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  • What the DeSantis and Newsom Debate Really Revealed

    What the DeSantis and Newsom Debate Really Revealed

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    The best way to understand last week’s unusual debate between Governors Gavin Newsom of California and Ron DeSantis of Florida is to think of them less as representatives of different political parties than as ambassadors from different countries.

    Thursday night’s debate on Fox News probably won’t much change the arc of either man’s career. DeSantis is still losing altitude in the 2024 GOP presidential race, and Newsom still faces years of auditioning before Democratic leaders and voters for a possible 2028 presidential-nomination run.

    What the debate did reveal was how wide a chasm has opened between red and blue states. The governors spent the session wrangling over the relative merits of two utterly divergent models for organizing government and society. It was something like watching an argument over whether the liberal government in France or the conservative government in England produces better outcomes for its people.

    “The way the debate will be heard is the nationals of each country cheering their guy on,” Michael Podhorzer, a progressive political strategist and a former political director for the AFL-CIO, told me.

    The sharp disagreements between the governors pointed toward a future of widening separation between red and blue blocs whose differences are growing so profound that Podhorzer has argued the sections should be understood as fundamentally different nations.

    As Podhorzer and other analysts have noted, this accelerating separation marks a fundamental reversal from the generally centralizing trends in American life through the late 20th century. Beginning with the New Deal investments under Franklin D. Roosevelt (such as agricultural price supports, the Tennessee Valley Authority, and Social Security), and continuing with massive expenditures on defense, infrastructure, and the social safety net after World War II (including Medicare, Medicaid, and federal aid for K–12 and higher education), federal spending for decades tended to narrow the income gaps between the southern states at the core of red America and the rest of the country.

    After World War II, in a dynamic that legal scholars call the rights revolution, the federal government nationalized more civil rights and liberties and limited the ability of states to constrain those rights. Through Supreme Court and congressional actions that unfolded over more than half a century, Washington struck down state-sponsored segregation and racial barriers to voting across the South, and invalidated a procession of state restrictions on abortion, contraception, interracial marriage, and same-sex relationships, among other things.

    But both big unifying trends reshaping the economy and the rules of social life have stalled and are moving in the opposite direction. Podhorzer has calculated that the convergence in per capita income between the South and other regions plateaued in 1980 and then started widening again around 2008. And, as I’ve written, the axis of Republican-controlled state governments, the GOP-appointed majority on the Supreme Court, and Republican senators wielding the filibuster are actively reversing the rights revolution that raised the floor of personal freedoms guaranteed in all 50 states.

    On issues including voting, LGBTQ rights, classroom censorship, book bans, public protest, and, most prominent, access to abortion, red states are imposing restrictions that are universally rejected in blue states. As Newsom argued in an interview with me a few hours before he went onstage, “This assault on our rights and the weaponization of grievance” is designed to “bring us back to … the pre-1960s world” in which people’s rights depended on their zip code. Under DeSantis, Florida has been a leader in that process, creating policies, such as limits on classroom discussion of sexual orientation and gender identity, widely emulated across other red states.

    Thursday night’s debate revolved around the differences between Florida and California, though the Fox moderator Sean Hannity hardly presented an accurate picture of the comparison. Both states have their successes and failures. But Hannity focused his questions entirely on measures that favor Florida (such as unemployment rate, violent-crime rate, and homelessness numbers) while ignoring all the contrasts that favor California (which has a much higher median income, far fewer residents without health insurance, and, according to the CDC, much lower rates of teen birth, infant mortality, and death from firearms, as well as a longer life expectancy). Hannity essentially joined in a tag team with DeSantis to frame the debate in terms familiar to his Fox audience that blue states are a chaotic hellhole of crime and “woke” liberalism; when Newsom pushed back against that characterization, or challenged DeSantis’s approach, Hannity often cut him off or steered the conversation in a different direction.

    The narrow focus on California and Florida made sense in a debate between their two governors. But those comparisons can obscure the bigger story, which is the expanding divergence between all the states in the red and blue sections.

    Podhorzer has documented that gap in an array of revealing measures. He divides the nation between states in which Republicans or Democrats usually hold unified control of the governorship and state legislature, and those in which control of state government is usually divided or frequently changes hands. That classification system yields 27 red states, 17 blue states (plus the District of Columbia), and six purple states. By these definitions, the red states account for just under half the population and the blue states just below two-fifths, while the blue states contribute slightly more of the nation’s GDP.

    Podhorzer’s data show that on many key measures, blue states as a group are producing far better outcomes than the red states.

    In new results provided exclusively to The Atlantic, Podhorzer calculates that the economic output per capita and the median family income are both now 27 percent higher in the blue section than in the red, while the share of children in poverty is 27 percent higher in the red states. The share of people without health insurance is more than 80 percent higher in the red states than in the blue, as are the rates of teen pregnancy and maternal death in childbirth. The homicide rate across the red states is more than one-third higher than in the blue, and the rate of death from firearms is nearly double in the red. Average life expectancy at birth is now about two and a half years higher in the blue states. On most of these measures, the purple states fall between red and blue.

    (Podhorzer also groups the states by their voting behavior in federal elections, which results in 24 red-leaning states, 18 blue ones, and eight purple states. But the comparisons between the two big sections don’t change much under that definition.)

    On most of these measures, Podhorzer calculates, the gap between the red and blue states has widened over the past 15 years. He attributes the expansion mostly to the kind of policy differences that DeSantis and Newsom debated. The difference in health outcomes, for instance, is rooted in disparities such as the continuing refusal of 10 red states, including Florida, to expand Medicaid eligibility under the Affordable Care Act (which every blue state has done). As other economic analysts have noted, with their higher concentrations of college graduates, blue states—and the large blue metropolitan areas of red states—are benefiting the most from the nation’s transition into an information-age economy.

    As DeSantis and Hannity did in the debate, defenders of the red-state approach point to other measures. Housing costs are typically much lower in red states than in blue, as are taxes. Those are probably the central reasons many of the blue states, despite their stronger results on many important yardsticks, are stagnant or shrinking in population, while several of the red states, especially those across the Sun Belt, have been adding middle-income families. Lower housing costs are also one reason homelessness is less of a problem in red states than in blue metros, especially along the West Coast.

    But the relative superiority of either model is probably less important to the nation’s future than the widening separation, and growing antagonism, between them that was displayed so vividly in the debate.

    Most experts I spoke with agree that there is now no single difference between the red and blue sections as great as the gulf during most of the 20th century between the states with and without Jim Crow racial segregation, much less the 19th-century distance between the slave and free states.

    But the number of issues dividing the states is reaching a historic peak, many of those same experts agree. Although civil rights and racial equity have made up the most important dividing line between the states for most of U.S. history, “the way in which these issues line up today—on everything from abortion to library books to the question of how much power states ought to have over their local governments … I think there’s not been since the founding such a far-reaching debate,” Donald Kettl, a former dean of the University of Maryland’s School of Public Policy, told me.

    To Kettl, the new wave of restrictive social legislation spreading across red states challenges the traditional idea that local variation benefits the country by allowing states to function as the fabled “laboratories of democracy.” “It strikes me as being incredibly dangerous,” Kettl said. “The good old arguments about the laboratories of democracy is that individual states would try different ideas, find out what works, and throw out the ones that didn’t work. We are not talking about that at all. We are talking about an effort to push a particular agenda and to push it as far as possible.”

    David Cole, the ACLU’s national legal director, likewise sees the erosion of a national floor of civil rights and liberties as the most ominous element of the widening red-blue separation. “We are supposed to be one nation, committed to a common set of fundamental rights,” Cole told me in an email. “But we have increasingly become two nations, with substantial rights protections for some, and robust repression for others. Federalism was designed to allow for some play in the joints, some variations among states—but not on the fundamental constitutional rights to which we are all entitled as human beings and U.S. residents.”

    It’s not clear that in the near term anything will close the space between red and blue states. Neither party has many realistic chances to win power in states that now prefer the other side. And particularly in red states, the dominance of the conservative media ecosystem makes it difficult for Democrats even to present their arguments, as the debate demonstrated.

    In the interview a few hours before he went onstage, Newsom told me that the principal reason he accepted the debate was not so much to rebut DeSantis as to reach Fox viewers. “I want to make the case in their filter bubble,” he told me. “We’ve got to get into their platforms.” Though the forum allowed Newsom to assert some positive facts about President Joe Biden’s record rarely heard on the network, any progress in reaching Fox viewers was likely blunted by Hannity’s framing of every issue as proof of the superiority of red over blue. After the debate, Newsom’s aides said they believed he had achieved his mission of evangelizing to Fox’s audience. But in the end, the evening may have validated Barack Obama’s lament during his presidency that it was virtually impossible for Democrats to communicate with red-state voters except through the negative filter that conservative media build around them.

    Podhorzer is among those skeptical that anything will reverse this process of separation in the foreseeable future. He views the late-20th-century trend toward convergence as the anomaly; “the default position” through most of American history has been for the states we now consider the red bloc to pursue very different visions of moral order, economic progress, and the role of government than those we now label as blue. To Podhorzer, the disagreements on display at the DeSantis-Newsom debate were just the modern manifestation of the deep divisions between the free and slave states, or the Union and the Confederacy.

    In the 2024 presidential race, Biden and the leading Republican candidates have each endorsed new national laws that would reverse our separation by imposing the dominant laws in one section on the other. Biden and other Democrats are backing federal bills to restore a national floor of abortion, LGBTQ, and voting rights in every state; Republicans in turn want to impose red-state restrictions on all those issues in blue states.

    Podhorzer believes that the differences between the states have hardened to the point where setting common national rules on these issues in either direction has become extremely risky. “Any compromise on any of these big issues,” he told me, “means half the country will see a loss in some aspect of what they like about the way they live.” From his perspective, courting that backlash might be worth the effort to restore core civil rights, such as access to abortion, nationally. But he warns that no one should underestimate the potential for fierce red-state resistance to such an effort, extending even to violence.

    It won’t be easy for either side to pass legislation nationalizing the social- and civil-liberties regime in their section; at the least, it would require them to not only hold unified control of the White House and Congress but also end the Senate filibuster, which remains an uncertain proposition. The more likely trajectory is for red and blue states to continue careening away from each other along the pathways that Newsom and DeSantis so passionately defended last week. “Without some major disruption, this cycle” of separation “hasn’t played itself out fully,” Podhorzer told me, in a view echoed by the other experts I spoke with. “There are hurricane-force winds in that direction.” Thursday’s gusty debate between these two ambitious governors only hinted at how hard those gales may blow in the years ahead.

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    Ronald Brownstein

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  • Health insurance in Canada: A primer for students and recent grads – MoneySense

    Health insurance in Canada: A primer for students and recent grads – MoneySense

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    If you’re in school, you most likely have supplemental health and dental insurance. Some educational institutions make this mandatory by including the cost in your tuition fees. However, if you’re a new grad, you may be getting accustomed to managing health insurance on your own (as opposed to through your parents or school). Here’s a quick lesson on what health insurance is, how it works, where you can buy it and the benefits you can receive. 

    What is health insurance?

    A health insurance plan helps to cover the costs of your medical and dental bills. Depending on the provider and type of plan you choose, health insurance can cover a number of health-related expenses. Coverage typically includes prescription drugs, vision care, dental care, medical equipment and visits to medical practitioners (such as physiotherapists, dietitians and registered massage therapists). 

    How does health insurance work for students?

    Depending on your school, you may be automatically enrolled in the health insurance plan that’s offered to students. Once you’re enrolled, you can download a copy of the plan details. You’ll also receive a benefits card that will have your plan identification on it. You will need to present this card to your healthcare provider at every visit when paying for your services (in my experience, most providers will keep this information in your file).

    Health insurance for students in university: How it works

    How can students access their benefits?

    Some health and dental service providers set up direct billing. This means they bill the insurance company directly, and you will only be required to pay the balance not covered by your plan. If they don’t have direct billing, then you’ll need to pay the full amount out of pocket, and then submit an online claim with your receipt to receive reimbursement. It can take several business days to assess your claim and for the amount to be deposited into your bank account. 

    Health insurance for international students in Canada

    If you’re an international or foreign-exchange student, you’ll need to research the health insurance for the particular province or territory in which you are studying. Some provinces provide health coverage to international students that is either free or for an added cost, and you’ll be required to apply through the province. 

    For example, international students studying at a university in Ontario must obtain mandatory health care coverage through the University Health Insurance Plan (UHIP), a not-for-profit insurance plan created by Ontario’s universities that is comparable to the Ontario Health Insurance Plan (OHIP). 

    In other cases where provincial health insurance is not offered, students need to purchase personal health insurance, typically through their school in Canada. Be sure to check if these health plans are mandatory or optional. 

    What happens to students when they leave school and no longer have coverage? 

    If you’re no longer in school and find yourself without any health insurance coverage, you’re not alone. Acquiring your own health insurance plan could be the solution—if you’re concerned about paying for hefty medical bills that may arise due to an injury or illness while finding employment. This can help bridge the gap while you’re looking to get a job offer from an employer that provides health insurance.

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    Sandy Yong

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  • ‘Miracle drug’ euphoria: Experts warn widespread use of weight loss medicine faces major hurdles

    ‘Miracle drug’ euphoria: Experts warn widespread use of weight loss medicine faces major hurdles

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    Two experts see major challenges facing the adoption of new obesity drugs.

    Dr. Kavita Patel, a physician and NBC News medical contributor, believes fresh data from Novo Nordisk on Ozempic’s ability to delay the progression of chronic kidney disease is among the strongest supporting evidence for secondary uses of the drug.

    However, she considers data supporting the use of obesity drugs for other conditions including Alzheimer’s and alcohol addiction as underdeveloped.

    “Those trials … are nowhere near as robust as the data we have on [Novo Nordisk trial] FLOW, on sleep apnea, cardiovascular risks, on diabetes control — double-blind placebo, randomized controlled trials that are incredible,” she told CNBC’s “Fast Money” on Wednesday. “We have a long way to go for that. I’ve seen a lot of miracle drugs before.”

    Novo Nordisk halted FLOW on Tuesday. According to the company’s press release, it happened more than a year after an interim analysis showed that Ozempic could treat chronic kidney disease in Type 2 diabetic patients.

    As of Friday’s close, Novo Nordisk is up 9.82% since its announcement. Its obesity drug maker competitor Eli Lilly is up 5.16% in the same period.

    Patel believes efficacy is just one of the major hurdles the medication needs to clear before it can be approved for uses outside of diabetes management.

    “We know this drug works really well in diabetics. But there are so many barriers to getting there —including cost, adherence, prescriber rate,” said Patel, who also served as a White House Health Policy Director under President Obama.

    Patients opting to use GLP-1 drugs — a group of medications initially designed to control diabetes — for weight management often must pay out-of-pocket.

    “Right now, we are seeing active employers, entire states that are declining to cover on the weight loss indication,” Patel said.

    What other industries could weight loss drugs disrupt?

    If the U.S. Food and Drug Administration approves Ozempic for use in Type 2 diabetics with chronic kidney disease, which Patel believes will happen, it could force the hand of insurance companies to expand their coverage of the drug.

    “We’ll see a final package of data that will just be so compelling, that it would be wrong not to cover this, because it should be superior to what we have available to us,” she noted. “That is something that I think the insurance companies will have a difficult time [with].”

    Mizuho Health Care Sector Strategist Jared Holz also expects challenges related to insurance coverage as more patients begin taking GLP-1 drugs, which could limit overall adoption.

    “The payers, at some point, are going to be saying, ‘We get it, but we cannot pay for these at this volume without seeing the benefit, which may be 10 years from now, 20 years from now, 30.’ We have no idea when the offset is going to be,” he also told CNBC’s “Fast Money.”

    Holz also pointed out the divide emerging in the health care sector between Novo Nordisk, Eli Lilly and their pharmaceutical peers.

    “We haven’t seen this kind of valuation disconnect between the peer group, maybe in the history of the sector,” he said.

    The growth trend may not be sustainable for Novo Nordisk and Eli Lilly, based on current supply constraints that have left patients unable to secure dosages.

    “The companies can’t make enough, I don’t think, to actually put out revenue that’s going to appease investors, given where the stocks are trading,” said Holz.

    A Novo Nordisk spokesperson did not offer a comment due to the company’s quiet period ahead of earnings. Eli Lilly did not immediately respond to a request for comment.

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  • Here are 3 stocks in our portfolio that Goldman Sachs think will rally on earnings

    Here are 3 stocks in our portfolio that Goldman Sachs think will rally on earnings

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    The Goldman Sachs logo is seen on at the New York Stock Exchange on September 13, 2022 in New York City.

    Michael M. Santiago | Getty Images News | Getty Images

    It’s encouraging to see three Club stocks on the bullish side of Goldman Sachs’ new list of 25 tactical trades for earnings season.

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  • 2023’s Best International Medical Insurance Plans for Global Citizens Announced by International Citizens Insurance

    2023’s Best International Medical Insurance Plans for Global Citizens Announced by International Citizens Insurance

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    Including Best Plans for U.S. Citizens Abroad, Foreigners in the USA, and World Nomads

    International Citizens Insurance, an international insurance broker based out of Boston, MA, is excited to announce its updated list of 2023’s best global health insurance plans for expats, global citizens, remote workers, and other people living outside of their home country. These recommendations simplify the overwhelming array of international medical insurance choices for the growing wave of expats moving to new countries.

    In a world where international travel and cross-border living have become increasingly common, having access to reliable and comprehensive health insurance is paramount. Today, we are excited to announce the unveiling of the Top 10 International Health Insurance Plans, recognizing the providers that have excelled in offering exceptional global healthcare coverage and peace of mind to individuals and families worldwide.

    “Helping international citizens find the right plan for their needs is our top priority. The companies in our top 10 list all excel at the key criteria that are most important to people living abroad,” said Joe Cronin, President of International Citizens Insurance. “These top international health insurance companies are trustworthy, reliable, and give our clients great service no matter where they want to seek medical care. We’re excited to congratulate this year’s winners on the enhanced benefits and great service they provide to global citizens around the world.”

    International Citizens Insurance judged each company and plan on six key criteria: the size of their network, the breadth of benefits available in their plans, the availability of added features such as telemedicine, the ease and user-friendliness of filing a claim, the ability to adjust a premium through copays and deductibles, and the financial stability of the insurer (based on their A.M. Best rating). The most trusted insurers include Cigna Global, notable for their worldwide comprehensive coverage and extensive network; GeoBlue, which provides U.S. citizens living overseas and expats in the United States with excellent telehealth services and easy claim filing; and IMG, known for their variety of coverage options and strong presence in Europe.

    In order to help expats find the best insurance for their specific needs, International Citizens Insurance has also identified the best plans for specific clients. These include the best premium international health insurance plans for U.S. citizens abroad, the best travel insurance plans, group health plans for employees abroad, the best international health insurance for foreigners residing in USA, and the most affordable plans for people on a budget.

    To learn more about the best international health insurance companies, visit: https://www.internationalinsurance.com/health/best-companies.php

    About International Citizens Insurance

    International Citizens Insurance is the insurance division of International Citizens Group, Inc. They provide unique comparison engines that enable travelers and expatriates to research, quote, compare, and purchase international health, life, travel, and expatriate insurance from a variety of international carriers.  

    Source: International Citizens Insurance

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  • RIL announces insurance entry; JIo Financial to offer life, general, health products

    RIL announces insurance entry; JIo Financial to offer life, general, health products

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    Reliance Industries on Monday announced its plans to foray into the insurance sector through Jio Financial Services (JFS), which will provide “simple, yet smart” life, general, and health insurance products through a digital interface.

    Jio Financial is looking to potentially partnering with global players, and will use predictive data analytics to co-create contextual products with partners to cater to customer requirements, RIL Chairman Mukesh Ambani said at the AGM.

    Ambani attributed Jio Financial’s growth potential to a digital-first architecture, healthy capitalisation, net worth of Rs 1.2 lakh crore and strong board of management led by K.V. Kamath.

    “Just like Jio and Retail, JFS too will prove to be an invaluable addition to the Reliance ecosystem of customer-facing businesses,” he said adding that the recent de-merger to set up Jio Financial has been like a “mini bonus” for RIL’s long-term investors.

    Each shareholder received one share of Jio Financial for every share of RIL held by them.

    Lending, payments

    “JFS is born to accelerate the replication of India’s dazzling growth story in Bharat,” Ambani said adding that the focus will be on the informal and underserved sectors in rural, semi-urban, and urban areas, with the aim of accelerating inclusive growth.

    This the NBFC plans to achieve by transforming and modernising financial services, with a digital-first approach which will help simplify products, reduce cost of service, and expands reach, he said, adding that for SMEs, merchants, and self-employed entrepreneurs, ease of doing business must mean ease in borrowing, investments, and payment solutions.

    In payments, Jio Financial will consolidate its payments infrastructure with an offering for both consumers and merchants, Ambani said, adding that the company will not just compete with current industry benchmarks but also “explore path-breaking features such as blockchain-based platforms and CBDC”.

    BlackRock JV

    Ambani also touched upon Jio Financial’s recent asset management JV with US-based BlackRock. The the world’s largest asset manager, BlackRock manages worth over $ 11 trillion.

    “Jio Financial Services brings digital infrastructure capabilities and local market knowledge, and BlackRock brings global investment and risk management expertise. Together, we will aim to transform India’s asset management industry through a digital-first offering and democratise access to affordable, innovative investment solutions,” said Larry Fink, Chairman and CEO of BlackRock.

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  • Georgia is now the only state with work requirements in Medicaid | CNN Politics

    Georgia is now the only state with work requirements in Medicaid | CNN Politics

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    CNN
     — 

    Georgia is now the only state in the US to implement work requirements in its Medicaid program – a feat many Republican lawmakers nationwide will be closely monitoring.

    But unlike GOP-led states’ prior attempts to impose work mandates in Medicaid, Georgia’s effort is expected to increase the number of people with health insurance, rather than strip coverage away from an untold number of low-income residents. That allowed it to pass muster in court, though critics still deride the program as complicated, ineffective and expensive.

    Pathways to Coverage, which began July 1, comes as House Republicans in Congress are pushing to expand work requirements in the nation’s safety net programs, particularly Medicaid and food stamps.

    There is no federal work mandate in Medicaid, but 13 states received permission during the Trump administration to require existing enrollees to work, volunteer or meet other criteria to retain their health insurance. In Arkansas, the only state that implemented work requirements and terminated coverage, more than 18,000 people were disenrolled in 2018 before its waiver was voided by a federal court.

    States paused their initiatives because of litigation or the Covid-19 pandemic, and then the Biden administration withdrew the waiver approvals. But Georgia challenged the withdrawal, and a federal judge ruled in the state’s favor in August 2022, allowing it to implement Pathways to Coverage.

    Georgia has among the nation’s strictest eligibility requirements for Medicaid. It is one of 10 states that has not expanded the program to all low-income adults under the Affordable Care Act. Parents only qualify if they make less than 31% of the federal poverty level for a family of three – or about $7,700 this year, according to KFF, a health policy research organization.

    Under Pathways to Coverage, adults making up to 100% of the federal poverty level – about $14,600 for an individual – can enroll if they work, participate in job training or community service, take higher education classes or meet other criteria for at least 80 hours a month.

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

    Just how many people are expected to gain coverage varies. In his speech, Kemp said up to 345,000 Georgians are potentially eligible for the program, while the state Department of Community Health said the state has budgeted for an estimated enrollment of 100,000 residents in the first year.

    Interest in the program is continuing to grow, said the department, which is working with insurers, community groups and others to get the word out.

    Others, however, estimate far fewer people will gain coverage. The state funds allotted for the program in the current fiscal year will allow about 47,500 to enroll, according to the Georgia Budget and Policy Institute, a left-leaning advocacy group.

    Fully expanding Medicaid would cover far more people and at a lower cost to the state, said Leah Chan, the institute’s director of health justice. Some 482,000 Georgians earning up to 138% of the federal poverty level – or about $20,100 for an individual – could gain coverage.

    Also, the federal government covers a larger share of the costs of the full expansion enrollees and would temporarily provide a boost in federal funding for existing traditional Medicaid participants under a provision of the American Rescue Plan Act aimed at enticing holdout states to expand.

    If Georgia fully expanded Medicaid, each newly eligible enrollee would cost the state about $496, Chan said. But under Pathways to Coverage, each will cost $2,490 because the program does not qualify for the enhanced federal match.

    “It doesn’t make sense for us to implement a program that’s going to cover fewer people at a higher cost when we have an option that could close the coverage gap and draw down millions and millions – some estimates say billions – in federal dollars,” Chan said.

    Plus, it could be tough for low-income residents, particularly those in rural areas of the state where many of the uninsured live, to work enough hours consistently to qualify, she said. And those who do may get tripped up in submitting the necessary monthly documentation.

    Another issue: There are no exemptions for parents of dependent children or other caregivers, said Joan Alker, executive director of the Center for Children and Families at Georgetown University. Other states that sought to implement work requirements during the Trump administration had such exemptions.

    “A small number of people may get coverage, but the likelihood of them retaining that coverage for a while is not very high,” Alker said. “And this is an especially problematic structure for parents.”

    Georgia officials, however, say Pathways to Coverage is the right program for the state.

    “This approach is Georgia-centric and ensures we can expand Medicaid coverage to those who were previously ineligible without forcing others off their preferred private insurance,” the state Department of Community Health said in a statement to CNN. “Unlike the top-down approach of traditional Medicaid expansion, Georgia Pathways was developed by Georgians and is run by Georgians to address our state’s specific needs.”

    This story has been updated with additional information.

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  • Lawsuit seeks to halt Medicaid terminations in Florida | CNN Politics

    Lawsuit seeks to halt Medicaid terminations in Florida | CNN Politics

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    CNN
     — 

    Two consumer advocacy groups filed a lawsuit in a Florida federal court Tuesday seeking to halt the state’s termination of residents’ Medicaid benefits.

    The suit is the first in the nation to challenge states’ resumption of reviewing Medicaid enrollees’ eligibility and dropping those deemed no longer qualified. The process, which Congress had suspended for three years during the Covid-19 pandemic, restarted as early as April, depending on the state.

    The Florida Health Justice Project and the National Health Law Program filed the lawsuit on behalf of three Floridians in US District Court in Jacksonville against the state’s Agency for Health Care Administration and the Department of Children and Families. The residents are a 25-year-old woman and her 2-year-old daughter, who has cystic fibrosis, as well as a 1-year-old girl.

    The plaintiffs argue that the notices the agencies are sending to inform enrollees that they are no longer eligible are confusing and don’t provide sufficient explanation as to why they are losing coverage.

    “As a result, Plaintiffs and class members are losing Medicaid coverage without meaningful and adequate notice, leaving them unable to understand the agency’s decision, properly decide whether and how to contest their loss of Medicaid coverage, or plan for a smooth transition of coverage that minimizes disruptions in necessary care,” the complaint reads. “Without Medicaid coverage, Plaintiffs are unable to obtain care they need, including prescription drugs, children’s vaccinations, and post-partum care.”

    The advocates are asking the court to require the state to stop terminating enrollees until the agencies provide adequate notice and an opportunity for a pre-termination fair hearing.

    Mallory McManus, deputy chief of staff for the Department of Children and Families, called the lawsuit “baseless.” While she said the state cannot comment on pending litigation, she said the letters to recipients are “legally sufficient.”

    The federal Centers for Medicare and Medicaid Services “approved the Department’s redetermination plan based on their regulations. There are multiple steps in the eligibility determination process and the final letter is just one of multiple communications from the Department,” said McManus, adding that the agency “continues to lead on Medicaid determinations and being fiscally responsible.”

    The Agency for Health Care Administration did not immediately return a request for comment.

    Nearly 183,000 Floridians have been issued notices saying they no longer qualify for Medicaid, according to the lawsuit. Hundreds of thousands more will have their coverage reviewed in the coming year.

    In addition to those determined ineligible, nearly 226,000 were dropped for so-called procedural reasons, typically because enrollees did not complete the renewal application, according to KFF, formerly the Kaiser Family Foundation. This often happens because it may have been sent to an old address, it was difficult to understand or it wasn’t returned by the deadline.

    Nearly 898,000 Florida residents have had their coverage renewed, according to KFF.

    Nationwide, more than 5.2 million people have been disenrolled since the so-called Medicaid unwinding began in the spring, according to KFF. Nearly three-quarters of those who have lost coverage were dropped for procedural reasons.

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  • YouTube to prohibit false claims about cancer treatments under its medical misinformation policy | CNN Business

    YouTube to prohibit false claims about cancer treatments under its medical misinformation policy | CNN Business

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    New York
    CNN
     — 

    YouTube announced Tuesday that it will start removing false claims about cancer treatments as part of an ongoing effort to build out its medical misinformation policy.

    Under the updated policy, YouTube will prohibit “content that promotes cancer treatments proven to be harmful or ineffective, or content that discourages viewers from seeking professional medical treatment,” Dr. Garth Graham, head of YouTube Health, said in a blog post Tuesday.

    “This includes content that promotes unproven treatments in place of approved care or as a guaranteed cure, and treatments that have been specifically deemed harmful by health authorities,” he said, such as the misleading claim that patients should “take vitamin C instead of radiation therapy.”

    The update is just one of several steps YouTube has made in recent years to build out its medical misinformation policy, which also prohibits false claims about vaccines and abortions, as well as content that promotes or glorifies eating disorders.

    As part of the announcement, YouTube is rolling out a broader updated medical misinformation policy framework that will consider content in three categories: prevention, treatment and denial.

    “To determine if a condition, treatment or substance is in scope of our medical misinformation policies, we’ll evaluate whether it’s associated with a high public health risk, publicly available guidance from health authorities around the world, and whether it’s generally prone to misinformation,” Graham said. He added that YouTube will take action on content that falls into that framework and “contradicts local health authorities or the World Health Organization.”

    Graham said the policy is designed to preserve “the important balance of removing egregiously harmful content while ensuring space for debate and discussion.”

    Cancer treatment fits YouTube’s updated medical misinformation framework because the disease poses a high public health risk and is a topic prone to frequent misinformation, and because there is “stable consensus about safe cancer treatments from local and global health authorities,” Graham said.

    As with many social media policies, however, the challenge often isn’t introducing it but enforcing it. YouTube says its restrictions on cancer treatment misinformation will go into effect on Tuesday and enforcement will ramp up in the coming weeks. The company has previously said it uses both human and automated moderation to review videos and their context.

    YouTube also plans to promote cancer-related content from the Mayo Clinic and other authoritative sources.

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  • Why Small Businesses Should Consider Self-Funded Health Insurance Plans | Entrepreneur

    Why Small Businesses Should Consider Self-Funded Health Insurance Plans | Entrepreneur

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    Opinions expressed by Entrepreneur contributors are their own.

    Health insurance premiums are increasing annually, at a rate that far outpaces inflation. Both employers and employees are paying more. If this trend continues unchecked, the average family’s health insurance premium will surpass the average wage by 2055.

    A common misconception among employers, particularly within small to medium-size businesses, is the notion that a fully insured health plan — where the employer pays premiums to an insurer to cover claims — is their only choice. This often leaves employers believing they have no option but to continuously accept increasing costs, shelling out more money each passing year. While this may have once been the case, the persistent rise in premiums has now tipped the balance, reshaping the landscape of available options.

    Historically, self-insurance — where employers take on the risk and handle claims directly — was largely viewed as a feasible strategy for companies employing 500 or more individuals. However, as these plans have evolved and become more adaptable, they now present a tangible opportunity for organizations with even as few as 25 employees. This approach allows employers of all sizes to not only mitigate healthcare expenses but also enhance the benefits they provide.

    Related: Healthcare Reform: Self-Funding Pros and Cons

    The benefits of self-funded health plans

    Self-funded health plans operate on a model where instead of paying premiums, the employer directly funds the healthcare claims for their people. In this structure, actual claims are paid directly to providers via a third-party administrator who manages the process.

    This is a contrast to the fully insured models where employers shell out annually for premiums, which include not just the cost of potential claims but also considerable profit margins and markups for the insurance companies. In essence, with self-funding, employers pay solely for the actual cost of claims, steering clear of inflated annual premiums and the hidden costs of insurer profits.

    Underwriting techniques have improved over the years, and risk management tools have evolved to the point that smaller businesses are now able to enjoy the freedom and savings that come with a self-funded plan. There are also tax advantages, as self-funding eliminates state premium taxes imposed by carriers.

    The concerns of self-funded health plans

    The No. 1 reason why small businesses are intimidated by self-insurance is the fear of large claims. Certain medical conditions can generate claims in the millions for a single individual, which obviously most small businesses couldn’t shoulder.

    Stop-loss insurance is the safety net that protects employers against any unexpected surge in claims. With these policies, employers can calculate a worst-case scenario for their self-funded plan. When they do, they often find that premiums have risen so sharply that even a worst-case scenario for a self-funded health plan can end up being cheaper than the price of the annual renewal of a fully insured health plan.

    When a company shifts from being fully insured to self-funded, employees are often anxious about the ability to keep seeing their providers and receiving their medications. Involving employees in the benefit design process can help reassure them and get them excited about the benefits of self-funding, which can include features such as $0 care/copays for virtual care or navigation lead benefits. Lower costs and better benefits have a way of getting people on the same page.

    Related: You Can Cut Employee Health Insurance Costs the Same Way Big Companies Do

    Own your own data and take control

    Another advantage of self-funded health plans — one that isn’t immediately evident in dollars and cents — is you gain access to your company’s claim data. Companies with fully insured plans have no idea what their actual claim costs were or what types of claims are driving costs up. Was the total cost more or less than the premiums? There’s no way to know.

    Oftentimes an employer will get a quote for the first year of a self-funded plan and see little to no difference compared to what they are paying in premiums to an insurance carrier. With the newfound access to claims data, the value becomes crystal clear in the second year, third year and beyond.

    Self-funded employers can analyze trends, forecast claim spending and better understand the healthcare needs of their group. It allows a company to optimize, customize and tailor its benefit plan. For instance, if telehealth and virtual care are going to be prominent within the group, tailoring coverage that way is an option.

    By tailoring benefits to align with historical usage, employers enhance the likelihood of ending the year with a surplus. While it’s important to prepare for the worst-case scenario, any more favorable outcome means the plan will undershoot the budget — a situation that is unheard of with fully insured plans.

    Offering healthcare navigation services can also help lower costs for the employer and members. Benefit navigators help employees find cost-effective care without sacrificing quality. The best way to deal with large claims is to avoid them in the first place.

    Level-funded health plans serve as a bridge

    While fully insured and self-insured health plans are the two main options on opposite ends of the spectrum, there is something in between. Level-funded plans are a sort of combination of the two that can serve as a bridge for employers to make the transition.

    A level-funded plan is set up so an employer makes predictable monthly payments, like with a fully insured plan, but gets a refund at the end of the year if there is a surplus, like with self-insurance.

    The regular payments, which cover anticipated claims, the stop-loss premium and administration expenses allow for more predictable expenditures for the company. When end-of-the-year costs are assessed, employers receive a refund if there’s a surplus. If claims exceed the predicted amount, the stop-loss premium will be adjusted upon renewal.

    Related: How Small-Business Owners Can Win the Health Insurance Game

    The future of self-funding is here

    As the benefits of self-funding become increasingly clear to a rising number of employers, there’s no doubt that this market will continue in its momentum forward. The advent of new technologies and member-centric programs are being born out of necessity, ushering in an era of unprecedented efficiency and user experience, while lowering costs.

    These advancements are setting a new bar in the industry, empowering employers to take an active role in their healthcare strategy. Employers are at a pivotal moment in history, where the potential to transform healthcare for their employees is within their reach. Working hand-in-hand with their benefit consultants to explore these innovations and stay abreast of the industry trends is no longer an option but a requisite.

    The future of self-funding is here, and it’s catalyzing a revolution that promises to redefine employer-sponsored healthcare benefits as we know it.

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  • PhonePe adds health insurance plans to its offerings

    PhonePe adds health insurance plans to its offerings

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    Walmart-owned fintech firm PhonePe’s subsidiary PhonePe Insurance Broking Services has launched its health insurance vertical, offering plans in partnership with multiple insurers.

    PhonePe users can set up monthly payments for the premium via its UPI platform. The company claimed that it has sold 5.6 million policies to date and is diversifying its insurance products with health insurance. PhonePe Insurance platform has also sold policies across 98 per cent of India’s pin codes and has served more than 200 million vehicle insurance quotes, it added in its statement.

    The health insurance plans, which come with coverage of up to ₹1 crore, allow users to choose any hospital room without any cap. A user can also avail of a bonus cover of up to 7 times of the base cover amount for each claim-free year, among other features.

    The health insurance plans being offered by PhonePe Insurance Broking are accompanied by pre- and post-sales assistance to help users make informed decisions, file claims and access other services.

    Users can buy health insurance on the PhonePe app by entering the details of the members they want to insure, comparing policies on the quotes page, entering health details and either setting up a monthly mandate or paying annually.

    “One of the biggest barriers in buying health insurance has been affordability and we have solved the same by creating India’s first health insurance marketplace focused on monthly payments. We believe this will drive deep penetration with users being able to pay in monthly subscriptions with a much lower financial burden,” said Hemant Gala, Vice-President Financial Services at PhonePe.

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  • Why economists say it’s a near certainty that housing inflation will soon fall

    Why economists say it’s a near certainty that housing inflation will soon fall

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    Richard Newstead | Moment | Getty Images

    Housing is perhaps the most consequential category in the consumer price index, a key inflation barometer.

    As the largest expense for an average U.S. household, shelter accounts for more than a third of the CPI weighting, the most of any other consumer good or service. That gives housing an outsized influence on the overall direction of inflation data.

    Housing inflation has been stubbornly high for months, according to CPI data. But economists think it has peaked and is on the precipice of a reversal.

    “I know this with about as high a degree of confidence as one could have,” Mark Zandi, chief economist at Moody’s Analytics, said of falling housing inflation being near at hand.

    How ‘shelter’ prices have changed

    Price changes in “shelter” were generally muted before the pandemic, economists said.

    But Covid-19 warped that dynamic: Housing costs shot up but have slowed and even started to fall in some areas, economists said.

    For example, Americans saw rents grow by 4.8% in May from a year earlier, to about $2,048 a month on average nationally, according to Zillow Observed Rent Index data. That’s a significant slowdown from 15.7% growth during the prior year, from May 2021 to May 2022.

    CPI isn’t ‘a particularly accurate gauge’ for housing

    Here’s the problem: The CPI doesn’t capture those price trends in real time.

    It operates with a substantial lag, meaning it can take six months to a year for a decline (or increase) in current housing prices to fully feed through to inflation data, economists said.

    “It’s not necessarily a particularly accurate gauge of what’s going on in the housing market right now,” Andrew Hunter, deputy chief U.S. economist at Capital Economics, previously told CNBC.

    More from Personal Finance:
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    Here’s the reason for the lag: The U.S. Bureau of Labor Statistics collects rent data from sample households every six months. The BLS also divides these sample households into six different subgroups (called “panels”) and staggers when it collects data for each. Per the BLS, rents for Panel 1 are collected in January and July; Panel 2, in February and August, and so on.

    That means it can take a year or so to collect data from all the subgroups.

    Why economists think housing inflation is poised to fall

    “Shelter is still playing a big role in inflation but that should be slowing in the second half of the year,” Jason Furman, an economist at Harvard University and former chair of the White House Council of Economic Advisers during the Obama administration, wrote Tuesday on Twitter.

    The latest CPI reading, issued Tuesday, showed a monthly increase in shelter inflation, to 0.6% in May from 0.4% in April. The most recent figure is on par with the monthly figure notched a year earlier, in May 2022.

    But a decline in CPI housing inflation is “almost as much of a certainty as you can get, really,” Hunter said.

    There’s an additional measurement quirk relative to housing inflation: The BLS tries to assess price changes for homeowners as well as renters, in a subcategory called “owners’ equivalent rent.”

    The measure is essentially a survey that reflects the price homeowners believe they could get if they were to rent their home.

    While somewhat tied to market rents, homeowners aren’t necessarily feeling those inflationary pressures — especially those who have a fixed mortgage (meaning their monthly payment doesn’t change) or own their home (meaning they don’t have a housing payment), Zandi said.

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  • How UnitedHealth Group grew bigger than the nation’s biggest banks

    How UnitedHealth Group grew bigger than the nation’s biggest banks

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    UnitedHealth Group has the highest price per share of any company on the Dow Jones Industrial Average and it’s the tenth heaviest-weighted stock on the S&P 500.

    In fact, not only is UnitedHealth the biggest health-care conglomerate in the United States based on market cap and revenue, it’s even bigger than JPMorgan Chase, the nation’s largest bank.

    And it is a Wall Street darling, with experts optimistic about the company’s future: 22 of 25 analysts currently label it a buy.

    “If I had to pick one stock, only one stock to buy, I’d buy United[Health],” said Ana Gupte, principal at AG Health Advisors.

    UnitedHealth “has had superior stock performance over everybody else for two reasons,” said Lance Wilkes, managing director and senior research analyst at Bernstein Research. “One would be strategic vision and the other is strategic capital management.”

    UnitedHealth has increased its annual revenue since 2012 by more than $100 billion, when adjusted for inflation. It achieved this by engaging in a unique acquisition strategy. It started with smaller deals that have grown while many of UnitedHealth’s competitors such as Aetna and Humana or Anthem and Cigna tried to broker much larger ones, only to be stopped by regulators.

    Conversely, UnitedHealth leaned into a vertical-integration strategy, buying up smaller companies and building them into its growing health-care business.

    UnitedHealth’s size makes it “relatively immune to economic cycles” due to the company’s wide diversity, Gupte said. “It makes it very attractive from an economic cycle and a macro environment perspective.”

    Until recently, its acquisition strategy allowed it to grow without catching too much scrutiny from regulators. But in January 2021, UnitedHealth and Change Healthcare announced a nearly $8 billion all-cash deal that was challenged by the Department of Justice due to antitrust concerns.

    Health-care companies “are becoming more and more [like] utilities,” Wilkes said. “Consequently, I think they’re going to have very large market shares because … you wouldn’t want redundant services through the system.”

    “I think at this point you we would consider UnitedHealth Group just kind of like … core health infrastructure at this point in America,” said Matt Stoller, director of research at the American Economic Liberties Project and author of Goliath: The Hundred Year War Between Monopoly Power and Democracy.” “It’s too big to manage.”

    “UnitedHealth Group is committed to improving the health system for everyone, advancing evidence-based practice and aligning incentives across the system to ensure people get the right care at the right time in the right place,” UnitedHealth Group told CNBC.

    “Because we serve people throughout every aspect of the health system, we have a unique ability to identify opportunities to better integrate care and benefits, develop solutions and deploy them at scale to improve access, lower costs and make the experience better for patients and providers,” it said.

    Watch the video above to learn how UnitedHealth Group grew so big and what that means for the U.S. health-care system.

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  • Two hospitals under federal investigation over care of pregnant woman who was refused abortion | CNN

    Two hospitals under federal investigation over care of pregnant woman who was refused abortion | CNN

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    CNN
     — 

    The Centers for Medicare and Medicaid Services is investigating two hospitals that “did not offer necessary stabilizing care to an individual experiencing an emergency medical condition, in violation of the Emergency Medical Treatment and Labor Act (EMTALA),” according to a letter from US Health and Human Services Secretary Xavier Becerra.

    Under EMTALA, health care professionals are required to “offer treatment, including abortion care, that the provider reasonably determines is necessary to stabilize the patient’s emergency medical condition,” Becerra said Monday in his letter to national hospital and provider associations.

    The National Women’s Law Center, which said in a statement that it filed the initial EMTALA complaint on behalf of Mylissa Farmer, identified the hospitals as Freeman Hospital West of Joplin, Missouri, and the University of Kansas Health System in Kansas City, Kansas.

    The patient was nearly 18 weeks pregnant when she had a preterm premature rupture of membranes, Becerra wrote, but she was told that her pregnancy wasn’t viable.

    “Although her doctors advised her that her condition could rapidly deteriorate, they also advised that they could not provide her with the care that would prevent infection, hemorrhage, and potentially death because, they said, the hospital policies prohibited treatment that could be considered an abortion,” Becerra wrote.

    Becerra added in a statement Monday, “fortunately, this patient survived. But she never should have gone through the terrifying ordeal she experienced in the first place. We want her, and every patient out there like her, to know that we will do everything we can to protect their lives and health, and to investigate and enforce the law to the fullest extent of our legal authority.”

    Abortion is banned in Missouri, with limited exceptions, such as to save the mother’s life. State law requires counseling and a 72-hour waiting period. In Kansas, abortion is generally banned at or after 22 weeks of pregnancy, with a 24-hour waiting period and counseling required.

    Passed in 1986, EMTALA requires that hospitals provide stabilizing treatment to patients who have emergency medical conditions, or transfer them to facilities where such care will be provided, regardless of any conflicting state laws or mandates.

    Changes to state laws in the wake of the US Supreme Court decision that overturned the right to an abortion have left many hospitals and providers uncertain or confused about the steps they can legally take in such cases. HHS issued guidance last year reaffirming that EMTALA requires providers to offer stabilizing care in emergency cases, which might include abortion.

    Hospitals found to be in violation of EMTALA could lose their Medicare and Medicaid provider agreements and could face civil penalties. An individual physician could also face civil penalties if they are found to be in violation.

    HHS may impose a $119,942 fine per violation for hospitals with more than 100 beds and $59,973 for hospitals with fewer than 100 beds. A physician could face a $119,942 fine per violation.

    The National Women’s Law Center says the new actions are the first time since Roe v. Wade was overturned that EMTALA has been enforced against a hospital that denied emergency abortion care.

    “The care provided to the patient was reviewed by the hospital and found to be in accordance with hospital policy,” the University of Kansas Health System said in a statement to CNN. “It met the standard of care based upon the facts known at the time, and complied with all applicable law. There is a process with CMS for this complaint and we respect that process. The University of Kansas Health System follows federal and Kansas law in providing appropriate, stabilizing, and quality care to all of its patients, including obstetric patients.”

    Freeman Hospital did not immediately respond to CNN’s request for comment.

    An HHS spokesperson told CNN that both hospitals are working toward coming into compliance with the law.

    In the law center’s statement, Farmer said she was pleased with the investigations, “but pregnant people across the country continue to be denied care and face increased risk of complications or death, and it must stop. I was already dealing with unimaginable loss and the hospitals made things so much harder. I’m still struggling emotionally with what happened to me, but I am determined to keep fighting because no one should have to go through this.”

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  • Federal judge says insurers no longer have to provide some preventive care services, including cancer and heart screenings, at no cost | CNN Politics

    Federal judge says insurers no longer have to provide some preventive care services, including cancer and heart screenings, at no cost | CNN Politics

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    CNN
     — 

    A federal judge in Texas said Thursday that some Affordable Care Act mandates cannot be enforced nationwide, including those that require insurers to cover a wide array of preventive care services at no cost to the patient, including some cancer, heart and STD screenings, and tobacco programs.

    In the new ruling, US District Judge Reed O’Connor struck down the recommendations that have been issued by the US Preventive Services Task Force, which is tasked with determining some of the preventive care treatments that Obamacare requires to be covered.

    The decision applies to task force recommendations issued on or after March 23, 2010 – the day the Affordable Care Act was signed into law. While the group had recommended various preventive services prior to that date, nearly all have since been updated or expanded.

    O’Connor’s ruling comes after the judge had already said that the task force’s recommendations violated the Constitution’s Appointments Clause. The judge also deemed unlawful the ACA requirement that insurers and employers offer plans that cover HIV-prevention measures such as PrEP for free.

    Other preventive care mandates under the ACA remain in effect.

    The full extent of the ruling’s impact and when its effects could be felt are unclear.

    It is likely the case will be appealed, and the Justice Department has the option to ask that O’Connor’s ruling be put on pause while the appeal is litigated.

    The Justice Department did not immediately respond to a CNN request for comment, nor did the US Department of Health and Human Services.

    White House spokesperson Karine Jean-Pierre called the case “yet another attack on the Affordable Care Act” and said that DOJ and HHS were reviewing Thursday’s ruling.

    The decision, in a case brought by employers and individuals in Texas, represents the latest legal affront to the landmark 2010 health care law. It is unclear what immediate practical effect O’Connor’s new ruling will have for those with job-based and Affordable Care Act policies because insurance companies will likely continue no-cost coverage for the remainder of the contracts even though the Obamacare requirements in question have been blocked. Contracts often last one calendar year.

    O’Connor’s Thursday ruling is expected to kick off a new phase of the legal battle over Obamacare’s preventive care measures. The judge rejected other claims that the ACA’s foes brought against the law – including challenges to the entities that determine no-cost coverage mandates for vaccines, an assortment of women’s health preventive care treatments, and services for infants and children. It’s possible that the plaintiffs appeal those aspects of O’Connor’s handling of the case, which could put at risk coverage requirements for additional preventive services at no cost.

    A lawyer for the challengers did not respond to CNN’s inquiry about Thursday’s decision.

    O’Connor is a George W. Bush-appointee who sits in the Northern District of Texas and who has issued anti-Obamacare rulings in major challenges to the law in the past. An appeal of the current case would head to the 5th US Circuit Court of Appeals, perhaps the most conservative federal appeals court in the country.

    While the case does not pose the existential threat to the Affordable Care Act that previous legal challenges did, legal experts say that O’Connor’s ruling nonetheless puts in jeopardy the access some Americans will have to a whole host of preventive treatments.

    “We lose a huge chunk of preventive services because health plans can now impose costs,” said Andrew Twinamatsiko, associate director of the O’Neill Institute for National and Global Health Law at Georgetown University. “People who are sensitive to cost will go without, mostly poor people and marginalized communities.”

    Thursday’s ruling, if left standing, could have significant consequences for Americans nationwide by limiting access to key preventive services aimed at early detection of diseases, including lung and colorectal cancer, depression and hypertension.

    Some of the US Preventive Services Task Force’s recommendations – including lung and skin cancer screenings, the use of statins to prevent cardiovascular disease and the offer of PrEP for those at high risk of HIV – were issued after the ACA’s enactment.

    Certain older recommendations have been updated with new provisions, such as screening adults ages 45 to 49 for colorectal cancer.

    “It would effectively lock in place coverage of evidence-based prevention with no cost sharing from 13 years ago,” said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation.

    Some of the cost-sharing for these preventive services can be substantial. PrEP, for instance, can cost up to $20,000 a year, plus lab and provider charges, according to Kaiser.

    In an earlier ruling, the judge upheld certain free preventive services for children, such as autism and vision screenings and well-baby visits, and for women, such as mammograms, well-woman visits and breastfeeding support programs.

    O’Connor also upheld the mandate that provides immunizations at no charge for the flu, hepatitis, measles, shingles and chickenpox.

    These services are recommended by the Health Resources and Services Administration and the Advisory Committee on Immunization Practices.

    Insurers will have to continue to cover preventive and wellness services since they are one of the Affordable Care Act’s required essential health benefits. But under O’Connor’s ruling, they could require patients to pick up part of the tab.

    Insurers’ trade associations stressed there would be no immediate disruption to coverage.

    “It is vitally important for patients to know that their care and coverage will not change because of today’s court decision,” said David Merritt, senior vice president of policy and advocacy for the Blue Cross Blue Shield Association. “Blue Cross and Blue Shield companies strongly encourage their members to continue to access these services to promote their continued well-being. We will continue to monitor further developments in the courts.”

    More than 150 million people with private insurance can receive preventive services without cost-sharing under the Affordable Care Act, according to a 2022 report published by HHS.

    Overall, about 60% of the 173 million people enrolled in private health coverage used at least one of the ACA’s no-cost preventive services in 2018 prior to the Covid-19 pandemic, according to a recent Kaiser analysis. These include some services that will continue to be available at no charge under the judge’s ruling.

    The most commonly received preventive care includes vaccinations, not including Covid-19 vaccines, well-woman and well-child visits, and screenings for heart disease, cervical cancer, diabetes and breast cancer, according to Kaiser. The most commonly used preventive services will continue to be covered at no cost.

    Studies have shown the Obamacare mandate prompted an uptake in preventive services and narrowed care disparities in communities of color.

    “There’s plenty of evidence that people responded to this incentive and started using preventive care more often,” said Paul Shafer, assistant professor of health policy at Boston University.

    This story has been updated with additional details.

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  • ICICI Lombard becomes first to offer ‘Anywhere Cashless’ feature

    ICICI Lombard becomes first to offer ‘Anywhere Cashless’ feature

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    In an industry-first, ICICI Lombard General Insurance launched ‘Anywhere Cashless’ feature for health insurance policyholders to avail cashless facilities at any hospital, even if not part of ICICI Lombard’s current network of hospitals.

    The feature will be subject to the hospital’s acceptance of the cashless facility. Policyholders must inform the company 24 hours prior to the date of admission by giving basic information about the patient, policy details, hospital name, diagnosis and treating doctor, among others.

    Initially launched as a pilot, the facility can now be availed through the ‘IL TakeCare’ application across India, wherein customers will not have to bear any out-of-pocket expenses. It provides a hassle-free experience through all aspects of the journey: from admission to discharge, and lets customers choose a nearby or recommended hospital, the insurer said in a release.

    The underlying mission is to expand insurance coverage in tier-II and tier-III cities by establishing more network partners, and actively seeking out and providing better options for customers, even as the number of cases continues to rise, it said.

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  • Why is it difficult for children to get a bed at pediatric hospitals? It’s more complicated than you think | CNN

    Why is it difficult for children to get a bed at pediatric hospitals? It’s more complicated than you think | CNN

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    CNN
     — 

    Effie Schnacky was wheezy and lethargic instead of being her normal, rambunctious self one February afternoon. When her parents checked her blood oxygen level, it was hovering around 80% – dangerously low for the 7-year-old.

    Her mother, Jaimie, rushed Effie, who has asthma, to a local emergency room in Hudson, Wisconsin. She was quickly diagnosed with pneumonia. After a couple of hours on oxygen, steroids and nebulizer treatments with little improvement, a physician told Schnacky that her daughter needed to be transferred to a children’s hospital to receive a higher level of care.

    What they didn’t expect was that it would take hours to find a bed for her.

    Even though the respiratory surge that overwhelmed doctor’s offices and hospitals last fall is over, some parents like Schnacky are still having trouble getting their children beds in a pediatric hospital or a pediatric unit.

    The physical and mental burnout that occurred during the height of the Covid-19 pandemic has not gone away for overworked health care workers. Shortages of doctors and technicians are growing, experts say, but especially in skilled nursing. That, plus a shortage of people to train new nurses and the rising costs of hiring are leaving hospitals with unstaffed pediatric beds.

    But a host of reasons building since well before the pandemic are also contributing. Children may be the future, but we aren’t investing in their health care in that way. With Medicaid reimbursing doctors at a lower rate for children, hospitals in tough situations sometimes put adults in those pediatric beds for financial reasons. And since 2019, children with mental health crises are increasingly staying in emergency departments for sometimes weeks to months, filling beds that children with other illnesses may need.

    “There might or might not be a bed open right when you need one. I so naively just thought there was plenty,” Schnacky told CNN.

    The number of pediatric beds decreasing has been an issue for at least a decade, said Dr. Daniel Rauch, chair of the Committee on Hospital Care for the American Academy of Pediatrics.

    By 2018, almost a quarter of children in America had to travel farther for pediatric beds as compared to 2009, according to a 2021 paper in the journal Pediatrics by lead author Dr. Anna Cushing, co-authored by Rauch.

    “This was predictable,” said Rauch, who has studied the issue for more than 10 years. “This isn’t shocking to people who’ve been looking at the data of the loss in bed capacity.”

    The number of children needing care was shrinking before the Covid-19 pandemic – a credit to improvements in pediatric care. There were about 200,000 fewer pediatric discharges in 2019 than there were in 2017, according to data from the US Department of Health and Human Services.

    “In pediatrics, we have been improving the ability we have to take care of kids with chronic conditions, like sickle cell and cystic fibrosis, and we’ve also been preventing previously very common problems like pneumonia and meningitis with vaccination programs,” said Dr. Matthew Davis, the pediatrics department chair at Ann & Robert H. Lurie Children’s Hospital of Chicago.

    Pediatrics is also seasonal, with a typical drop in patients in the summer and a sharp uptick in the winter during respiratory virus season. When the pandemic hit, schools and day cares closed, which slowed the transmission of Covid and other infectious diseases in children, Davis said. Less demand meant there was less need for beds. Hospitals overwhelmed with Covid cases in adults switched pediatric beds to beds for grownups.

    As Covid-19 tore through Southern California, small hospitals in rural towns like Apple Valley were overwhelmed, with coronavirus patients crammed into hallways, makeshift ICU beds and even the pediatric ward.

    Only 37% of hospitals in the US now offer pediatric services, down from 42% about a decade ago, according to the American Hospital Association.

    While pediatric hospital beds exist at local facilities, the only pediatric emergency department in Baltimore County is Greater Baltimore Medical Center in Towson, Maryland, according to Dr. Theresa Nguyen, the center’s chair of pediatrics. All the others in the county, which has almost 850,000 residents, closed in recent years, she said.

    The nearby MedStar Franklin Square Medical Center consolidated its pediatric ER with the main ER in 2018, citing a 40% drop in pediatric ER visits in five years, MedStar Health told CNN affiliate WBAL.

    In the six months leading up to Franklin Square’s pediatric ER closing, GBMC admitted an average of 889 pediatric emergency department patients each month. By the next year, that monthly average jumped by 21 additional patients.

    “Now we’re seeing the majority of any pediatric ED patients that would normally go to one of the surrounding community hospitals,” Nguyen said.

    In July, Tufts Medical Center in Boston converted its 41 pediatric beds to treat adult ICU and medical/surgical patients, citing the need to care for critically ill adults, the health system said.

    In other cases, it’s the hospitals that have only 10 or so pediatric beds that started asking the tough questions, Davis said.

    “Those hospitals have said, ‘You know what? We have an average of one patient a day or two patients a day. This doesn’t make sense anymore. We can’t sustain that nursing staff with specialized pediatric training for that. We’re going to close it down,’” Davis said.

    Registered nurses at Tufts Medical Center hold a

    Saint Alphonsus Regional Medical Center in Boise closed its pediatric inpatient unit in July because of financial reasons, the center told CNN affiliate KBOI. That closure means patients are now overwhelming nearby St. Luke’s Children’s Hospital, which is the only children’s hospital in the state of Idaho, administrator for St. Luke’s Children’s Katie Schimmelpfennig told CNN. Idaho ranks last for the number of pediatricians per 100,000 children, according to the American Board of Pediatrics in 2023.

    The Saint Alphonsus closure came just months before the fall, when RSV, influenza and a cadre of respiratory viruses caused a surge of pediatric patients needing hospital care, with the season starting earlier than normal.

    The changing tide of demand engulfed the already dwindling supply of pediatric beds, leaving fewer beds available for children coming in for all the common reasons, like asthma, pneumonia and other ailments. Additional challenges have made it particularly tough to recover.

    Another factor chipping away at bed capacity over time: Caring for children pays less than caring for adults. Lower insurance reimbursement rates mean some hospitals can’t afford to keep these beds – especially when care for adults is in demand.

    Medicaid, which provides health care coverage to people with limited income, is a big part of the story, according to Joshua Gottlieb, an associate professor at the University of Chicago Harris School of Public Policy.

    “Medicaid is an extremely important payer for pediatrics, and it is the least generous payer,” he said. “Medicaid is responsible for insuring a large share of pediatric patients. And then on top of its low payment rates, it is often very cumbersome to deal with.”

    Pediatric gastroenterologist Dr. Howard Baron visits with a patient in 2020 in Las Vegas. A large portion of his patients are on Medicaid with reimbursement rates that are far below private insurers.

    Medicaid reimburses children’s hospitals an average of 80% of the cost of the care, including supplemental payments, according to the Children’s Hospital Association, a national organization which represents 220 children’s hospitals. The rate is far below what private insurers reimburse.

    More than 41 million children are enrolled in Medicaid and the Children’s Health Insurance Program, according to Kaiser Family Foundation data from October. That’s more than half the children in the US, according to Census data.

    At Children’s National Hospital in Washington, DC, about 55% of patients use Medicaid, according to Dr. David Wessel, the hospital’s executive vice president.

    “Children’s National is higher Medicaid than most other children’s hospitals, but that’s because there’s no safety net hospital other than Children’s National in this town,” said Wessel, who is also the chief medical officer and physician-in-chief.

    And it just costs more to care for a child than an adult, Wessel said. Specialty equipment sized for smaller people is often necessary. And a routine test or exam for an adult is approached differently for a child. An adult can lie still for a CT scan or an MRI, but a child may need to be sedated for the same thing. A child life specialist is often there to explain what’s going on and calm the child.

    “There’s a whole cadre of services that come into play, most of which are not reimbursed,” he said. “There’s no child life expert that ever sent a bill for seeing a patient.”

    Low insurance reimbursement rates also factor into how hospital administrations make financial decisions.

    “When insurance pays more, people build more health care facilities, hire more workers and treat more patients,” Gottlieb said.

    “Everyone might be squeezed, but it’s not surprising that pediatric hospitals, which face [a] lower, more difficult payment environment in general, are going to find it especially hard.”

    Dr. Benson Hsu is a pediatric critical care provider who has served rural South Dakota for more than 10 years. Rural communities face distinct challenges in health care, something he has seen firsthand.

    A lot of rural communities don’t have pediatricians, according to the American Board of Pediatrics. It’s family practice doctors who treat children in their own communities, with the goal of keeping them out of the hospital, Hsu said. Getting hospital care often means traveling outside the community.

    Hsu’s patients come from parts of Nebraska, Iowa and Minnesota, as well as across South Dakota, he said. It’s a predominantly rural patient base, which also covers those on Native American reservations.

    “These kids are traveling 100, 200 miles within their own state to see a subspecialist,” Hsu said, referring to patients coming to hospitals in Sioux Falls. “If we are transferring them out, which we do, they’re looking at travels of 200 to 400 miles to hit Omaha, Minneapolis, Denver.”

    Inpatient pediatric beds in rural areas decreased by 26% between 2008 and 2018, while the number of rural pediatric units decreased by 24% during the same time, according to the 2021 paper in Pediatrics.

    Steve Inglish, left, and registered nurse Nikole Hoggarth, middle, help a father with his daughter, who fell and required stiches, inside the emergency department at Jamestown Regional Medical Center in rural North Dakota in 2020.

    “It’s bad, and it’s getting worse. Those safety net hospitals are the ones that are most at risk for closure,” Rauch said.

    In major cities, the idea is that a critically ill child would get the care they need within an hour, something clinicians call the golden hour, said Hsu, who is the critical care section chair at the American Academy of Pediatrics.

    “That golden hour doesn’t exist in the rural population,” he said. “It’s the golden five hours because I have to dispatch a plane to land, to drive, to pick up, stabilize, to drive back, to fly back.”

    When his patients come from far away, it uproots the whole family, he said. He described families who camp out at a child’s bedside for weeks at a time. Sometimes they are hundreds of miles from home, unlike when a patient is in their own community and parents can take turns at the hospital.

    “I have farmers who miss harvest season and that as you can imagine is devastating,” Hsu said. “These aren’t office workers who are taking their computer with them. … These are individuals who have to live and work in their communities.”

    Back at GBMC in Maryland, an adolescent patient with depression, suicidal ideation and an eating disorder was in the pediatric emergency department for 79 days, according to Nguyen. For months, no facility had a pediatric psychiatric bed or said it could take someone who needed that level of care, as the patient had a feeding tube.

    “My team of physicians, social workers and nurses spend a significant amount of time every day trying to reach out across the state of Maryland, as well as across the country now to find placements for this adolescent,” Nguyen said before the patient was transferred in mid-March. “I need help.”

    Nguyen’s patient is just one of the many examples of children and teens with mental health issues who are staying in emergency rooms and sometimes inpatient beds across the country because they need help, but there isn’t immediately a psychiatric bed or a facility that can care for them.

    It’s a problem that began before 2020 and grew worse during the pandemic, when the rate of children coming to emergency rooms with mental health issues soared, studies show.

    Now, a nationwide shortage of beds exists for children who need mental health help. A 2020 federal survey revealed that the number of residential treatment facilities for children fell 30% from 2012.

    “There are children on average waiting for two weeks for placement, sometimes longer,” Nguyen said of the patients at GBMC. The pediatric emergency department there had an average of 42 behavioral health patients each month from July 2021 through December 2022, up 13.5% from the same period in 2017 to 2018, before the pandemic, according to hospital data.

    When there are mental health patients staying in the emergency department, that can back up the beds in other parts of the hospital, creating a downstream effect, Hsu said.

    “For example, if a child can’t be transferred from a general pediatric bed to a specialized mental health center, this prevents a pediatric ICU patient from transferring to the general bed, which prevents an [emergency department] from admitting a child to the ICU. Health care is often interconnected in this fashion,” Hsu said.

    “If we don’t address the surging pediatric mental health crisis, it will directly impact how we can care for other pediatric illnesses in the community.”

    Dr. Susan Wu, right, chats with a child who got her first dose of the Pfizer-BioNtech Covid-19 vaccine at Children's Hospital Arcadia Speciality Care Center in Arcadia, California, in 2022.

    So, what can be done to improve access to pediatric care? Much like the reasons behind the difficulties parents and caregivers are experiencing, the solutions are complex:

    • A lot of it comes down to money

    Funding for children’s hospitals is already tight, Rauch said, and more money is needed not only to make up for low insurance reimbursement rates but to competitively hire and train new staff and to keep hospitals running.

    “People are going to have to decide it’s worth investing in kids,” Rauch said. “We’re going to have to pay so that hospitals don’t lose money on it and we’re going to have to pay to have staff.”

    Virtual visits, used in the right situations, could ease some of the problems straining the pediatric system, Rauch said. Extending the reach of providers would prevent transferring a child outside of their community when there isn’t the provider with the right expertise locally.

    • Increased access to children’s mental health services

    With the ongoing mental health crisis, there’s more work to be done upstream, said Amy Wimpey Knight, the president of CHA.

    “How do we work with our school partners in the community to make sure that we’re not creating this crisis and that we’re heading it off up there?” she said.

    There’s also a greater need for services within children’s hospitals, which are seeing an increase in children being admitted with behavioral health needs.

    “If you take a look at the reasons why kids are hospitalized, meaning infections, diabetes, seizures and mental health concerns, over the last decade or so, only one of those categories has been increasing – and that is mental health,” Davis said. “At the same time, we haven’t seen an increase in the number of mental health hospital resources dedicated to children and adolescents in a way that meets the increasing need.”

    Most experts CNN spoke to agreed: Seek care for your child early.

    “Whoever is in your community is doing everything possible to get the care that your child needs,” Hsu said. “Reach out to us. We will figure out a way around the constraints around the system. Our number one concern is taking care of your kids, and we will do everything possible.”

    Nguyen from GBMC and Schimmelpfennig from St. Luke’s agreed with contacting your primary care doctor and trying to keep your child out of the emergency room.

    “Anything they can do to stay out of the hospital or the emergency room is both financially better for them and better for their family,” Schimmelpfennig said.

    Knowing which emergency room or urgent care center is staffed by pediatricians is also imperative, Rauch said. Most children visit a non-pediatric ER due to availability.

    “A parent with a child should know where they’re going to take their kid in an emergency. That’s not something you decide when your child has the emergency,” he said.

    Jaimie and Effie Schnacky now have an asthma action plan after the 7-year-old's hospitalization in February.

    After Effie’s first ambulance ride and hospitalization last month, the Schnacky family received an asthma action plan from the pulmonologist in the ER.

    It breaks down the symptoms into green, yellow and red zones with ways Effie can describe how she’s feeling and the next steps for adults. The family added more supplies to their toolkit, like a daily steroid inhaler and a rescue inhaler.

    “We have everything an ER can give her, besides for an oxygen tank, at home,” Schnacky said. “The hope is that we are preventing even needing medical care.”

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  • Biden and Trump agree on one big thing | CNN Politics

    Biden and Trump agree on one big thing | CNN Politics

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    CNN
     — 

    Joe Biden and Donald Trump are bizarrely on the same page on the top issue so far in the 2024 White House race, as they aim huge, possibly campaign-defining swings at Republicans who they claim will shred retirement benefits.

    The current and former presidents – bitter rivals who agree on little else – are both forcing their foes into political retreats and attempts to whitewash past support for changes that could cut Medicare and Social Security payouts.

    Their strategy is reinforcing a truism of presidential election campaigns that candidates who even entertain the notion of “reforming” these cherished entitlement programs for seniors are playing with fire.

    With typical bluntness, Trump has blasted his potential top rival, Florida Gov. Ron DeSantis, as a “wheelchair over the cliff kind of guy” after he voted, as a member of the US House, for non-binding resolutions that would have raised the age at which most seniors can collect their benefits to 70. As a 2012 congressional candidate, he supported privatizing Social Security, CNN’s KFile has reported. But trying to ease his vulnerability on the issue, DeSantis insisted in a Fox News interview last week: “We’re not going to mess with Social Security.”

    Despite his own proposed cuts to these programs as president, Trump has kept up the attacks. “We’re not going back to people that want to destroy our great Social Security system – even some in our own party; I wonder who that might be – who want to raise the minimum age of Social Security to 70, 75 or even 80 in some cases, and who are out to cut Medicare to a level that will be unrecognizable,” he said at the Conservative Political Action Conference last Saturday.

    A few days later, another Republican hopeful gave both Biden and Trump a new opening to exploit.

    Former South Carolina Gov. Nikki Haley was forced to make clear Thursday that her striking and unspecific call the day before for raising the retirement age was only supposed to refer to Americans currently in their 20s, who are in effect a half century away from drawing their pensions. But her clarification won’t protect the former ambassador to the United Nations from Trump, who is splitting his party down the middle, yet again, by pouncing on competitors who have voiced traditional conservative orthodoxy on cutting or changing the programs. Biden is sure to also highlight Haley’s remarks as he claims only he can thwart a secret GOP agenda to kill off the vital programs.

    “I guarantee you, I will protect Social Security and Medicare without any change. Guaranteed,” the president vowed in Philadelphia on Thursday. “I won’t allow it to be gutted or eliminated as MAGA Republicans have threatened to do.”

    Biden browbeat Republicans during his “State of the Union” address last month to confirm on camera that they support shoring up Social Security and Medicare. And he’s anchoring his likely reelection bid on the most forceful campaign by a Democratic candidate in years on the issue. Some of his attacks are fair; others take statements by GOP leaders out of context. But they’re still potent – since both he and Trump know that when conservatives are explaining that they don’t plan to cut Medicare or retirement benefits, they are usually trying to dig out of a losing position.

    And Biden has public opinion on his side. A Fox News poll last month, for instance, showed that Democrats are preferred over Republicans to better handle Medicare (by 23 points) and Social Security (by 16 points). No wonder Biden seems to relish this particular political battlefield.

    The odd confluence of approaches – from a former president who sought to overturn an election and a successor who sees his administration as vital to saving democracy – says so much about each man’s political instincts, backgrounds and campaign strategy. It is also reflects the shifting character of the Republican Party, which Trump has torn from its corporate, ideologically pure conservative roots to build a new coalition that includes working class voters, often in the Midwest, that Biden is battling hard to win back.

    In one sense, possibly the most thorny domestic issue of the years to come should, of course, have a place in a presidential campaign. But when candidates use it to inflame their political bases, it only makes it harder to address in government. This is especially the case with entitlements since they cut into the DNA of each party and have defined the dividing lines between them for decades – at least until Trump came along and took over the GOP.

    Ever since the New Deal reforms of Franklin Roosevelt, who was president from 1933 to 1945, Democrats – through presidents Lyndon Johnson, Barack Obama and Biden, especially – have sought to use government power to secure the living standards and health care of less well-off and elderly Americans. Republicans, from 1980s President Ronald Reagan onwards, have increasingly sought to find ways to shift the burden of some of this care to the private sector and to reduce or eliminate government’s role in an attempt to whittle away the New Deal reforms of FDR and the Great Society program of LBJ, who was president in the 1960s. They have often paid a heavy price. Republican President George W. Bush’s failed attempt to partially privatize Social Security contributed to a disastrous second term. And Trump still rails against former House Speaker Paul Ryan, who promoted a similar plan.

    While raising the alarm about threats to social programs for seniors might be a shrewd political tactic – especially in mobilizing older voters more likely to show up at the polls – it usually does nothing to address the program’s increasingly dire solvency challenges.

    The latest Congressional Budget Office projection found that Social Security’s retirement trust fund could be exhausted by 2032. At that point, with fewer workers paying into the program and with a rapidly aging population, benefits could be cut by at least 20%, CNN’s Tami Luhby reported. Medicare is even more precarious since its hospital insurance trust fund, known as Part A, will only be able to fully pay scheduled benefits until 2028, its trustees said in their most recent forecast.

    Biden, who released a new budget on Thursday that will help shape the message of his likely reelection bid, has proposed a plan to raise taxes on people earning more than $400,000 a year to shore up the program and would expand the range of drugs for which its managers can negotiate prices. He says the move would keep Medicare solvent until 2050 and would involve no cuts in benefits. The president also wants to target those who earn more than $400,000 with increasing payroll taxes to secure Social Security for the future. There is an infinitesimal chance, however, that the Republican-led House will agree to tax increases, so Biden’s plan represents more a device to deliver a political message than a viable plan.

    Despite warning his fellow Republicans to avoid cutting these programs, it’s unclear how Trump would save them if he wins back the White House – and doing nothing isn’t an option. And while other Republicans insist they don’t want to cut benefits or raise taxes, it’s unclear how they can square the circle.

    Florida Sen. Rick Scott has now excluded Social Security and Medicare from his proposal for all spending programs to be reviewed every five years. His original plan, released when he was leading the Senate GOP’s campaign arm, sparked the ire of his Republican Senate colleagues, including Minority Leader Mitch McConnell, who quickly identified it as a political liability. That hasn’t stopped Biden from repeatedly claiming that it represents Republican policy.

    House Speaker Kevin McCarthy has, meanwhile, said that cuts to Social Security and Medicare are “completely off the table” in what he insists must be negotiations with Biden over raising the government’s borrowing limit later this year. But that position has put him in a bind because it means that in order for the GOP to honor their pledge to slash spending, they will probably have to take aim at other social programs that could also prove unpopular with voters.

    America is not the only country staring down a crisis.

    French President Emmanuel Macron sparked nationwide strikes and protests with his plan to raise the retirement age to 64 from 62. Even China’s Communist Party is struggling as a falling birthrate threatens to inflict severe costs on the world’s most dynamic emerging economy.

    Back in the US, whoever wins the 2024 elections for the White House and Congress, there seems no easily identifiable solution to safeguard these vital programs on which millions of Americans depend. And time is running out.

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  • Advanced Breast Cancer: How It Affects You at Work

    Advanced Breast Cancer: How It Affects You at Work

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    A diagnosis of metastatic breast cancer doesn’t mean you have to quit working. But you might find it easier to manage everything that comes with your condition when you’re not also concerned with work. 

    There’s no right or wrong answer. It’s a personal choice that depends on many factors. Here’s what to consider when making the decision, and how to make it work if you decide to stay at your job.

    To Work or Not to Work

    “Many with advanced breast cancer still work and maintain their family life with amazing ease, even with regular appointments and sometimes ongoing outpatient intravenous therapies,” says Rebecca Crane-Okada, PhD, director of Cancer Navigation & Willow Sage Wellness Programs at the Margie Petersen Breast Center at Providence Saint John’s Health Center in Santa Monica, CA.

    Working may help you feel grounded and productive. It may be a good distraction and give you a sense of power when other parts of your life feel beyond your control. But if your job feels like too much to manage on top of your treatments and symptoms, you may decide to take a break or not return to work.

    To Share or Not to Share

    Who you tell and how much you share is up to you.

    It may be helpful to tell your boss. If your manager knows what’s going on, they may be able help by extending deadlines, changing meeting times, or letting you work from home. You can come up with a plan together.

    If you need work accommodations like regular breaks or a flexible schedule, you’ll have to share some information with your human resources department. Your human resources department and supervisor are legally required to keep your medical information private. But they may have to tell their managers.

    There may be benefits to sharing with your colleagues. They could be a source of emotional support and help you manage your work better.

    Marlena Murphy, 45, who has metastatic breast cancer and is an advocate for TurningPoint Breast Cancer Rehabilitation in Atlanta, GA, decided to share her cancer diagnosis at work so she could balance her work with her treatments. 

    “The main thing for me was to communicate with people I work directly with, regarding treatment and medical appointment dates,” Murphy says.

    Sharing with co-workers can have drawbacks. They may pepper you with questions about your health and treatment. You may get unwanted medical advice or opinions. And they’re not required to keep whatever you share to themselves. 

    How to Find Balance

    How you feel and how you manage at work may change on a day-to-day basis.

    On some days you may feel energetic, like you can handle anything. On other days, you may feel tired or struggle with symptoms like fatigue, nausea, constipation, diarrhea, and muscle or bone pain. Try to let your body be your guide.

    When you feel tired, take a break. If your job is physically demanding or you’re on your feet a lot, you may need regular rest breaks. Modifications like moving your desk closer to a restroom or working from home can help you find balance.

    Getting Help at Work

    There’s a lot you can do to make it easier to work while managing advanced breast cancer.

    For example, if you’re in the middle of treatment, ask your boss if you can set your own hours. It may help to shift your working hours to times in the day when you have more energy and will be more productive.

    Consider adjustments like:

    • Compressed work weeks
    • Flexible hours
    • Regular breaks throughout the day
    • Remote work
    • Shorter schedule

    If you need extended time off, you may want to use sick leave.

    If you’re going back to work after being out for a while, ask your boss if you can ease back into work with shorter or fewer days. Ask your co-workers to bring you up to speed on anything you missed, like new systems or procedures that started when you were out.

    Know Your Rights

    You may be entitled to several types of support while managing advanced breast cancer. Here are a few to look into:

    Americans with Disabilities Act (ADA). This requires your employer to make adjustments like shorter work hours, a modified work schedule, or reassignment to an open position. It also protects you from discrimination, so you get the same consideration you’d have without cancer.

    Family and Medical Leave Act (FMLA). This requires your employer to give you up to 12 work weeks of unpaid leave during a 12-month period. You can also use it if you’re a caregiver for your spouse, child, or a parent with a serious health condition.

    Employee Assistance Programs. These programs offer help with personal issues that may affect your ability to do your job. For example, they may help you with financial and emotional concerns. 

    Disability policies. If advanced breast cancer prevents you from being able to work, you may qualify for short-term or long-term disability insurance. These policies may give you 40%-70% of your base salary. Short-term disability may be about 3-6 months. Long-term disability starts after short-term disability ends.

    Talk to your human resources representative about what you qualify for and how to start the process.

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