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Tag: iab-healthcare industry

  • US sues Rite Aid for missing opioid red flags | CNN Business

    US sues Rite Aid for missing opioid red flags | CNN Business

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    CNN
     — 

    The Justice Department on Monday filed a lawsuit against Rite Aid for allegedly violating the Controlled Substances Act, alleging that the company “knowingly filled unlawful prescriptions for controlled substances.”

    In a statement, Attorney General Merrick Garland said the Department of Justice is “using every tool at our disposal” to hold Rite Aid accountable for contributing to the opioid epidemic.

    Associate Attorney General Vanita Gupta said “Rite Aid’s pharmacists repeatedly filled prescriptions for controlled substances with obvious red flags, and Rite Aid intentionally deleted internal notes about suspicious prescribers. These practices opened the floodgates for millions of opioid pills and other controlled substances to flow illegally out of Rite Aid’s stores.”

    In the complaint, The Justice department alleges that from May 2014 to June 2019, Rite Aid filled thousands of unlawful combinations of prescriptions known as “the trinity” which included prescriptions for “excessive quantities of opioids, such as oxycodone and fentanyl.”

    Rite Aid pharmacists were accused of ignoring obvious signs of misuse and intentionally deleting some pharmacists’ internal warnings about suspicious prescribers, such as “cash only pill mill???”

    “These practices opened the floodgates for millions of opioid pills and other controlled substances to flow illegally out of Rite Aid’s stores,” Associate Attorney General Vanita Gupta said.

    The Justice Department said the prescriptions, who were issued illegally, “lacked a legitimate medical purpose, were not for a medically accepted indication, or were not issued in the usual course of professional practice.”

    Rite Aid is one of the country’s largest pharmacy chains, with more than 2,330 stores in 17 US states. It did not immediately respond to requests for comment.

    The Justice Department accused Rite Aid of violating the federal False Claims Act by submitting false prescription claims to government health care programs such as Medicare and Medicaid.

    It joined a whistleblower lawsuit filed in 2019 by two pharmacists and a pharmacy technician from Rite Aid stores in Pennsylvania, North Carolina and West Virginia.

    The Justice Department occasionally joins whistleblower cases it considers stronger.

    It has also sued Walmart and drug distributor AmerisourceBergen Corp over their alleged roles in the nation’s opioid crisis.

    More than 500,000 people died from drug overdoses in the United States from 1999 to 2020, including more than 90,000 in 2020 alone, according to the US Centers for Disease Control and Prevention.

    Reuters contributed to this report.

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  • Mental health startup exposes the personal data of more than 3 million people | CNN Politics

    Mental health startup exposes the personal data of more than 3 million people | CNN Politics

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    Washington
    CNN
     — 

    A mental health startup exposed the personal data of as many as 3.1 million people online. In some cases, possibly sensitive information on mental health treatment was leaked, according to a company statement and a Department of Health and Human services filing.

    Cerebral, a California-based firm that connects people suffering from anxiety and depression with mental health professionals via video calls, said it discovered the “inadvertent” data exposure more than three years after it started using “pixels” – a common method that companies and advertisers use to track user behavior for marketing purposes.

    The company determined in January that tracking pixels had been sharing client and user data to “third-party platforms” and “subcontractors” that it didn’t name, according to a privacy notice near the bottom of its website.

    Cerebral said it was unaware of any misuse of the protected health information that was disclosed. But privacy advocates have for years warned that such data troves can be used to aggressively market products at consumers and infringe on their privacy.

    Some of the data potentially exposed in the Cerebral breach includes answers to online “self-assessments” about mental health that Cerebral asks prospective clients to fill out. That can include questions on whether someone is experiencing panic attacks, abusing alcohol or has a personality disorder, CNN’s review of the online assessments found.

    Cerebral said in a statement to CNN on Friday that it was “committed to correcting historical errors and leading the industry in privacy standards moving forward.”

    Cerebral notified the Department of Health and Human Services (HHS), which said in a filing this month that the breach affects over 3.1 million users. The department investigates potential violations of the Health Insurance Portability and Accountability Act (HIPAA), a law that requires medical providers to safeguard patient data.

    Rachel Seeger, a spokesperson for the HHS Office for Civil Rights, said the office typically “does not comment on open or potential investigations.”

    Cerebral said in its public statement that it had disabled the tracking pixels on its platforms and stopped sharing data with subcontractors “not able to meet all HIPAA [Health Insurance Portability and Accountability Act] requirements.”

    “It is important to note that Cerebral never impermissibly transmitted clinician generated notes or clinician communications,” the company told CNN.

    Cerebral spokesperson Chris Savarese did not respond to emailed questions about which and how many platforms and contractors to which the company disclosed the client health information.

    Some analysts argue that the broader market for data tracking tools is out of control. A group of conservative Catholics has spent millions of dollars to buy mobile data that identified priests who used gay dating and hookup apps, the Washington Post reported this week.

    Andrea Downing, who has done extensive research on pixel tracking and privacy, said patients are often unaware of how much personal data health care startups collect and potentially transmit to other parties.

    “What is in the fine print or the details of how data is being shared for advertising is not apparent to us when we’re going through the trauma of a diagnosis and seeking knowledge,” said Downing, who is co-founder of Light Collective, a digital rights nonprofit.

    “The only thing that is incentivizing change right now is the threat of liability,” Downing told CNN.

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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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  • Senate confirms Biden’s IRS nominee Daniel Werfel | CNN Politics

    Senate confirms Biden’s IRS nominee Daniel Werfel | CNN Politics

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    CNN
     — 

    The Senate voted Thursday to confirm Daniel Werfel, the former acting commissioner of the Internal Revenue Service, to lead the IRS.

    He was approved on a bipartisan 54-42 vote.

    Werfel’s confirmation to the agency comes after he was grilled by the Senate Committee on Finance last month on how he plans to utilize the money in new funding coming to the IRS over the next decade to revitalize the tax agency as taxpayers could see increased audit rates. Democrats approved the $80 billion for the agency last year when they approved the Inflation Reduction Act in a party-line vote. Democrats backed the funding in its bid to crack down on tax dodgers and to provide better services for taxpayers, arguing that the IRS could boost federal revenue by more than $100 billion over the 10-year time period if they collect more in taxes.

    But Republicans have made the IRS and the new funding a political target, claiming that the money will create additional audits for taxpayers.

    After Republicans took control of the House earlier this year, two of the party’s first legislative votes were aimed at the IRS. One bill called for rescinding roughly all the new funding for the agency and others called for abolishing the IRS altogether. However, it is highly unlikely that either bill will become law because Democrats still control the Senate.

    Werfel said last month he would follow through on Treasury Secretary Janet Yellen’s previous directive that the IRS will not use the new funding to increase audit rates, relative to historic levels, for households making less than $400,000 a year.

    “If I am fortunate enough to be confirmed, the audit and compliance priorities will be focused on enhancing the IRS’ capabilities to ensure that America’s highest earners comply with applicable tax laws,” Werfel said at the February hearing.

    “If poor people are more likely to be audited than the wealthy, that is something I think potentially degrades public trust and needs to be addressed within the tax system,” he added.

    But ranking Republican committee member, Republican Sen. Mike Crapo of Idaho, said at the time he remains “very concerned” about how twhe funds will be used to increase tax enforcement, pointing out that Yellen’s directive “leaves a lot of wiggle room.”

    “I don’t expect to see wiggle room in this commitment,” Crapo told Werfel.

    The Inflation Reduction Act states that the new investment going to IRS is not “intended to increase taxes on any taxpayer or small business with a taxable income below $400,000.” However, there is some uncertainty about how the IRS will decide how it will ramp up audits.

    Moderate Democratic Sen. Joe Manchin of West Virginia voted against Werfel’s nomination. He has also opposed several of President Joe Biden’s other recent nominees.

    Manchin said his vote against Werfel had to do with the Biden administration ignoring the “congressional intent” in implementing the Inflation Reduction Act.

    “As far as the gentleman for the IRS, most qualified, he’ll do a good job. That was a message I’m sending because the president and his administration is not adhering to the piece of legislation called the Inflation Reduction Act,” Manchin said on “CNN This Morning” Thursday ahead of the vote, explaining his reasoning for voting against Werfel. “They have touted that as strictly an environmental bill.”

    Werfel was the acting IRS commissioner for seven months in 2013 during a difficult time for the agency. His predecessor had resigned following revelations that the agency targeted conservative groups seeking tax-exempt status for extra scrutiny.

    Before his stint at the IRS, Werfel worked for nearly 16 years at the White House’s Office of Management and Budget, where he served as deputy controller and later federal controller.

    After he left government, Werfel joined Boston Consulting Group, where he is currently a managing director and partner on the federal and public sector teams.

    This story has been updated with additional developments.

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  • Elite athletes with genetic heart disease can safely return to play with diagnosis and treatment, early study suggests | CNN

    Elite athletes with genetic heart disease can safely return to play with diagnosis and treatment, early study suggests | CNN

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    CNN
     — 

    In a new study, most elite athletes with a diagnosed genetic heart disease did not experience serious or fatal symptoms of their condition, such as sudden cardiac death. The research suggests it can be “feasible” and “safe” for athletes to continue to participate in their sport.

    Among a sample of 76 elite athletes with a genetic heart disease who had competed or are still competing in either Division I university or professional sports, 73 out of the 76 did not experience a cardiac event triggered by their disease during the study period, according to researchers behind a late-breaking clinical trial presented Monday at the American College of Cardiology’s Annual Scientific Session Together With the World Congress of Cardiology.

    Among those elite athletes with a genetic heart disease, 40 of them – 52% – were asymptomatic, the study abstract finds.

    Over the years, researchers have become more aware of alarming reports about elite athletes experiencing heart problems, or even suddenly collapsing during games.

    “For athletes with genetic heart conditions, and I would add non-athletes, the tragedies occur when we don’t know of their condition,” said Dr. Michael Ackerman, a genetic cardiologist at Mayo Clinic in Rochester, Minnesota, who was a senior author of the new research. “When we know of their condition, and we assess the risk carefully and we treat it well, these athletes and non-athletes, they can expect to live and thrive despite their condition.”

    The new research has not yet been published in a peer-reviewed journal, but the findings suggest that many athletes with a genetic heart disease can decide with their health care professionals on whether to continue competing in their sport and how to do so safely, instead of being automatically disqualified due to their health conditions.

    “In sports, historically, we’ve been paternalistic and de-emphasize patient preference and risk tolerance, but we know that athletes come from all walks of life. They are intelligent and when there’s scientific uncertainty, their values should be incorporated in medical decision-making,” Dr. J. Sawalla Guseh, cardiologist at Massachusetts General Hospital, who was not involved in the new study, said during Monday’s scientific session.

    “Shared decision-making when done well can have very favorable outcomes,” he said.

    Elite basketball, hockey, soccer and football players, were among the 76 athletes included in the new study, conducted by researchers at Mayo Clinic and other institutions in the United States. They wrote in their study abstract that this is the first study to their knowledge describing the experience of athletes competing at the NCAA Division I level or in professional sports with a known genetic heart disease that puts them at risk of sudden cardiac death.

    The athletes in the study were cleared for return-to-play at either a NCAA Division I school or at the professional level. They were studied over an average of seven years, and all had been diagnosed with a genetic heart disease in the past 20 years, being treated at either Mayo Clinic, Morristown Medical Center, Massachusetts General Hospital or Atrium Health Sports Cardiology Center.

    “Only three of them had a breakthrough cardiac event, which means after they were diagnosed and treated, they were still having an event,” said Katherine Martinez, an undergraduate student at Loyola University in Baltimore, who helped conduct the research as an intern in the Mayo Clinic’s Windland Smith Rice Sudden Death Genomics Laboratory.

    Fainting was the most common event, and one athlete received a shock with an implantable cardioverter defibrillator, or ICD. None of the athletes died.

    “The majority of these athletes went on to continue their career with no events at all,” Martinez said. But most of the athletes in the study – 55 of them, or 72% – were initially disqualified from competing by their primary provider or institution after their diagnosis. Most ultimately opted to return to play with no restrictions after undergoing comprehensive clinical evaluations and talking with their doctors.

    While each sports league has its own set of rules, historically, some people diagnosed with a genetic heart disease that puts them at an increased risk for sudden cardiac death have been restricted from competitive sports, the researchers wrote in their study abstract.

    “Just because you were given this diagnosis, doesn’t mean that your life, your career, the future that you see for yourself is over, but taking a second opinion from an expert who knows what they’re doing and is comfortable with shared decision-making is the next step,” said Martinez, who worked on the new research alongside her father, Dr. Matthew Martinez, director of Atlantic Health System Sports Cardiology at Morristown Medical Center and an author of the new research.

    Regarding the new study, “the take-home message is, if you have one of these findings, seek out an expert who’s going to help you identify a safe exercise plan for you and determine what level you can continue to safely participate in,” he said. “This is the next best step – the next evolution – of how we manage athletes with genetic heart disease.”

    Leaving their sport due to a genetic heart disease can be “very destructive” for athletes who have devoted their lives to excelling in competitions, said Dr. Lior Jankelson, director of the Inherited Arrhythmia Program at NYU Langone Heart in New York, who was not involved in the new research.

    Yet he added that these athletes still need to consult with their doctors and be watched closely because some genetic diseases could be more likely to cause a serious cardiac event than others.

    The new study highlights that “the majority of athletes with genetic heart disease could probably – after careful, meticulous expert risk-stratification and care strategy – participate in sports,” Jankelson said. “But at the same time, this is exactly the reason why these patients should be cared only in high-expertise genetic cardiology clinics, because there are other conditions that are genetic, that could respond very adversely to sports, and have a much higher risk profile of developing an arrhythmia during intense activity.”

    Separately, the NCAA Sports Science Institute notes on its website, “Though many student-athletes with heart conditions can live active lives and not experience health-related problems, sudden fatality from a heart condition remains the leading medical cause of death in college athletes.”

    For athletes with a genetic heart disease, their symptoms and their family history of cardiac events should be considered when determining their risks, said Dr. Jayne Morgan, a cardiologist with Piedmont Healthcare in Atlanta, who was not involved in the new research.

    “Certainly, there is concern with elite athletes competing and whether or not they are being screened appropriately,” Morgan said. But she added that the new research offers “some understanding” to the mental health implications for athletes with a genetic heart disease who may be required to step away from a competitive sport that they love.

    “This study, I think, begins to go a long way in identifying that we may not need to pull the trigger so quickly and have athletes step away from something that they love,” Morgan said.

    The new study is “timely” given the recent national attention on athletes and their risk of sudden cardiac death, Dr. Deepak Bhatt, director of Mount Sinai Heart in New York City, who was not involved in the research, said in an email.

    “These are some of the best data showing that the risk of return to play may not be as high as we fear,” Bhatt said about the new research.

    “Some caveats include that the majority of these athletes were not symptomatic and about a third had an implantable defibrillator,” he added. “Any decision to return to the athletic field should be made after a careful discussion of the potential risks, including ones that are hard to quantify. Input from experts in genetic cardiology and sports cardiology can be very helpful in these cases.”

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  • Woman missing more than 30 years and thought to be dead found living in Puerto Rico nursing home | CNN

    Woman missing more than 30 years and thought to be dead found living in Puerto Rico nursing home | CNN

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    CNN
     — 

    A Pennsylvania woman who disappeared more than 30 years ago and was believed to be dead by her family was recently found living in a nursing home in Puerto Rico, her family and police said at a news conference Thursday.

    Patricia Kopta, 83, was last seen in Pittsburgh in the summer of 1992, according to a missing person flier posted by the Pennsylvania Emergency Response Center.

    Her husband, Bob Kopta, reported her missing a few months later in the fall. At the time, he advised authorities that it wasn’t uncommon for his wife to “drop out of sight for short periods,” according to the flier.

    “I come home one night and she’s gone, and nobody knew where she was at,” Kopta said at the news conference with Ross Township Police.

    Police said they were first informed about the discovery of the missing woman when an agent from the International Criminal Police Organization (INTERPOL) and a social worker from Puerto Rico contacted them last year saying that they believed Patricia was living in an adult care home in Puerto Rico.

    “What they reported to us was that she came into their care in 1999, when she was found in need in the streets of Puerto Rico,” Ross Township Deputy Chief Brian Kohlhepp said.

    INTERPOL and the social worker said Patricia was found wandering the streets and through the years she had “refused to ever discuss her private life or where she came from,” Kohlhepp said.

    In her advanced age, Patricia started revealing nuggets that would eventually spur those around her to contact Ross police, Kohlhepp said.

    When she was in Pittsburgh, Patricia was a “well-known street preacher,” according to the missing person flier. She would approach strangers, telling them she had visions of the Virgin Mary and that the world was coming to an end, the flier said.

    Police said her disappearance wasn’t overtly suspicious because they “knew she had a mental health history and she had made statements to other family individuals that she was leaving, that she was concerned that she was going to be placed into a care facility here,” Kohlhepp said. Kohlhepp said police knew she had likely left of her own volition.

    Her husband said that his wife had talked about wanting to go to Puerto Rico to live in a tropical environment.

    “I even advertised in the paper down in Puerto Rico looking for her,” Kopta said at the news conference, adding that he spent a lot of money over the years searching for her.

    Patricia and Bob were married for 20 years before she went missing, Kohlhepp told CNN. He added that Patricia had no known family or connections in Puerto Rico.

    Police determined the woman was in fact Patricia through a nine-month-long process in which they compared DNA samples provided by her sister, Gloria Smith, and her nephew.

    “We really thought she was dead all those years,” Smith said at the news conference.

    Even before DNA testing was completed, the family knew it was Patricia as soon as they saw her photo, Kohlhepp said.

    Smith said that she has called the adult care home in Puerto Rico several times but has been unable to hold a conversation with her sister because she has dementia.

    “We didn’t expect it. It was a very big shock to see – to know that she’s still alive,” her sister said. “You know, we’re so happy and I hope I can get down to see her.”

    CNN has not been able to directly contact the woman’s family.

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  • Tennessee governor signs ban on gender-affirming care for minors | CNN Politics

    Tennessee governor signs ban on gender-affirming care for minors | CNN Politics

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    Washington
    CNN
     — 

    Tennessee Gov. Bill Lee on Thursday signed a law that prohibits gender-affirming care for minors, the latest state to do so as part of a wider Republican-pushed effort nationwide.

    Senate Bill 0001 prohibits health care providers “from performing on a minor or administering to a minor a medical procedure if the performance or administration of the procedure is for the purpose of enabling a minor to identify with, or live as, a purported identity inconsistent with the minor’s sex.”

    It specifies that minors who receive care cannot be held liable but lawsuits could be brought up against a minor’s parents “if the parent of the minor consented to the conduct that constituted the violation on behalf of the minor.”

    The newly signed law also grants the attorney general the authority to fine health care professionals who provide the care with a civil penalty of $25,000 per violation.

    The law – enacted on the same day that Lee signed a bill restricting drag show performances in the state – will go into effect on July 1. Gender-affirming care that began prior to July 1 is not considered a violation “provided that the treating physician must make a written certification that ending the medical procedure would be harmful to the minor,” though access to such care must conclude by March 31, 2024.

    LGBTQ advocates and many physicians regard the treatment as medically necessary, evidence-based care that uses a multidisciplinary approach to help a person transition from their assigned gender – the one the person was designated at birth – to their affirmed gender, the gender by which one wants to be known.

    But Tennessee’s legislation – similar in its aim to more than 80 such bills nationwide seeking to restrict access to the treatment, according to data compiled by the American Civil Liberties Union and shared with CNN – expresses concern over long-term outcomes and questions whether minors are capable of making such consequential decisions.

    Major medical associations agree that gender-affirming care is clinically appropriate for children and adults with gender dysphoria, which, according to the American Psychiatric Association, is psychological distress that may result when a person’s gender identity and sex assigned at birth do not align.

    Though the care is highly individualized, some children may decide to use reversible puberty suppression therapy. This part of the process may also include hormone therapy that can lead to gender-affirming physical change. Surgical interventions, however, are not typically done on children and many health care providers do not offer them to minors.

    In pushing the health care bans, Republicans have argued that decisions around such care should be made after an individual becomes an adult, though lawmakers in some states have sought to push bans as far back as the age of 26.

    “The state has a compelling interest to protect children from experimental and unproven medical procedures,” Tennessee state Sen. Jack Johnson, a Republican, told CNN. “We want children suffering from gender dysphoria to get the important mental health treatment they need, but it’s not appropriate to subject children to irreversible procedures with lifelong health complications.”

    Tennessee’s law comes in the wake of similar restrictions in other Republican-controlled states.

    Earlier this week, Mississippi enacted a similar ban, joining Utah and South Dakota, which passed their own bans earlier this year. Arkansas enacted a ban in 2021, and Alabama put one on its books last year. Arizona also enacted restrictions on gender-affirming care in 2022, though its ban was less sweeping than the others.

    Blasting Lee’s signing, the ACLU on Thursday said Tennessee’s law takes a critical and sensitive decision away from families of transgender youth and promised to mount a legal challenge in court.

    “We will not allow this dangerous law to stand,” the ACLU, its Tennessee chapter and Lambda Legal said in a statement. “Certain politicians and Gov. Lee have made no secret of their intent to discriminate against youth who are transgender or their willful ignorance about the life-saving health care they seek to ban. Instead, they’ve chosen fearmongering, misrepresentations, intimidation, and extremist politics over the rights of families and the lives of transgender youth in Tennessee.

    The statement continued, “We are dedicated to overturning this unconstitutional law and are confident the state will find itself completely incapable of defending it in court. We want transgender youth to know they are not alone and this fight is not over.”

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  • 2 more Michigan State shooting victims sent home from hospital while 2 remain hospitalized | CNN

    2 more Michigan State shooting victims sent home from hospital while 2 remain hospitalized | CNN

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    CNN
     — 

    Two Michigan State students wounded in the mass shooting on campus in February have been discharged from hospital, according to the university’s police department.

    The tweet did not identify the students who were released but said they were previously listed in serious condition.

    One student remains hospitalized in critical condition and one is in fair condition, the MSU Police and Public Safety Department said.

    One other student was discharged last week. Troy Forbush wrote in a Facebook post on February 26 he had a “brush with death” after being shot in the chest.

    He credited the “incredible doctors” who saved his life with emergency surgery. He said he spent a week in the ICU and three more days being cared for by the “superhero staff.”

    “My world has been turned upside down so suddenly but I refuse to be a number, a statistic. Alongside my family, friends, community, university, & state government officials, we will enact change,” he wrote.

    Three students – Arielle Anderson, Brian Fraser and Alexandria Verner – were killed in February 13 when a man opened fire in a classroom and then in another building.

    It’s still unclear why the gunman – a man with no known ties to MSU – targeted the university. He died from a self-inflicted gunshot wound the night of the killings, authorities said, and had a note threatening other shootings hundreds of miles away in New Jersey.

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  • Amazon closes its acquisition of One Medical, but scrutiny of the deal is not over | CNN Business

    Amazon closes its acquisition of One Medical, but scrutiny of the deal is not over | CNN Business

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    Washington, DC
    CNN
     — 

    Amazon closed its acquisition of health care provider One Medical and its parent in a $3.9 billion deal on Wednesday, hours after the Federal Trade Commission said it would not challenge the purchase but that regulators were still investigating potential competitive and consumer harms of the transaction.

    The landmark deal will turn the e-commerce giant into a provider of primary medical care with access to more than 200 brick-and-mortar doctors’ offices, along with roughly 815,000 One Medical members, according to that company’s latest financial statement.

    The One Medical deal would also allow Amazon to expand its telehealth services and acquire valuable relationships with hospital systems, industry analysts have said.

    On Wednesday, Amazon said One Medical will offer new customers a $55 discount on annual memberships for a limited time.

    “We’re on a mission to make it dramatically easier for people to find, choose, afford, and engage with the services, products, and professionals they need to get and stay healthy, and coming together with One Medical is a big step on that journey,” said Neil Lindsay, senior vice president of Amazon Health Services, in a release. “One Medical has set the bar for what a quality, convenient, and affordable primary care experience should be like. We’re inspired by their human-centered, technology-forward approach and excited to help them continue to grow and serve more patients.”

    But while Amazon can consummate the deal without the immediate threat of an FTC antitrust suit, the agency is still investigating the acquisition and can still challenge the deal after the fact.

    “The FTC’s investigation of Amazon’s acquisition of One Medical continues,” said FTC spokesman Douglas Farrar. “The commission will continue to look at possible harms to competition created by this merger, as well as possible harms to consumers that may result from Amazon’s control and use of sensitive consumer health information held by One Medical.”

    The FTC plans to warn Amazon it may close the deal at its own risk, an agency official said. Known as a “pre-consummation warning,” the FTC began sending such letters to merging companies in 2021 in response to a surge in proposed deals that threatened to overwhelm regulators’ investigative capacity.

    The warning highlights the continued legal risk for Amazon and the potential concerns driving the FTC probe. Worries include not only the potential for Amazon to entrench its economic dominance but also fears that its acquisition of valuable health data could lead to the misuse of that information for other purposes, such as targeted advertising or e-commerce, the agency official said.

    Amazon’s deal to acquire One Medical follows its 2018 purchase of the online pharmacy service PillPack, which later became Amazon Pharmacy. Separately, Amazon partnered with JPMorgan Chase and Berkshire Hathaway on an effort to provide better health care services and insurance at a lower cost to workers and families at the three companies, and possibly other businesses, too. That effort, called Haven, shut down in 2021.

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  • South Korean court grants gay couple health benefits in landmark ruling | CNN

    South Korean court grants gay couple health benefits in landmark ruling | CNN

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    Seoul, South Korea
    CNN
     — 

    A South Korean court on Tuesday ruled in favor of a same-sex couple seeking equal health benefits, overturning a lower court’s earlier decision in a ruling hailed by supporters and activists as the first recognition of the legal rights of such couples.

    The plaintiff, So Seong-wook, had previously been registered as a “spousal dependent” for state health insurance coverage, under the government-affiliated National Health Insurance Service (NHIS), according to his lawyer Park Han-hee.

    But the NHIS revoked So’s rights as a dependent and imposed premium payments after realizing he was in a same-sex relationship, Park told reporters after Tuesday’s hearing.

    South Korea does not legally recognize same-sex marriage.

    So and his partner sued the NHIS in 2021 citing discrimination, but lost in a lower court. They appealed the decision, with South Korea’s High Court ruling in their favor on Tuesday.

    The NHIS now has two weeks to appeal against the High Court’s decision.

    “After the first trial, despite the loss, I said that our love won, is winning and will win. And today demonstrates more clearly that our love has won and is winning,” So said Tuesday. “I’m really happy that through this ruling, the world will be more aware of the inequality that my husband and I, as well as other sexual minorities in South Korea, have gone through.”

    LGBTQ organizations and supporters around the world also celebrated the decision.

    Korean advocacy group Gagoonet, which includes the law firm representing So and his partner, congratulated the couple in a statement Tuesday, saying it welcomed “the first ruling where the judiciary recognized the equal rights of same-sex couples.”

    Amnesty International also praised the ruling, with its East Asia Researcher Boram Jang saying it “moves South Korea closer to achieving marriage equality” and “offers hope that prejudice can be overcome.”

    However, Jang added, the country has a long way to go. For instance, it has no anti-discrimination law despite years of campaigning and multiple draft legislation proposals.

    South Korea has also drawn international criticism for its military penal code, which makes sexual activity between men punishable by up to two years in prison. In past years, dozens have been arrested in what critics have called a “gay witch-hunt.”

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  • Ohio governor drinks the tap water as the EPA demands Norfolk Southern manage all cleanup of a toxic train wreck — or face consequences | CNN

    Ohio governor drinks the tap water as the EPA demands Norfolk Southern manage all cleanup of a toxic train wreck — or face consequences | CNN

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    CNN
     — 

    The US Environmental Protection Agency is ordering Norfolk Southern to handle and pay for all necessary cleanup after a train carrying toxic chemicals derailed in East Palestine, Ohio.

    The EPA announced its legally binding order Tuesday, 18 days after the freight train derailed. The disaster ignited a dayslong inferno, shot plumes of black smoke into the air and led to the intentional release of vinyl chloride to help avert a more catastrophic blast.

    Some residents have reported health problems, and about 3,500 fish have died in Ohio waterways since the wreck.

    “Norfolk Southern will pay for cleaning the mess that they created and the trauma that they inflicted on this community,” EPA Administrator Michael Regan said Tuesday.

    As part of the EPA’s legally binding order, Norfolk Southern will be required to:

    • Identify and clean up any contaminated soil and water resources,

    • Reimburse the EPA for cleaning services to be offered to residents and businesses to provide an additional layer of reassurance, which will be conducted by EPA staff and contractors,

    • Attend and participate in public meetings at the EPA’s request and post information online, and

    • Pay for the EPA’s costs for work performed under the order.

    The order will take effect Thursday. The EPA said it will exercise its strongest authority against the train’s operator under CERCLA – the Comprehensive Environmental Response, Compensation, and Liability Act.

    “In no way, shape or form will Norfolk Southern get off the hook for the mess that they created,” Regan said.

    If the rail company fails to meet the demands, the EPA said it will immediately step in, conduct the necessary work and then seek to compel Norfolk Southern to pay triple the cost.

    In response to the EPA’s announcement, Norfolk Southern said it has been working to clean up the site and will continue helping residents.

    “We recognize that we have a responsibility, and we have committed to doing what’s right for the residents of East Palestine,” Norfolk Southern said in a statement to CNN.

    “We have been paying for the clean-up activities to date and will continue to do so. We are committed to thoroughly and safely cleaning the site, and we are reimbursing residents for the disruption this has caused in their lives. We are investing in helping East Palestine thrive for the long-term, and we will continue to be in the community for as long as it takes. We are going to learn from this terrible accident and work with regulators and elected officials to improve railroad safety.”

    Hours before the EPA’s announcement, Regan and Gov. Mike DeWine visited an East Palestine home and tried to reassure residents that the municipal water supply is safe.

    They raised two glasses filled with water straight from the tap and toasted before drinking.

    The municipal water supply comes from five wells deep underground that are encased in steel, state officials have said. But residents with private well water should get that water tested before using it, since that water may be sourced closer to the ground’s surface.

    “State and local authorities will continue the water sampling efforts, and EPA will continue indoor air screenings to residents within the evacuation zone,” Regan said Tuesday.

    But “I recognize that no matter how much data we collect or provide, it will not be enough to completely reassure everybody,” the EPA chief said.

    “It may not be enough to restore the sense of safety and security that this community once had. But we’re going to work together, day by day, for as long as it takes to make sure that this community feels at home once again.”

    The soil under the railroad track at the site of the wreck is still contaminated, and the tracks need to be lifted to remove that soil, the director of Ohio’s Environmental Protection Agency said Tuesday.

    The governor acknowledged residents’ concerns about the contaminated soil and said 4,588 cubic yards of soil and 1.1 million gallons of contaminated water have been removed from East Palestine.

    “The railroad got the tracks back on and started running and the soil under the tracks had not been dealt with,” DeWine said. “The tracks will have to be taken up, and that soil will have to be removed.”

    To address the growing reports of rashes, headaches, nausea and other symptoms in East Palestine, the state opened a new health clinic for residents.

    The health clinic will have registered nurses, mental health specialists and – at times – a toxicologist, the Ohio Department of Health said.

    Medical teams from the US Centers for Diseases Control and Prevention and the US Department of Health are expected to arrive in the community as early as this week to help assess what dangers might remain.

    Authorities have repeatedly assured residents that the air and municipal water supply in the town are safe. Crews have checked hundreds of homes and have not detected any dangerous levels of contaminants, the EPA said.

    Still, life in East Palestine has been uprooted as residents question the findings and wonder whether it’s really safe to drink the water or breathe the air.

    “It will be important to monitor people’s health and the environment around the train derailment for some time to come since health impacts may not emerge until later,” said Dr. Erin Haynes, an environmental health scientist at the University of Kentucky.

    “We should never say we’re done looking at this community for potential exposures and health impacts.”

    Petroleum based chemicals float on the top of the water in Leslie Run creek after being agitated from the sediment on Monday in East Palestine.

    Some waterways were contaminated after the crash, killing an estimated 3,500 fish. But officials have said they believe those contaminants have been contained.

    Norfolk Southern installed booms and dams to restrict the flow of contaminated water from Sulphur Run and Leslie Run – two streams where fish were found dead, the EPA said.

    “The spill did flow to the Ohio River during that initial slug, but the Ohio River is very large, and it’s a water body that’s able to dilute the pollutants pretty quickly,” Ohio Environmental Protection Agency official Tiffani Kavalec said last week.

    Kavalec said the agency is pretty confident that the “low levels” of contaminants that remain are not getting passed on to water customers.

    A series of pumps have been placed upstream to reroute Sulphur Run around the derailment site, Norfolk Southern said Monday.

    “Environmental teams are treating the impacted portions of Sulphur Run with booms, aeration, and carbon filtration units,” Norfolk Southern added. “Those teams are also working with stream experts to collect soil and groundwater samples to develop a comprehensive plan to address any contamination that remains in the stream banks and sediment.”

    Water intakes from the Ohio River that were shut off Sunday “as a precautionary measure” were reopened after sampling found “no detections of the specific chemicals from the train derailment,” the Greater Cincinnati Water Works and Northern Kentucky Water District said Monday.

    A third utility provider – Maysville utility in Kentucky – announced that it temporarily shut off water intakes from the Ohio River on Saturday, when the toxic chemicals released into the river from the derailment were expected to arrive at the water treatment intake in Kentucky, utility general manager Mark Julian said.

    Water measurements have been below the level of concern, Julian said, and Maysville took precautionary measures in temporarily shutting down their Ohio River intake valve due to the public concern.

    “The takeaway is that anyone along the Ohio River where the contaminants made their way can breathe a sigh of relief,” he said.

    A member of Ohio EPA Emergency Response looks for fish at Leslie Run creek and checks for chemicals in East Palestine on Monday.

    Meanwhile, the majority of the hazardous rail cars remain at the crash site as investigators continue to probe the wreck. But about 15,000 pounds of contaminated soil and 1.1 million gallons of contaminated water have been removed from the scene, Norfolk Southern announced Monday.

    The contaminated soil became a point of contention last week after a public document sent to the EPA on February 10 did not list soil removal among completed cleanup activities. It is not yet known what significance or impact the soil that was not removed before the railroad reopened on February 8 will have had on the surrounding areas.

    As skepticism spreads about the safety of the air and water, some local businesses say they’ve seen fewer customers.

    “Everybody’s afraid … They don’t want to come in and drink the water,” Teresa Sprowls, a restaurant owner in East Palestine, told CNN affiliate WOIO.

    A stylist at a hair salon told WOIO there’s no doubt the salon lost business and that customers may be worried about what may be in the water washing their hair.

    “I know a lot of our businesses are already suffering greatly because people don’t want to come here,” local greenhouse owner Dianna Elzer told CNN affiliate WPXI.

    Her husband, Donald Elzer, echoed her concerns, saying, “It’s devastating. The longer it goes on, the worse it gets.”

    Dianna Elzer also worried about longer-term economic impacts to the community.

    “Our property values – who is going to want to buy a house here now?” she told WPXI. “It’s going to be a long struggle to get back to where we were.”

    As residents call for accountability from both Norfolk Southern and government officials, US Transportation Secretary Pete Buttigieg said he plans to visit East Palestine “when the time is right” – but did not announce a date.

    He did announce Monday new efforts by the Department of Transportation to improve rail safety.

    “We are accelerating and augmenting our ongoing lines of effort on rail regulation and inspection here at the US DOT, including further regulation on high hazard flammable trains and electronically controlled pneumatic brakes – rules that were clawed back under the previous administration – to the full extent of that we are allowed to under current law, and we will continue using resources from the Bipartisan Infrastructure Law to fund projects that improve rail safety,” Buttigieg said.

    A DOT news release said the agency will continue to press for the “Train Crew Staffing Rule,” which would require a minimum of two crew members during most railroad operations. Norfolk Southern has opposed the proposed rule.

    Norfolk Southern has committed millions of dollars’ worth of financial assistance to East Palestine, including $3.4 million in direct financial assistance to families and a $1 million community assistance fund, among other aid, the company said.

    Norfolk Southern CEO Alan Shaw posted an open letter telling East Palestine residents, “I hear you” and “we are here and will stay here for as long as it takes to ensure your safety and to help East Palestine recover and thrive.”

    “Together with local health officials,” Shaw said, “we have implemented a comprehensive testing program to ensure the safety of East Palestine’s water, air, and soil.”

    Correction: An earlier version of this story misspelled the first name of Ohio Environmental Protection Agency official Tiffani Kavalec.

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  • How an old debate previews Biden’s new strategy for winning senior voters | CNN Politics

    How an old debate previews Biden’s new strategy for winning senior voters | CNN Politics

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    CNN
     — 

    In pressing Republicans on Social Security and Medicare, President Joe Biden is reprising one of the most dramatic moments of his long career.

    During the 2012 vice-presidential debate, Biden engaged in a nearly 11-minute exchange with GOP nominee Paul Ryan over Republican plans to reconfigure the two massive programs for the elderly, several of which Ryan had authored himself.

    Biden and many Democrats felt he had won the argument on stage. Yet on Election Day, Ryan and GOP presidential nominee Mitt Romney routed Biden and President Barack Obama among White seniors, and beat them soundly among seniors overall, exit polls found.

    That outcome underscores the obstacles facing Biden now as he tries to recapture older voters by portraying Republicans as threats to the two towers of America’s safety net for the elderly. While polls consistently show that voters trust Democrats more than Republicans to safeguard the programs, GOP presidential nominees have carried all seniors in every presidential election back to 2004 and have reached at least 58% support among White seniors in each of the past four contests, exit polls have found. Democrats have likewise consistently struggled among those nearing retirement, older working adults aged 45-64.

    Those results suggest that for most older voters, affinity for the GOP messages on other issues – particularly its resistance, in the Donald Trump era, to cultural and racial change – has outweighed their views about Social Security and Medicare. Those grooves are now cut so deeply, over so many elections, that Biden may struggle to change them much no matter how hard he rails against a range of GOP proposals that could retrench or restructure the programs.

    Biden’s charge that Republicans are threatening the two giant entitlement programs for the elderly – which triggered his striking back and forth exchanges with GOP legislators during the State of the Union – fits squarely in his broader political positioning as he turns toward his expected reelection campaign.

    As I’ve written, the 80-year-old Biden, at his core, “remains something like a pre-1970s Democrat, who is most comfortable with a party focused less on cultural crusades than on delivering kitchen-table benefits to people who work with their hands.” As president he’s expressed that inclination primarily through what he calls his “blue-collar blueprint to rebuild America” – the planks in his economic plans, such as generous incentives to revive domestic manufacturing, aimed at creating more opportunity for workers without a college degree. Politically, Biden’s staunch defense of Social Security and Medicare, programs critical to the economic security of financially vulnerable retirees, represents a logical bookend to that emphasis.

    “We all know that whose side you are on is a critical debate point for every election and this debate over Social Security and Medicare really helps crystallize whose side Biden is on versus whose side Republicans are on in a very effective way for him,” said Democratic pollster Matt Hogan, who helped conduct an extensive series of bipartisan polls during the 2022 campaign measuring attitudes among seniors for the AARP, the giant lobby for the elderly.

    From Franklin Roosevelt through Hubert Humphrey and Tip O’Neill, generations of Democrats have framed themselves as the defenders of the social safety net for seniors against Republicans who they say would unravel it. Biden showed how comfortable he was stepping into those shoes during his 2012 vice-presidential debate with Ryan, then a young representative from Wisconsin who Romney had selected as his running mate.

    Nearly 30 years Biden’s junior, Ryan was an unflinching advocate of restructuring Social Security and Medicare to reduce costs over time. In particular, Ryan was the principal supporter of a conservative plan to convert Medicare, the giant federal health insurance program for the elderly, into a system called “premium support.” Under that proposal, Medicare would be transformed from its current structure, in which the government directly pays doctors and hospitals who provide care for beneficiaries, into a voucher (or “premium support”) system, in which the government would provide recipients a fixed sum to purchase private insurance. Ryan had also drafted proposals to partially privatize Social Security by allowing workers to divert part of their payroll taxes into private investment accounts, a change that would have reduced the tax dollars flowing into the system and eventually required substantial cuts in guaranteed benefits.

    For nearly 11 minutes during the debate in October 2012, moderator Martha Raddatz of ABC skillfully guided Biden and Ryan through a heated, but civil and substantive, discussion of Social Security and Medicare’s future. Ryan insisted that changes were needed to preserve the programs’ long-term viability and that current seniors and those near retirement would not see their benefits reduced.

    Biden appealed openly to the Democrats’ historic image as the programs’ protectors and condemned Ryan and the GOP for wanting to partially privatize them. At one point in the debate, Biden declared: “we will be no part of a [Medicare] voucher program or the privatization of Social Security.” A few moments later, he insisted: “These guys haven’t been big on Medicare from the beginning. And they’ve always been about Social Security as little as you can do. Look, folks, use your common sense. Who do you trust on this?”

    At the time, Democrats felt Biden had at least held his own, restoring the party’s momentum after Obama’s surprisingly listless performance eight days earlier in his first debate against Romney. And Democrats through the rest of the campaign railed against the Republican ticket as a threat to Social Security and Medicare.

    But on election day, those arguments did not translate into gains for Obama and Biden among seniors or the older working adults (aged 45-64) nearing retirement. As Hogan noted, the newly passed Affordable Care Act, which generated some of its funding through savings in Medicare, was extremely unpopular at the time among older voters. Obama and Biden not only lost seniors and the older working age adults, but actually ran slightly more poorly among both groups in 2012 than they did in 2008.

    In fact, no Democratic presidential nominee since Al Gore in 2000 has carried most seniors in a presidential campaign; Obama in 2008 was the only one since Gore to carry most of the older working age adults. Among older Whites, the Democratic deficit is even more pronounced: the Republican presidential nominee has carried around three-fifths of both White seniors and those nearing retirement in each of the past four elections. Biden in 2020 slightly improved on Hillary Clinton’s anemic 2016 performance with both groups, but still lost to Trump by 15 percentage points among White seniors and by 23 points among the Whites nearing retirement, according to the exit polls conducted by Edison Research for a consortium of media organizations including CNN. Biden performed especially poorly among older Whites without a college degree – an economically stressed group heavily reliant on the federal retirement programs.

    Estimates by Catalist, a Democratic targeting firm, and the Pew Research Center likewise found that Trump in both 2016 and 2020 beat his Democratic opponents among both seniors and the older working adults. Like the exit polls, the Catalist data show the Republican nominees carrying about three-fifths of White seniors and older working adults in each of the past three presidential elections.

    The story is similar in congressional contests. In House elections, the exit polls found Republicans winning all seniors and older working adults comfortably in the 2014 and 2022 midterm campaigns and narrowly carrying them even in 2018 when Democrats romped overall. In all three of those midterm congressional elections, Republicans carried about three-fifths of the near retirement White adults, while they also reached that elevated threshold among White seniors in both the 2014 and 2022 campaigns.

    Republicans have maintained these advantages with older voters despite polls showing that most Americans trust Democrats more than the GOP to protect Social Security and Medicare, and that most Americans, especially seniors, oppose the intermittently surfacing GOP proposals to partially privatize both programs.

    Politically, “Democrats have used Social Security and Medicare really a lot over the past two or three decades, maybe four decades,” said Jim Kessler, executive vice president for policy at Third Way, a centrist Democratic group. “The payoff has been a lot less than Democrats have generally thought it would be.”

    Could this time be different for Biden and the Democrats? Congressional Republicans have certainly provided plenty of evidence for his claim that they still hope to restructure the programs. The proposed 2023 budget by the Republican Study Committee, the members of which include about three-fourths of House Republicans, reprises the ideas of converting Medicare into a premium support system and establishing private investment accounts under Social Security, while also raising the retirement age for both programs and reducing Social Security benefits over time. And although Florida Sen. Rick Scott renounced the idea late last week, his “Rescue America” agenda did include a proposal to require Congress to reauthorize all federal programs, including Social Security and Medicare, every five years.

    These ideas have precipitated an unusual degree of open Republican dissension. Senate GOP Leader Mitch McConnell repeatedly, and unreservedly, denounced the Scott plan until the Florida senator backed off. Trump recently released a video in which he declared the GOP should not cut “a single penny” of Social Security or Medicare benefits – which put him directly at odds with the three-fourths of House Republicans in the Republican Study Committee. House Speaker Kevin McCarthy, bending more toward Trump’s position, seems unlikely to incorporate into the GOP budget plans the RSC’s most sweeping changes in Social Security and Medicare.

    Kessler believes Biden may succeed where other Democrats have failed at hurting the GOP with the issue, and he argued that the conspicuous Republican infighting demonstrates they share that concern. “We are watching a high-profile battle that I’ve never really seen before on these issues in the Republican Party,” Kessler said. “And part of it is clearly they think it’s a problem when they didn’t years ago. If they think it’s a problem, maybe it’s a problem.”

    Stuart Stevens, who served as Romney’s chief strategist in the 2012 campaign but has since become a fierce critic of the Trump-era GOP, also believes the party could face more risk over its entitlement agenda than it did back then. The reason is that he thinks the idea of sunsetting Social Security and Medicare every five years, even if Scott is trying to jettison it, may prove more immediately tangible and understandable to voters than Ryan’s complex ideas of partially privatizing both programs.

    “The question I always ask myself in campaigns is ‘are you talking about something the other side doesn’t want to talk about?’” Stevens said. “That’s probably a good sign that they are losing on the issue.”

    Whether Biden proves more effective than other recent Democrats at attracting older voters around Social Security and Medicare will likely pivot on whether seniors believe the GOP genuinely would cut the programs if given the power to do so, argued Robert Blendon, a professor emeritus at the Harvard School of Public Health, who specializes in public attitudes about the social safety net. “If the senior community actually believes that it’s being threatened it really would affect their votes,” he predicted. But, he added, “as long as they are not threatened, the other values of seniors on top issues more and more correspond with Republicans.”

    There’s no doubt about the second half of that equation. Polling has consistently found that older Whites, in particular, are more receptive than their younger counterparts to hardline Trump-era GOP messages around crime, immigration and the broader currents of racial and cultural change: for instance, about half of Whites older than 50 agree that discrimination against Whites is now as big a problem as bias against minorities, a far higher percentage than among younger Whites, according to a new national survey by the Public Religion Research Institute. Older Whites are also more likely than younger generations to lack a college degree or to identify as Christians, attributes that generally predict sympathy for GOP cultural and racial arguments.

    Through the 21st century, those cultural and racial attitudes among older White voters have consistently trumped any concerns they may hold about the Republican commitment to Social Security and Medicare. Despite Biden’s impassioned articulation of the case against the GOP, that didn’t change even in 2012 when Republicans placed on their national ticket a vice presidential nominee who directly embodied the GOP aspirations to reconfigure and retrench those programs.

    Even small changes in seniors’ preferences could have a big impact in closely balanced states with a large retiree population like Arizona and Pennsylvania. But the entrenched GOP advantage among older voters over the past two decades suggests Biden’s hopes in 2024 may pivot less on improving with the “gray” than maximizing his vote among the “brown”: the diverse, younger generations that recoil from the same Republican messages on culture and race that electrify so many older Whites.

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  • As residents near the toxic train wreck in Ohio worry about rashes, sore throats and nausea, the state sets up a health clinic | CNN

    As residents near the toxic train wreck in Ohio worry about rashes, sore throats and nausea, the state sets up a health clinic | CNN

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    CNN
     — 

    While officials have repeatedly sought to assure residents that the water and air in East Palestine, Ohio, are safe after the derailment of a train carrying hazardous materials earlier this month, anxiety has permeated the community amid reports of rashes, nausea and headaches.

    The state now plans to open a health clinic in East Palestine Tuesday for residents concerned about possible symptoms related to the derailment and the Biden administration announced it deployed experts to help assess what dangers remain in the area after Ohio Gov. Mike DeWine requested medical teams from the US Centers for Diseases Control and Prevention and the US Department of Health.

    It’s been over two weeks since a train carrying vinyl chloride derailed in the small community of less than 5,000 people, igniting a dayslong inferno and prompting crews to carry out detonations to the toxic chemical to prevent a potentially deadly explosion.

    The detonations unleashed a black cloud of smoke over the area, where a chemical stench lingered for days. While it was deemed safe for evacuated residents to return home on February 8, community members have questioned how safe their village is and the validity of the air and water tests.

    US Sen. Sherrod Brown said residents are “right to be skeptical.”

    “We think the water’s safe,” Brown told CNN, citing comments made by the administrators of the state and federal Environmental Protection Agencies. “But when you return to your home, you should be tested again for your water and your soil and your air, not to mention those that have their own wells.”

    Testing of air quality in more than 530 homes has shown no detection of contaminants, the US Environmental Protection Agency said Sunday.

    As for the water, no vinyl chloride has been detected in any down-gradient waterways near the train derailment, EPA official Tiffani Kavalec told CNN last week.

    And while some waterways in the area were contaminated – killing thousands of fish downstream – officials have said they believe those contaminants to be contained.

    After crews discovered the contaminated runoff on two surface water streams, Sulphur Run and Leslie Run, Norfolk Southern installed booms and dams to restrict the flow of contaminated water, according to the EPA.

    Still, despite the assurances from officials that the water is safe, some residents are too afraid to drink from their taps and the town has been distributing bottled water.

    Desiree Walker – a 19-year resident of the town who lives just 900 feet from the derailment site – told CNN affiliate WOIO that she refuses to let her children drink the water, fearing it could have long-term health effects.

    “There’s a big concern because they’re young. They’ve got their whole life ahead of them,” Walker said. “I don’t want this to impact them down the road. I want them to have a long, happy life.”

    Walker said her family is feeling symptoms, but doctors tell them they don’t know what to test for.

    “At nighttime especially is when we smell it the most,” she told the station. “Our throats are sore, we’re coughing a lot now. My son, his eyes matted shut.”

    As anger and frustration bubbled in the small town, hundreds of East Palestine residents attended a town hall last week to express concerns over air and water safety in their community.

    Residents reported a variety of issues – including rashes, sore throats, nausea and headaches – and shared worries that the symptoms could potentially be related to chemicals released after a train derailment.

    “Why are people getting sick if there’s nothing in the air or in the water,” one resident yelled during the gathering.

    Ayla Antoniazzi and her family returned to their house less than a mile from the crash site the day after evacuation orders were lifted. The mother made sure to air the house out and wash all the linen before bringing her children home.

    “But the next day when they woke up, they weren’t themselves,” Antoniazzi said. “My oldest had a rash on her face. The youngest did too but not as bad. The 2-year-old was holding her eye and complaining that her eye was hurting. She was very lethargic, so I took them back to my parents’ home.”

    The Ohio Department of Health’s clinic opening Tuesday is meant to help East Palestine recover from the incident, officials said. The clinic will have registered nurses, mental health specialists and, at times, a toxicologist, the agency said.

    “I heard you, the state heard you, and now the Ohio Department of Health and many of our partner agencies are providing this clinic, where people can come and discuss these vital issues with medical providers,” said the department’s director, Dr. Bruce Vanderhoff.

    The decision to conduct controlled detonations at the derailment site on February 6 has also fueled skepticism and questions about safety.

    Ayla Antoniazzi's 4-year-old daughter developed a rash after going back to school in East Palestine.

    Officials said the move was meant to avert an explosion at the site of the derailment by venting the toxic vinyl chloride gas and burning it in a pit, a move that shot up a thick plume of smoke over the town.

    Vinyl chloride – a man-made substance used to make PVC – can cause dizziness, sleepiness and headaches and has also been linked to an increased risk of cancer in the liver, brain, lungs and blood.

    The burning vinyl chloride gas could break down into compounds including hydrogen chloride and phosgene, a chemical weapon used during World War I as a choking agent, according to the US Environmental Protection Agency and CDC.

    After the detonation, crews checked the air for chemicals of concern, including phosgene and hydrogen chloride, as well as butyl acrylate, ethylene glycol monobutyl ether acetate, and 2-ethylhexyl acrylate, according to the EPA, and reported that the data was normal.

    Work now continues to clear the crash site.

    The train’s operator, Norfolk Southern, is “scrapping and removing rail cars at the derailment location, excavating contaminated areas, removing contaminated liquids from affected storm drains, and staging recovered waste for transportation to an approved disposal facility,” the EPA said Sunday.

    “Air monitoring and sampling will continue until removal of heavily contaminated soil in the derailment area is complete and odors subside in the community,” the agency said.

    US Transportation Secretary Pete Buttigieg sent a letter Sunday to Norfolk Southern CEO Alan Shaw, demanding accountability and calling for greater safety regulations.

    “The people of East Palestine cannot be forgotten, nor can their pain be simply considered the cost of doing business,” Buttigieg wrote to the railway’s chief executive.

    “You have previously indicated to me that you are committed to meeting your responsibilities to this community, but it is clear that area residents are not satisfied with the information, presence, and support they are getting from NorfolkSouthern in the aftermath and recovery,” Buttigieg added.

    Brown also pledged to hold the rail company accountable for the impacts on the community, saying in a news conference he would “make sure Norfolk Southern does what it says it’s going to do, what it’s promised.”

    “All the cleanup, all the drilling, all the testing, all the hotel stays, all of that is on Norfolk Southern. They caused it, there’s no question they caused it,” Brown said, adding the total cost could amount to either tens or hundreds of millions of dollars.

    Norfolk Southern’s CEO posted an open letter Saturday telling East Palestine residents, “I hear you” and “we are here and will stay here for as long as it takes to ensure your safety and to help East Palestine recover and thrive.”

    “Together with local health officials, we have implemented a comprehensive testing program to ensure the safety of East Palestine’s water, air, and soil,” Shaw said in the letter, adding that the company also started a $1 million fund “as a down payment on our commitment to help rebuild.”

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  • Romanian doctors investigated for reusing implants from dead patients | CNN

    Romanian doctors investigated for reusing implants from dead patients | CNN

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    CNN
     — 

    Romanian prosecutors said on Saturday they have opened a criminal investigation into five doctors suspected of reusing hundreds of medical implants extracted from dead patients.

    One of the five doctors, who was working at a hospital in the eastern Romanian city of Iasi, has been taken into custody pending the investigation on charges of abuse of power and bribe taking, prosecutors said in a statement.

    They said the unnamed doctor oversaw a network of four other physicians who provided him with cardiac implants extracted from deceased patients without prior approval from them or their families.

    Prosecutors allege the doctor performed 238 surgeries over seven years from 2017, illegally using implants extracted from dead patients or of unknown provenance and putting his patients at risk of serious complications or death.

    “A large part of the implants recommended by the doctor…were not necessary and were prompted by fake diagnoses or by previously prescribed medication that would trigger specific symptoms,” the statement said.

    Romania’s healthcare system, one of the least developed within the European Union, has been dogged by corruption, inefficiencies and politicized management.

    The state has built one hospital in the last three decades and spends the least on healthcare in the EU, with tens of thousands of doctors and nurses having emigrated.

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  • How ‘extraordinary’ survivors are still being pulled from rubble 10 days after massive earthquake | CNN

    How ‘extraordinary’ survivors are still being pulled from rubble 10 days after massive earthquake | CNN

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    CNN
     — 

    More than 10 days after the devastating 7.8 magnitude earthquake that hit Turkey and Syria, people continue to be pulled from the rubble alive, defying expectations for survival after so many hours.

    “We, of course, thought this wouldn’t be possible, because getting somebody out alive after 10 days would’ve been a really great surprise for us,” rescue worker Özer Aydinli told CNN Chief Medical Correspondent Dr. Sanjay Gupta this week.

    Aydinli and his team rescued a 13-year-old boy named Mustafa from the rubble 228 hours – nearly 10 days – after the quake.

    “When [our friends] said, ‘We found a person alive,’ we thought, ‘No, they must be hallucinating.’ We couldn’t believe it. But it is a miracle. … The only thing we can say is that this is a great miracle,” he said.

    Search and rescue teachings have historically emphasized the “golden 48 hours” after a building collapse in which the chance of live rescues is highest. Some studies say the majority of live rescues happen within the first five or six days.

    However, people continue to be rescued alive from the rubble of the February 6 quake, including Mustafa.

    “I have no clue how he survived for 228 hours, because as the excavator was in operation, there was more debris falling around, filling the space above and under him, and so we couldn’t see any intact residential structure, because it was all rubble,” rescue worker Uğur Sevgin told Gupta. “Then, from the rubble, we got him out, digging him out by hand.”

    Amid the rubble, Aydinli said, there was just a pair of eyes and then the call of “Brother!”

    “When we saw it, when we heard it, there were 70, 80 people in the crew, and when we said there was a person alive, all our friends swarmed the area,” Aydinli said. “Nobody moved, and we all cried. And even now, we get tears in our eyes from time to time.”

    Aydinli says Mustafa may have been trapped in the “triangle of life,” explained by a theory that when buildings collapse, ceilings fall on objects or furniture inside, leaving a viable space next to the person.

    “After seeing Mustafa, I absolutely believe that there will be others. It is a miracle,” Sevgin said. “But, of course, it seems scientifically impossible. It has been 10 days and counting.”

    Some rescue teams follow a “rule of fours,” which assumes that trapped people can survive four minutes without air, four days without water and four weeks without food.

    However, research suggests that “rigid, universal timeframes” may be inaccurate, as survival can be extended under rare conditions.

    In Turkey, for example, experts say those who were stuck in collapsed residential buildings may have had access to some source of water or food.

    “You really only need a little bit of air, oxygen, water and probably a little bit of food to survive, hopefully just enough to get to a point where the rescuers can find you,” said Dr. Jarone Lee, an emergency and disaster medicine expert at Massachusetts General Hospital. “But I think it also relates to what kind of injuries happen during the initial sort of collapse and insult, if they only had a minor injury versus a major injury to the internal organs like your liver and such.”

    Lee said a person’s baseline health status is key. Those with pre-existing medical conditions – who may be unable to access their medication or whose medication includes side effects such as dehydration – have a lower likelihood of survival.

    “I do think that the ones that will continue to be found will be the younger, probably kids and other folks who are more robust. … Kids are usually smaller too, and there’s always a chance that they might be in an area of the collapse that they can survive longer just because they are smaller,” Lee said.

    Experts say cold temperatures may prevent dehydration and heat exhaustion among trapped people, but the subfreezing temperatures in Turkey and Syria are doing more harm than good.

    “In trauma patients, cold temperature is not a good thing for the physiology in general. After some degree of hypothermia, cardiac arrest can be a problem. Blood clotting factors do not work well, and other serious physiologic derangements happen,” said Dr. Girma Tefera, medical director of the American College of Surgeons’ Operation Giving Back.

    Advances in search and rescue training and technologies, including the use of dogs, drones and on-site IV rehydration, may also account for the extended survival times.

    Lee said that although he is hopeful there will be many more survivors, these are “extraordinary or rare circumstances” amid the more than 43,000 deaths after the earthquake. “These are in many ways still a handful of survivors in a massive amount of unfortunate devastation and death.”

    Rescue is only the beginning of a survivor’s road to recovery.

    At the Adana City Teaching and Research Hospital, the largest trauma hospital in the region, more than 5,000 patients were treated in the week after the earthquake.

    Dr. Suleyman Cetinkunar, chief of staff at the hospital, told Gupta that the majority of injuries include “limb loss, tissue crushes and brain trauma.”

    In addition to traumatic injuries from the collapse, patients may have “crush syndrome,” when compressed muscle tissues are finally freed and broken down, releasing toxins into the blood. These toxins can injure the kidneys and lead to kidney failure, causing seemingly stable patients to rapidly deteriorate after rescue.

    An earthquake survivor was flown to Adana City Teaching and Research Hospital to receive care.

    During their interview, the team received another call to the helipad to receive a 26-year-old who had crush syndrome and was in need of immediate dialysis.

    “Even just getting out of the rubble is a big step to get them stabilized into the hospital. But they are not out of the woods in any way. There’s a good chance that they still might not survive in the hospital,” said Massachusetts General’s Lee.

    Receiving lifesaving medical care becomes even more difficult as hospital buildings, like most other buildings, were not spared by the earthquake.

    The government and nonprofit organizations have set up field hospitals, tent hospitals and even hospital ships to continue to care for earthquake victims.

    Gupta spoke to doctors who are performing essential orthopedic surgery in tents set up in the parking lot of a ruined hospital in Antakya, Hatay province.

    “I’ve worked in places before where people like this don’t have the operation. They lay at home, languish. Some of them would get bedsores, blood clots, pneumonia and maybe die from that,” Dr. Greg Hellwarth, an orthopedic surgeon from Indiana, told Gupta.

    Dr. Elliott Tenpenny, an ER doctor from North Carolina and director of the International Health Unit for Samaritan’s Purse, showed Gupta around the field hospital where, amid 5.0 aftershocks, they continue to manage critical conditions like blood loss and asthma.

    “It’s not just about the broken bones and the crush injuries. It’s about these patients also,” Tenpenny told Gupta.

    The floating hospital also provides immediate beds, operating rooms and even a maternity ward. Unlike the field hospitals on the ground, hospital ships are relatively protected from the aftershocks that continue to devastate the land, the captain told Gupta.

    Experts say this disaster causes disruptions in the health care system that put people with chronic medical conditions at risk of losing access to lifesaving medications or medical appointments.

    “The consequences of that are going to be in weeks to years, months to years,” Lee said. “The fallout is going to be unfortunately massive from this.”

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  • Kentucky Supreme Court ruling allows state’s near-total abortion bans to remain in place for now | CNN Politics

    Kentucky Supreme Court ruling allows state’s near-total abortion bans to remain in place for now | CNN Politics

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    CNN
     — 

    The Supreme Court of Kentucky ruled Thursday that a lower court wrongfully stopped the enforcement of two state abortion laws, according to court documents.

    The two measures are Kentucky’s so-called trigger law banning the procedure and a separate “heartbeat” law restricting abortions at around six weeks of pregnancy.

    Siding with Republican Attorney General Daniel Cameron, Justice Debra Hembree Lambert asserted in her opinion that the circuit court “abused its discretion by granting abortion provider’s motion for a temporary injunction.”

    Planned Parenthood, along with an abortion provider represented by the American Civil Liberties Union and the ACLU of Kentucky, sued to block Kentucky’s sweeping abortion laws after the Supreme Court overturned Roe v. Wade last year.

    They filed two complaints challenging the two statutes, which effectively prohibit abortions in Kentucky except in limited circumstances where it is necessary to preserve the life of the mother, according to the opinion.

    The near-total bans outlaw abortion in most instances with no exceptions for rape or incest, making Kentucky one of 13 states that have banned or severely restricted abortion.

    The plaintiffs argued that the laws violate the state’s constitutional rights to privacy, bodily autonomy, and self-determination, Planned Parenthood and the ACLU said in a statement.

    After a circuit court temporarily enjoined the abortion bans last summer, an appellate court judge granted the attorney general’s emergency request to dissolve the injunction, but an appellate panel later recommended that the state’s highest court weigh in on the injunction.

    The Supreme Court of Kentucky ruled that the abortion providers did not have the standing to challenge the six-week ban because they had not argued it violated their own constitutional rights, only those of their patients.

    Although the court found that the abortion providers have standing to challenge the trigger ban, it ruled that the abortion providers did not show they were sufficiently harmed by the ban to warrant a temporary injunction on its enforcement, according to the opinion.

    Instead, the court remanded the case to the lower court to determine the constitutionality of the trigger ban, the opinion stated.

    The opinion does not determine whether the Kentucky Constitution protects the right to receive an abortion, as there was no “appropriate party” to raise the issue in the suit, according to Lambert.

    “Nothing in this opinion shall be construed to prevent an appropriate party from filing suit at a later date,” she said.

    In a statement, Planned Parenthood and the ACLU expressed disappointment with the ruling but said “this fight is not over.”

    “Once again, the Kentucky Supreme Court failed to protect the health and safety of nearly a million people in the state by refusing to reinstate the lower court order blocking the law,” the statement said.

    The statement added, “Even after Kentuckians overwhelmingly voted against an anti-abortion ballot measure, abortion remains banned in the state. We are extremely disappointed in today’s decision, but we will never give up the fight to restore bodily autonomy and reproductive freedom in Kentucky.”

    Cameron called the ruling a “significant victory” Thursday.

    “Since the U.S. Supreme Court overruled Roe v. Wade last June, we have vigorously defended Kentucky’s Human Life Protection Act and Heartbeat Law,” he said in a statement. “We are very pleased that Kentucky’s high court has allowed these laws to remain in effect while the case proceeds in circuit court.”

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  • Denver council member dragged himself onto stage before a political debate due to a lack of wheelchair accessibility | CNN

    Denver council member dragged himself onto stage before a political debate due to a lack of wheelchair accessibility | CNN

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    CNN
     — 

    A Denver city council member who uses a wheelchair faced a difficult situation this week when he participated in a political debate at a venue that did not have full accessibility, prompting him to drag himself onto its stage.

    Chris Hinds, who is running for reelection, said he has received apologies from the venue for the incident.

    “I felt like a circus monkey. I felt exploited,” Hinds told CNN Thursday.

    When Hinds arrived for the Monday debate, which was held at the Cleo Parker Robinson Dance facility’s theater in Denver, he was told organizers intended to carry him onto the stage. Hinds found the idea both humiliating and impractical.

    “My wheelchair weighs 400 pounds. I’m about 200 pounds. That’s 600 pounds they wanted to try to lift,” Hinds said.

    Organizers asked Hinds if he could raise himself onto the stage’s floor so they would only have to lift his chair, he said. Video shows Hinds, who is paralyzed from the middle of his chest down, shifting himself from the chair’s edge to the edge of the stage floor, and then using his arms to pull his legs onto the stage.

    He then struggles to sit upright until someone brings him a chair to lean on, the video, which Hinds provided, shows.

    Hinds was reluctant to try to get onstage without his wheelchair, he said, but felt he had no choice because candidates in Denver must forfeit public campaign funds if they decline to participate in an official debate.

    “My thought process was, I have to participate in this debate or end my campaign,” Hinds said.

    Eventually, organizers agreed to allow the debate to take place on the main floor of the theater at the foot of the stage, where he could sit in his wheelchair. Video shows him sliding himself back off the stage’s edge to his wheelchair.

    In a written statement, Cleo Parker Robinson Dance’s executive director Malik Robinson publicly apologized to Hinds.

    “I deeply regret it took this incident to elevate the urgency for this change and we are committed to ensuring that no one experiences lack of access to the stage again,” Robinson said.

    Hinds says he also received an apology from the office of the county clerk, who organizes the debates, and says he is satisfied with their response.

    Hinds pointed out that many people with disabilities continue to struggle with lack of access more than 30 years after the passage of the Americans with Disabilities Act. When he became the first person in a wheelchair elected to the council, the chambers where they hold meetings were not wheelchair-accessible, nor were the restrooms at City Hall, he said. That was quickly rectified after he was elected, he said.

    “I sure hope that we can use this as a teaching moment to understand why it’s important for democracy to be representative of all the people, including people with disabilities,” he said.

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  • Millions of children are at risk of losing Medicaid coverage starting in April | CNN Politics

    Millions of children are at risk of losing Medicaid coverage starting in April | CNN Politics

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    CNN
     — 

    The majority of American children now receive their health insurance through Medicaid and the Children’s Health Insurance Program, according to a new report published Wednesday by the Georgetown Center for Children and Families.

    But that could change starting this spring. As many as 6.7 million children are at risk of losing that coverage once states restart their reviews of recipients’ eligibility, according to Georgetown.

    Medicaid enrollment ballooned during the pandemic thanks to an early Covid-19 pandemic relief provision passed by Congress that barred states from involuntarily disenrolling beneficiaries in exchange for higher federal matching funds. But lawmakers voted late last year to end that continuous enrollment provision on April 1, freeing states to start winnowing ineligible recipients.

    More than 42 million children were covered by Medicaid and CHIP as of August, up 17.5% from February 2020, just before the pandemic started.

    Ten states plus the District of Columbia have more than 60% of their children insured through the public programs, according to Georgetown. New Mexico leads the nation with more than three-quarters of its kids covered by Medicaid and CHIP.

    By contrast, fewer than a quarter of children in Utah are enrolled in the programs.

    The number of children who gained Medicaid and CHIP coverage during the pandemic varied by state. Indiana had the largest surge, with a nearly 45% increase. Wyoming, North Dakota, Missouri and Georgia saw their child enrollment grow by roughly a third.

    On the flip side, Vermont experienced less than an 8% growth in child enrollment in Medicaid and CHIP.

    More than 83 million people, including more than 34 million children, were covered by Medicaid as of August. And another 4 million children were enrolled in Medicaid financed by CHIP. All will have their eligibility reviewed, and in some cases, the children will continue to qualify even if their parents do not.

    “If they’re getting the message that they’re losing their own coverage, a lot of times a parent understandably thinks that their child is also losing coverage,” said Joan Alker, executive director of the Georgetown Center for Children and Families.

    A total of roughly 15 million people could be dropped from Medicaid when the continuous enrollment requirement ends, according to an analysis the Department of Health and Human Services released in August. About 8.2 million folks would no longer qualify, but 6.8 million people would be terminated even though they are still eligible, the department estimated.

    When states reevaluate families’ eligibility, they need to look separately at adults and children, Alker said. Officials should work with pediatricians, schools, child care centers and others to explain the situation to parents and make sure the children retain coverage if they continue to qualify.

    Nearly three-quarters of the children projected to be dropped will remain eligible for Medicaid but will likely lose coverage because of administrative issues, such as their parents not submitting the necessary paperwork or procedural errors, according to Georgetown.

    Although states have 14 months to complete the unwinding process, some will look to do so more quickly.

    “My concern is that a large number of children could become uninsured in states that do not take their time and pay particular attention to the unique needs of children,” Alker said.

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  • GOP lawmakers escalate fight against gender-affirming care with bills seeking to expand the scope of bans | CNN Politics

    GOP lawmakers escalate fight against gender-affirming care with bills seeking to expand the scope of bans | CNN Politics

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    CNN
     — 

    A flurry of bills seeking to restrict access to gender-affirming care for trans youth have been introduced by Republican state lawmakers this year, with debates around the issue reaching new heights thanks to proposals that would dramatically expand the scope of bans on such care.

    More than 80 bills seeking to restrict access to gender-affirming care have been introduced around the country through February 9, according to data compiled by the American Civil Liberties Union and shared with CNN.

    Gender-affirming care is medically necessary, evidence-based care that uses a multidisciplinary approach to help a person transition from their assigned gender – the one the person was designated at birth – to their affirmed gender – the gender by which one wants to be known.

    Though many of the bills introduced so far this year target trans youth and their access to gender-affirming care, at least four states saw bills introduced this session that would restrict such care for individuals over the age of 18, including at least two states where proposed bans covered people under the age of 26.

    Legislation aimed at trans adults has alarmed LGBTQ advocates, who worry that even if those measures don’t become law, they will make future bills exclusively targeting minors seem like sensible compromises.

    The slew of new bills underscores the shifting policy goals of some conservatives seeking to politicize the lives of transgender Americans by imposing restrictions on a small and vulnerable group that, LGBTQ advocates say, are largely misunderstood, making their existence ripe for attacks. A number of GOP-led states have in recent years been successful in banning trans youth from competing on sports teams that match their gender identity, but now it appears the focus has largely turned to gender-affirming care.

    “It’s really, I think, a big but important, notable moment that they’re no longer pretending that this is about caring about young folks, and making it very clear that all that they really want to do is prevent trans folks from being able to receive medically necessary, life-saving care basically at any age,” said Cathryn Oakley, state legislative director and senior counsel for the Human Rights Campaign, one of the nation’s largest LGBTQ rights groups.

    “They have abandoned women’s sports entirely but doubled down on trying to hurt trans kids,” she added. “So, you know, the through line here is about hurting trans people. And yes, they’re looking for the next discriminatory measure that they can get passed.”

    In pushing the health care bans, Republicans have argued that decisions around such care should be made after an individual becomes an adult – a position that is facing intense scrutiny as some lawmakers have moved the age goalpost this year.

    Many of the bills likely won’t get far in the legislative process. An HRC report released last month said that of the 315 anti-LGBTQ bills introduced in 2022, only 29 – or less than 10% – became law. Still, the influx of bills this session is already helping to grow the small group of states that previously enacted bans on gender-affirming care.

    Last month, Utah became the first state this year to enact a ban on gender-affirming care for trans youth, joining Arkansas, which enacted its ban in 2021, and Alabama, which put a similar ban on its books last year. Arizona also enacted restrictions on gender-affirming care in 2022, though its ban was less sweeping than the others.

    Two of those laws have already brought forth a complicated legal landscape around the issue. The ACLU sued Arkansas over its ban and a federal judge temporarily blocked it in 2021, and Alabama’s law was partially blocked by a federal judge last May.

    As states consider the dozens of health care bans introduced this year, they’ll do so under threat of federal legal action, with the legislative efforts having caused the US Department of Justice to take notice.

    Last year, DOJ’s Civil Rights Division sent a stern warning to state attorneys general on the matter, saying in a letter that it “is committed to ensuring that transgender youth, like all youth, are treated fairly and with dignity in accordance with federal law.”

    “Intentionally erecting discriminatory barriers to prevent individuals from receiving gender-affirming care implicates a number of federal legal guarantees,” the letter read in part.

    Major medical associations agree that gender-affirming care is clinically appropriate for children and adults with gender dysphoria, which, according to the American Psychiatric Association, is psychological distress that may result when a person’s gender identity and sex assigned at birth do not align.

    Though the care is highly individualized, some children may decide to use reversible puberty suppression therapy. This part of the process may also include hormone therapy that can lead to gender-affirming physical change. Surgical interventions, however, are not typically done on children and many health care providers do not offer them to minors.

    LGBTQ advocates have long argued that the health care bans further marginalize a vulnerable community and could cause serious harm to a group that suffers from uniquely high rates of suicide.

    “LGBTQ youth are not inherently prone to mental health challenges and suicide. They are placed at higher risk by the hostility and discrimination they face because of who they are,” said Kasey Suffredini of the Trevor Project, a nonprofit that works to prevent suicide among LGBTQ youth. “It is on adults to carry young people through this period until we get to the place where lawmakers aren’t attacking these young people anymore.”

    At least four states saw bills introduced this year that would restrict gender-affirming care for individuals over the age of 18, dramatically raising the bar in Republicans’ efforts to regulate such care.

    Among those bills was one in Mississippi that would have criminalized people who provided or aided in the provision of gender-affirming care for individuals under the age of 21, with violators of the ban facing “the felony crime of ‘gender disfigurement.’” If convicted, a violator could have been sentenced to a maximum of five years in prison and face a fine of at least $10,000. That bill, however, died in committee in late January.

    A Kansas bill would prohibit medical professionals from “knowingly performing … or causing to be performed” gender-affirming care on an individual under the age of 21 and would make violations of the ban a felony under state law. The bill makes some exceptions, including in the case of someone born intersex.

    A bill in South Carolina, meanwhile, would impose similar restrictions. But the measure, among other things, would require someone older than 21 who is seeking gender-affirming care to first get a referral from their “primary care physician and a referral from a licensed psychiatrist who must certify that the person has been diagnosed with gender dysphoria or a similar condition by the psychiatrist and that the psychiatrist believes that gender transition procedures would be appropriate for the person.”

    Two near-identical bills in South Carolina and Oklahoma go a step further, providing that a “physician or other healthcare professional shall not provide gender transition procedures” to anyone under the age of 26. Medical professionals convicted of violating the act would be guilty of a felony, with a conviction in Oklahoma carrying a maximum sentence of five years in prison. The bills also prohibit public funds from being used “directly or indirectly” at organizations that provide such care.

    “Surgical and chemical genital mutilation has been occurring in our great state, and it must be stopped,” the bill’s sponsor, Oklahoma GOP state Sen. David Bullard, said in a statement, using incendiary language to describe the clinically appropriate health care he’s trying to restrict.

    The statement said Bullard “chose the age of 26 to account for scientific findings that the brain does not fully develop and mature until the mid- to late 20s with the prefrontal cortex, the part responsible for critical skills like planning and controlling urges, developing last.”

    Bullard’s bill was later gutted by a Senate committee, with the changes removing the ban on care but maintaining the public funds prohibition.

    “These are people who are old enough to enlist in the military, buy guns, buy alcohol, buy tobacco, get married, do a variety of other things that we leave to adults to do,” Oakley said. “And yet we would be forbidding them from being able to receive gender affirming care, as if that is in some way a more permanent decision.”

    The push to restrict gender-affirming care has been a central focus for a number of well-funded national right-wing groups, including the conservative American Principles Project.

    The group’s president, Terry Schilling, told CNN that it works with states to introduce and pass such bans, saying their overall goal is to eliminate gender-affirming care for all Americans, regardless of age. “The movement to oppose (gender-affirming care) has never said, ‘we only care about children.’ We’ve said, ‘we want to protect children,’” he said.

    “And so, we want to protect who we can as quick as possible. And the group of people that we can protect as quick as possible is children,” Schilling added. “And so that’s the thrust of the strategy – is we want to protect everyone from this stuff. But ultimately, we have to start with children because that’s where the vast majority of the American people are right now.”

    Lawmakers in Texas have introduced a number of bills that would outlaw gender-affirming care for trans youth, with most of them setting up blanket bans similar to ones being floated elsewhere.

    But the state is also attempting to approach the issue in a unique way, with lawmakers there having introduced at least four bills that would expand the definition of child abuse to include providing gender-affirming care to minors.

    The bills are seeking to codify a non-legally binding opinion released last year by Texas Attorney General Ken Paxton that said providing gender-affirming surgical procedures and drugs that affect puberty should be considered child abuse under state law.

    Paxton’s move prompted the Texas Department of Family and Protective Services to begin investigating parents who provide their children with such care. But LGBTQ advocates sued, and a district judge ruled last September that the state cannot pursue investigations into parents providing such care if their children and those families are part of one of the groups suing the state.

    One of the bills states in part that abuse “includes the following acts by a medical professional or mental health professional for the purpose of attempting to change or affirm a child ‘s perception of the child’s sex, if that perception is inconsistent with the child ‘s biological sex.”

    When Republican state Rep. Bryan Slaton pre-filed the bill last year, he said in a statement that it “will designate genital removal surgeries, chemical castration, puberty blockers, and other sex change therapies as child abuse.”

    Elsewhere, states are pushing ahead with bans similar to the ones in Arkansas and Alabama that are currently in legal jeopardy.

    In Utah, the Republican-controlled legislature moved a ban on gender-affirming care for minors through the statehouse in under a month, with Republican Gov. Spencer Cox giving it his stamp of approval in late January.

    “More and more experts, states and countries around the world are pausing these permanent and life-altering treatments for new patients until more and better research can help determine the long-term consequences,” Cox said in a statement explaining his decision to sign the bill into law.

    “This is a devastating and dangerous violation of the rights and privacy of transgender Utahns, their families, and their medical providers,” said Chase Strangio, deputy director for transgender justice at the ACLU, in a statement. “Claims of protecting our most vulnerable with these laws ring hollow when lawmakers have trans children’s greatest protectors – their parents, providers, and the youth themselves – pleading in front of them not to cut them off from their care.”

    LGBTQ advocates hoped Cox would veto the ban, pointing to the governor’s decision last year to veto an anti-trans sports bill in the state. At the time, he questioned the need for it and stressed that it targets a marginalized group that suffers from high rates of suicide. Lawmakers, however, quickly overrode his veto, with the drama underscoring how Republicans are not always in lockstep on matters pertaining to the LGBTQ community.

    Last month, Mississippi’s House passed a bill that similarly makes it illegal to “knowingly provide gender transition procedures to any person under” the age of 18. Physicians and other medical professionals found to have violated the ban would have their license to practice health care in the state revoked.

    “I just believe a child needs to wait until they’re 18-years-old, then they can make their own decision,” the bill’s sponsor, Republican state Rep. Gene Newman, told CNN. Decisions about the type of care Newman’s bill seeks to limit, however, are made by a mix of people, including a child’s parents and the medical provider.

    A South Dakota bill would also prohibit health care professionals in the state from providing gender-affirming care to minors. Like the Mississippi bill, providers found to be in violation of the ban by a professional or occupational licensing board would get their license to practice medicine revoked, according to the bill. The bill cleared South Dakota’s Senate on Thursday and is now headed to Republican Gov. Kristi Noem, who is supportive of the legislation.

    South Dakota has been especially hostile to trans youth in recent years, with Noem having signed a bill last year banning transgender women and girls in the state from competing on sports teams consistent with their gender at accredited schools and colleges. That legislation codified an executive order the governor signed in 2021.

    As lawmakers continue to debate these bans, advocates like Strangio, who is involved in the ACLU’s legal fight against some of the bans, are vowing to take states to court over any enacted restrictions.

    “It will be the government’s burden to defend it in court,” he told a Tennessee House committee last month that went on to approve a ban there. “And Tennessee, like Alabama, like Texas, like Arkansas, will not be able to do so.”

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  • Republican senator warns Congress must take action now to protect Medicare and Social Security | CNN Politics

    Republican senator warns Congress must take action now to protect Medicare and Social Security | CNN Politics

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    CNN
     — 

    Republican Sen. Mike Rounds of South Dakota offered Sunday a stark warning about the future of Social Security and Medicare if Congress fails to take action now.

    “In the next 11 years, we have to have a better plan in place than what we do today. Or we’re going to see – under existing circumstances – some reductions of as much as 24% in some sort of a benefit. So, let’s start talking now because it’s easier to fix it now that it would be five years or six years from now,” Rounds told CNN’s Jake Tapper on “State of the Union.”

    In recent days, President Joe Biden has made a forceful argument against Republicans by highlighting his support for Social Security and Medicare. The president has specifically seized on a proposal from GOP Sen. Rick Scott of Florida to sunset federal legislation – including Social Security and Medicare – every five years and require Congress to pass them again.

    Referencing his “spirited debate” with Republicans at the State of the Union, Biden called Scott’s proposal “outrageous” and vowed he would veto such a plan during a speech in Florida last week.

    “The very idea the senator from Florida wants to put Social Security and Medicare on the chopping block every five years I find to be somewhat outrageous. So outrageous that you might not even believe it,” he said, pulling out a pamphlet detailing Scott’s plan.

    Scott told CNN’s Kaitlan Collins last week that his proposal is intended to eliminate wasteful spending and help ensure the government can “figure out how to start living within our means.”

    “I want to make sure we balance our budget and preserve Medicare and Social Security, and I’ve been clear all along,” he said.

    Rounds also stressed Sunday that Republicans want to better manage Medicare and Social Security in order to improve the programs – not strip them from the American people.

    “We think that there are possibilities out there of long-term success without scaring people and without tearing apart the system and without reducing benefits. But it requires management. And it requires actually looking at and making things better,” he said.

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