trump in the past because “there is a lot of grievance in this country and there is a lot of unhappiness. And what Trump was a master at was being able to exploit fear and exploit grievance.”

    She said part of the reason the AFT and other top unions endorsed Biden nearly 18 months before Election Day 2024 was to promote Biden’s economic record against Republican-championed cultural issues.

    Until now, Biden’s primary campaign activity has been fundraising. He raised money at a private home in Greenwich, Connecticut, on Friday and soon will hold fundraisers in California, Maryland, Illinois and New York.

    Biden is “going to feel very, very comfortable when he’s in Philadelphia. He’s going to be among friends,” added Lee Saunders, president of the American Federation of State, County and Municipal Employees, who pushed for a coordinated endorsement of Biden’s reelection campaign from top unions early in the cycle.

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  • Republicans in Oregon Senate end six-week walkout that blocked bills on abortion, trans health care

    Republicans in Oregon Senate end six-week walkout that blocked bills on abortion, trans health care

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    SALEM, Ore. — Enough Republican members showed up in the Oregon Senate on Thursday to end a six-week walkout that halted the work of the Legislature and blocked hundreds of bills, including some on abortion, transgender health care and gun safety.

    The boycott, which prevented the Senate from reaching a two-thirds quorum needed to pass bills, was prompted by a sweeping measure on abortion and gender-affirming care that Republicans said was too extreme.

    The walkout also blocked the approval of the two-year state budget and a gun-safety measure opposed by the GOP that would increase the purchasing age to 21 for semiautomatic rifles.

    GOP Minority Leader Sen. Tim Knopp had said the boycott would end only on the session’s last day — June 25 — to pass “bipartisan” legislation and budget bills. But an optimistic mood took over the Capitol this week as GOP and Democratic leaders met to negotiate compromises.

    “We asked for lawful, we asked for constitutional, we asked for compromise, and I see that from your side,” Knopp said as he addressed Democratic Senate President Rob Wagner following Thursday’s roll call. “We appreciate everyone who was involved.”

    Republicans particularly opposed a provision in the measure on abortion and transgender health care that would allow doctors to provide abortions regardless of the patient’s age, with medical providers not required to notify the parents of a minor, especially when doing so could endanger the child, such as in cases of incest.

    The gun-control measure originally would have punished the manufacturing or transferring of undetectable firearms with a maximum 10-year sentence and $250,000 fine. Republicans objected to amendments that would limit concealed-carry rights and increase the purchasing age to 21 for semiautomatic rifles such as AR-15s.

    The longest walkout in the Legislature’s history happened despite voters passing a ballot measure in 2022 that disqualifies lawmakers with 10 or more unexcused absences from reelection. Republican senators are likely to sue over the measure if they’re not allowed to register as candidates, starting in September, for the 2024 election. Republicans also walked out in 2019, 2020 and 2021.

    On June 1, Senate Democrats voted to fine senators $325 every time their absence denied a quorum.

    On Wednesday, more than 40 Oregon Democratic House and Senate members sponsored a joint resolution proposing an amendment to the state Constitution to require a majority of each chamber in the Legislature to be present to conduct business. If passed by the Legislature, it would go before Oregon voters in a ballot measure in the 2024 election.

    Democratic Gov. Tina Kotek can bring lawmakers back for a special session if the House and Senate don’t approve the budgets by the time the regular session ends.

    The Republicans had initially said they were boycotting because bill summaries did not meet a long-forgotten state law that required them to be written at a level an eighth-grader could understand.

    The walkout, which began on May 3, is the longest in the 163-year history of the Oregon Legislature and the second-longest of any U.S. state, after Rhode Island, according to a list by Ballotpedia.

    In 1924, Republican senators in Rhode Island fled to Rutland, Massachusetts, and stayed away for six months, ending Democratic efforts to have a popular referendum on the holding of a constitutional convention.

    That self-imposed exile followed the detonation of a gas bomb in the Senate chamber. Democrats and Republicans both accused each other of setting it off.

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  • Report: 2020 US census helped guide distribution of $2.8 trillion in annual government spending

    Report: 2020 US census helped guide distribution of $2.8 trillion in annual government spending

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    The head count of every U.S. resident in 2020 helped guide the distribution of $2.8 trillion in annual federal spending, underscoring the importance of participating in the once-a-decade census

    ByMIKE SCHNEIDER Associated Press

    FILE – Albert Maghbouleh, far left, and Miles Santamour, 89, with Amigos de Jaibalito Foundation (ADJ) share lunch outdoors guarding social distancing, overlooking the skyline of Los Angeles on Jan. 11, 2021. America got older last decade. The share of seniors age 65 or older in the U.S. grew by more than a third, while the share of children declined, particularly among those under age 5, according to new figures from the 2020 census released Thursday, May 25, 2023. (AP Photo/Damian Dovarganes, File)

    The Associated Press

    The head count of every U.S. resident in 2020 helped guide the distribution of $2.8 trillion in annual federal spending, underscoring the importance of participating in the once-a-decade census, according to a new report released Wednesday by the U.S. Census Bureau.

    There were 353 federal assistance programs that used the Census Bureau data in 2021 to steer the allocation of the federal funding, up from 316 programs accounting for $1.5 trillion in 2017 when a similar study was conducted, according to the report.

    The federal funding is distributed to state and local governments, nonprofits, businesses and households. In 2021, it helped pay for health care, education, school lunch programs, COVID-19 relief, child care and highway construction, among other things.

    “The Census Bureau’s new, more comprehensive report shows that an accurate decennial census is critical to the fair distribution of federal nondefense spending,” said Andrew Reamer, a George Washington University research professor who helped produce the report.

    The Census Bureau, which conducts the U.S. censuses every 10 years, doesn’t determine how the federal funding is distributed.

    The breadth of the programs and the amount of money at stake underscore how some communities can miss out on funding opportunities if they aren’t counted. The 2020 census was among the most difficult in recent memory because of obstacles posed by the spread of COVID-19, which in the U.S. coincided with the head count.

    Adding to the difficulties were hurricanes along the Gulf Coast, wildfires in the West and unsuccessful efforts by the Trump administration to add a citizenship question to the census questionnaire, which critics say may have scared off immigrants and others.

    Black, Hispanic and American Indian residents were missed at higher rates in the 2020 census than they were in the 2010 census, with the undercount 3.3% for the Black population, almost 5% for Hispanics and 5.6% for American Indians and Native Alaskans living on reservations.

    Besides helping guide the distribution of federal funding, figures from the census determine how many congressional seats each state gets and are used for redrawing political districts.

    ___

    Follow Mike Schneider on Twitter at @MikeSchneiderAP

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  • Debt limit deal is in place, but budget deficit is still a multi-decade challenge for US government

    Debt limit deal is in place, but budget deficit is still a multi-decade challenge for US government

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    WASHINGTON — Even with the new spending restraints in the debt limit deal that cut borrowing by $1.5 trillion, the U.S. government’s deficits are still on course to keep climbing to record levels over the next few decades.

    The projections are a sign that the two-year truce between President Joe Biden and House Speaker Kevin McCarthy, R-Calif., might be only a pause before a far more wrenching set of showdowns over the federal budget. The Congressional Budget Office said Tuesday that the agreement would reduce spending by $1.3 trillion and interest payments by $188 billion over 10 years. But that sum is too modest to fully offset the growing costs of Social Security, Medicare and Medicaid.

    Both Biden and McCarthy ruled out any cuts to Social Security and Medicare, two programs that benefit older voters, before their teams even began their budget talks. That omission reflects the politics around two popular programs as Democrats and Republicans prepare for next year’s presidential election.

    It also means the agreement finalized on Sunday keeps the risk of ever-escalating debt on the table, setting up the possibility of another bruising battle when the debt limit needs to be raised again in 2025.

    “You should think of this as one step,” said Marc Goldwein, senior vice president at the Committee for a Responsible Federal Budget. “The question is, can they take the next step after that?”

    Lawmakers know there are difficult choices ahead and that the only way through them likely involves some combination of deep spending cuts, broad tax hikes and major changes to the retirement income and health care programs that consume an ever-growing share of federal spending.

    Mandatory spending — which includes Social Security, Medicare and Medicaid — already account for the majority of government spending. That category is equal in size to 14% of U.S. gross domestic product, and the CBO expects it will grow to 15.6% by 2023. By contrast, discretionary spending was 6.5% of gross domestic product last year and was already projected to fall to 6% within 10 years.

    Goldwein said he’s optimistic that leaders in both parties will find ways to reduce the growth in spending for health care programs. Social Security will also face a reckoning as its trust fund will be unable to pay out full benefits within a decade.

    But some budget experts saw the deal as more focused on optics than sustainability.

    “This debt limit agreement is shaking out to be a political face-saving deal without much substance in terms of changing the U.S. debt trajectory,” said Romina Boccia, director of budget and entitlement policy at the libertarian Cato Institute.

    The agreement, which still has to be approved by Congress, would hold discretionary spending essentially flat for the coming year, while allowing increases for military and veterans accounts. Spending growth would be capped at 1% for 2025, essentially a cut given the likely rate of inflation.

    Some Democratic allies see the deal as problematic because it cedes ground to Republicans who want to use the debt limit fight as an opportunity to press their policy aims, despite the risk of a default.

    “Looking forward, we must find a path to abolish the debt ceiling and end the absurd debt ceiling hostage-taking that Republicans engage in when they can use it as a bludgeon against a Democratic president,” said Sharon Parrott, president of the Center on Budget and Policy Priorities, a liberal think tank.

    Other economic analysts took issue with GOP suggestions that the U.S. was already hamstrung by debt, even though investors continue, for the moment, to buy Treasury notes. While total federal debt — including money the government owes itself — exceeds $31 trillion, the U.S. economy possesses more than $143 trillion worth of non-financial assets in a sign that the current debt loads are manageable.

    “It is simply not true that the United States is broke and on the verge of a debt and deficit crisis,” said Joe Brusuelas, chief economist at the consultancy RSM U.S.

    But even if there isn’t an immediate reckoning over debt, there is a long-term problem that the talks purposefully ignored. The president challenged Republicans to shield Social Security and Medicare from cuts at his State of the Union address in February. GOP lawmakers jeered him for suggesting they would dare to cut the programs, leading Biden to declare, “We’ve got unanimity.”

    Biden specifically hailed the bipartisan agreement on Sunday for protecting Social Security and Medicare, while saying the agreement that must pass the House and Senate would prevent a possibly catastrophic default that could occur on June 5.

    “This is a deal that’s good news,” the president said, “for the American people.”

    Yet House members received a specific briefing in March indicating that entitlement programs would drive up the debt. CBO director Phillip Swagel gave a presentation showing that publicly held debt would more than double to 195% of gross domestic product in 2053. The key challenge is that an aging population means that programs for older people have costs that exceed tax revenues.

    Swagel provided 17 policy options for reducing the debt, six of which were tax hikes that could raise trillions of dollars over 10 years. Tax increases have been a nonstarter with Republicans, while Democrats have generally shied away from reductions to benefits.

    His slide deck included this warning: “The longer action is delayed, the larger the policy changes would need to be.”

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  • More companies help with fertility care, but it is still out of reach for many

    More companies help with fertility care, but it is still out of reach for many

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    Jessica Tincopa may leave the photography business she spent 14 years building for one reason: to find coverage for fertility treatment.

    After six miscarriages, Tincopa and her husband started saving for in vitro fertilization, which can cost well over $20,000. But the pandemic wiped out their savings, and they can’t find coverage for IVF on their state’s health insurance marketplace. So, the California couple is saving again, and asking politicians to help expand access.

    “No one should ever have to go through this,” Tincopa said.

    Infertility, or the inability to get pregnant after a year or more of trying, is a common problem. The federal Centers for Disease Control and Prevention estimates that it affects nearly one in five married girls or women between the ages of 15 and 49.

    Yet coverage of fertility treatments can be hard to find in many corners of health insurance even as it grows briskly with big employers who see it as a must-have benefit to keep workers.

    It’s a divide researchers say is leading to haves and have nots for treatments, which can involve a range of prescription drugs and procedures like artificial insemination or IVF, where an embryo is created by mixing eggs and sperm in a lab dish.

    “It is still primarily for people who can afford to pay quite a bit out of pocket,” said Usha Ranji, associate director of women’s health policy at KFF, a nonprofit that studies health care issues.

    Clouding this picture are insurer concerns about cost as well as questions about how much fertility coverage should be emphasized or mandated versus helping people find other ways to build families, such as adoption.

    “If you’re going to offer one, there should be a corollary and maybe even more significant benefits for adoption,” medical ethicist Dr. Philip Rosoff said.

    A total of 54% of the biggest U.S. employers — those with 20,000 workers or more — covered IVF in 2022, according to the benefits consultant Mercer. That’s up from 36% in 2015. Walmart started offering coverage last fall and banking giant JPMorgan began this year.

    Many businesses that offer the coverage extend it beyond those with an infertility diagnosis, making it accessible to LGBTQ+ couples and single women, according to Mercer.

    The benefits consultant also said there’s big growth among employers with 500 or more workers, as 43% offered IVF coverage last year. But coverage gets spotty with smaller employers.

    Lauderhill (Florida) Fire Rescue Lt. Ame Mason estimates she and her husband have spent close to $100,000 of their own money on fertility treatments over the past few years, including several unsuccessful IVF attempts. Mason and her husband both work for the same department.

    Her brother-in-law also has a fertility issue. He works for a bigger fire department in nearby Palm Beach County and got coverage. Mason said that couple has a son.

    “It’s pretty wild. You could work a county away and have coverage,” Mason said. “There’s nothing regulating it … both government jobs.”

    Twenty-one states have laws mandating coverage of fertility treatments or fertility preservation, which some patients need before cancer treatments, according to the nonprofit patient advocacy organization Resolve. Of those states, 14 require IVF coverage.

    But most of these requirements don’t apply to individual insurance plans or coverage sold through small employers.

    “People tell us that their biggest barrier to family building is lack of insurance coverage,” Resolve CEO Barbara Collura said, adding that some insurers don’t view the care as medically necessary.

    The state and federally funded Medicaid program for people with low incomes limits coverage of fertility issues largely to diagnosis in several states, according to KFF, which says Black and Hispanic women are disproportionately affected. States also can exclude fertility drugs from prescription coverage.

    “By not covering this for poor folks, we’re saying we don’t want you to reproduce,” said medical ethicist Lisa Campo-Engelstein of the University of Texas Medical Branch in Galveston, Texas. She noted Medicaid programs do cover birth control and sterilization procedures like vasectomies.

    In California, Tincopa says she has talked to both state and federal legislators about creating some sort of option for people to purchase individual insurance with the coverage.

    The state Senate is weighing a bill that would require coverage of fertility treatments, including IVF, for large employers. But the California Association of Health Plans opposes it, just as it opposed similar bills in recent years, because of how much it might cost.

    Spokeswoman Mary Ellen Grant noted independent analysis has shown that bills like this could increase premiums by as much as $1 billion in the state. She also said it would create a coverage gap because it wouldn’t apply to the state’s Medicaid enrollees.

    “This is not about the treatment itself,” she said. “It’s strictly based on the increased costs for our members. It would impact everybody regardless of whether they received the benefit.”

    But large fertility cost estimates often overstate how many people will use the benefit, said Sean Tipton, of the American Society for Reproductive Medicine. He also said most people with fertility problems don’t need IVF.

    Tipton, who has advocated for benefit mandates in several states, said he expects to see fertility treatment coverage grow, especially with small employers who may need to offer it to attract and keep workers.

    Any states that decide to require fertility treatment coverage should also require support for adoption, said Rosoff, a retired Duke University medical school professor. He said “fairness and justice” dictate doing so, adding that adoption promotes the social good of finding homes for children.

    Many companies that have expanded fertility benefits also support adoption.

    Ame Mason’s employer helps with neither.

    Mason said she has thought about adoption, but will stick with IVF for now — scrimping wherever they can and working overtime as much as possible to pay for it. They’ve found a doctor in Florida after traveling to Barbados for care that was slightly less expensive.

    Plus, she and her husband are seeing improvements in their most recent IVF attempts. This makes her reluctant to stop trying.

    “We keep getting that glimmer of hope,” she said.

    ___

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

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  • Biden pressures House Republicans on debt limit in campaign-style speech

    Biden pressures House Republicans on debt limit in campaign-style speech

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    VALHALLA, N.Y. — President Joe Biden on Wednesday blasted Republican-demanded spending cuts as “devastating,” making his case in a campaign-style speech to voters as lawmakers met in Washington on raising the government’s borrowing limit to avoid a potentially catastrophic U.S. default.

    The president is showing an increased willingness to discuss possible budget restraints, yet he insisted anew that any talks on that should occur without the risk of the federal government being unable to pay its bills. As he spoke, negotiators from the White House and Congress met for two hours privately at the Capitol to discuss a path forward.

    “America is the strongest economy in the world, but we should be cutting spending and lowering the deficit without a needless crisis,” Biden said Wednesday.

    His words were a challenge to House Speaker Kevin McCarthy, who met Tuesday with Biden at the White House, declaring afterward that sharp spending cuts were required for House Republicans to increase the debt limit and stave off the risk of default.

    Biden laid into that GOP proposal on Wednesday in Valhalla, New York, saying spending cuts recently passed by the Republican House could hurt schools and the country’s “sacred” obligations to military veterans.

    The faceoff comes as the government is rapidly bumping up against its legal borrowing authority, meaning that it may not be able to pay its bills as early as the start of next month unless lawmakers agree to lift the limit.

    Wednesday’s events marked a preview of what the coming 18 months will look like for Biden as he performs his presidential duties while also trying to campaign in the 2024 election. He went to a region represented by first-term Republican Rep. Mike Lawler, whose district Biden won in 2020. Yet the president was gracious to the congressman, saying that Lawler is “the kind of Republican I was used to dealing with.”

    Biden used the trip to trumpet recent economic progress — pointing to the 12.7 million jobs created during his term and a fresh focus on domestic manufacturing — while warning that an unprecedented debt default would threaten millions of jobs and raise the prospect of a recession. Yet GOP lawmakers blame his coronavirus relief spending for the high inflation that has many voters already worrying about the U.S. economy.

    Back in Washington, senior White House officials and congressional aides were starting to discuss a path to avert a painful debt default that could come as soon as June 1. Negotiators are racing to strike a budget deal that could unlock a vote on separate debt ceiling legislation. Biden and Capitol Hill leaders are to meet again on Friday.

    But McCarthy has shown few signs that he and other House Republicans were willing to budge from their debt limit proposal, leaving Senate Majority Leader Chuck Schumer to warn the speaker is being “reckless.”

    Senate Republican Leader Mitch McConnell, who has stepped aside as McCarthy tries to negotiate with the White House, has assured, “America is not going to default.”

    McConnell has said that the past several times the debt ceiling has been raised, Congress has attached priorities that were agreed to with the White House, including a deal negotiated between then-President Donald Trump and former Speaker Nancy Pelosi.

    “There has to be an agreement between the speaker and the president — and there will be,” McConnell said.

    In his remarks Tuesday, Biden raised the specter of cuts to veterans’ care, an issue that has become particularly sensitive in the back-and-forth rhetoric between the White House and congressional Republicans. When the president suggested during the meeting on Tuesday that the House GOP plan could end up cutting benefits to veterans, McCarthy told reporters that he shot back that was a “lie.” But Biden disputed that it was a lie, saying that the across-the-board cuts would affect veterans’ care and other vital domestic programs.

    The president has countered the GOP plan with his own budget proposal, which could save $800 billion through changes to government programs. Of that sum, Biden said that $200 billion over 10 years would come from expanding Medicare’s ability to negotiate on prescription drug prices. He said by contrast that the House Republican bill could jeopardize medical care for U.S. families, while his deficit savings would lower costs.

    “Would you rather cut Big Pharma or cut health care for Americans?” Biden asked. “These are real world choices.”

    After his speech, Biden told reporters he was still holding out hope for a long term debt limit increase. He said he hadn’t been briefed yet on what lawmakers were discussing on the budget. But when he meets with them on Friday, he said he wants specifics of what spending cuts Republicans hope to make. “What are they going to cut?” he asked.

    Biden is also scheduled to spend a week abroad on a trip to Japan, Australia and Papua New Guinea later this month. He said postponing his travel is “possible but not likely.”

    With debt talks showing minimal progress, the White House hopes that Biden’s public outreach — starting in a congressional district that will be key for Democrats seeking to wrest House control back from Republicans next year — increases pressure on GOP lawmakers who can’t afford politically to alienate moderate voters.

    Rep. Lawler, as one of 18 House Republicans hailing from a congressional district won by Biden, is a prime target for the White House.

    Still, Lawler accepted the invitation from the White House, “maybe to their surprise,” the lawmaker said in an interview Tuesday. He said it was a “little disappointing” that Biden was spending his time traveling to his district rather than negotiating with other leaders in Washington.

    “He told me he wasn’t here to put any pressure on me,” Lawler told reporters after the president spoke. “Look, I showed up because I believe very strongly that we all have an obligation to work together.”

    House Republicans, in their debt measure that passed in April, are aiming for $4.5 trillion in deficit savings through cuts in spending, eliminating tax breaks for investing in clean energy, and undoing the Biden administration’s proposal that would forgive student loan debt. The White House has made it clear that Biden would veto that legislation.

    Democrats, who control the Senate by 51-49, are calling for a “clean” debt limit hike without any conditions such as spending cuts, but any such measure would require the support of at least nine Republican senators, and most of them say they will oppose doing so.

    While in New York on Wednesday, Biden, who formalized his reelection campaign on April 25, also was holding a pair of fundraisers.

    ___

    AP Writer Josh Boak reported from Washington. AP Congressional Correspondent Lisa Mascaro and White House Correspondent Zeke Miller contributed to this report.

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  • Congress eyes work rules for millions covered by Medicaid

    Congress eyes work rules for millions covered by Medicaid

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    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.

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  • Error, confusion plague review kicking millions off Medicaid

    Error, confusion plague review kicking millions off Medicaid

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    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.

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