Tag: prevention and wellness

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

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

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

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

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

Other preventive care mandates under the ACA remain in effect.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This story has been updated with additional details.

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March 30, 2023
Faucets in McCarthy’s district are running dry after years of drought. Constituents want him to do more | CNN Politics

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CNN
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Shortly after Benjamin Cuevas and his family moved into their new home three years ago in Tooleville, California, he realized something was horribly wrong.

In the middle of the day, the water pressure would drop completely. Cranking up both hot and cold could only coax a little drip out of the faucet.

Then there was the water itself, contaminated with chemicals from agriculture runoff and treated with so much chlorine that it turned his family’s black clothing gray in the wash. His daughter and her baby live in the house, and Cuevas’s wife only bathes her granddaughter in the bottled water they receive from the county for drinking.

Cuevas is not alone; the entire town of under 300 people faces the same water crisis. In many rural parts of the state, faucets and community wells are running dry after years of drought and heavy agriculture use pulls more water from the same groundwater residents use.

One local nonprofit told CNN that about 8,000 people in the San Joaquin Valley need thousands of gallons of hauled water just to keep their taps flowing – and that number is growing.

Newly elected House Speaker Kevin McCarthy has represented Tooleville for the past decade – though the small town is just outside his newly redrawn congressional district. The Republican lawmaker has long represented Kern and Tulare counties, and his redrawn seat adds portions of Fresno County.

Throughout his tenure, this region of California has spent more time than any other part of the country in exceptional drought – the US Drought Monitor’s most severe category – a drought scientists say has been made more intense by human-caused climate change. Recent rainfall has put a dent in the region’s surface drought, though experts have told CNN it will do little to solve the ongoing groundwater shortage.

Tulare, Kern and Fresno counties have endured more than 200 weeks in exceptional drought over the past decade, according to Drought Monitor data.

Multiple people CNN spoke to for this story said McCarthy and his office don’t often engage on this issue in the district, especially compared with neighboring members of Congress. And they wish he would do more with his power in Washington – especially now that he holds the speaker’s gavel.

McCarthy proposed an amendment this past summer to set up a grant program to help connect small towns like Tooleville with larger cities that have better water systems. The measure passed the House but died in the Senate. But as more and more wells go dry, McCarthy has made a point to vote against other bills addressing climate change and drought, including the Inflation Reduction Act and the bipartisan infrastructure law.

“In my experience, he has never engaged with us on any of these kinds of emergencies,” said Jessi Snyder, the director of community development at local nonprofit Self-Help Enterprises, who focuses on getting hauled water to entire communities that have gone dry.

In a statement to CNN, McCarthy’s office said he has been “a staunch advocate on water issues in the Central Valley and California” since he was first elected to the House. McCarthy has joined his colleagues to “introduce broad legislative solutions every Congress related to this topic since our water situation continues to worsen,” his spokesperson Brittany Martinez said.

But McCarthy does not mention climate change when talking about his district’s drought, and his office did not respond to questions from CNN about whether he believes climate change is playing a role. Instead, he often blames the drought on state mismanagement of water and has called for new and larger dams and reservoirs to be built to capture rainwater during wet years.

Water experts in California say that’s missing the new reality.

“Part of what’s happening now is the reality that there is no more new water,” said Peter Gleick, co-founder and senior fellow of California-based water nonprofit Pacific Institute. “The knee-jerk response of politicians has always been build another dam; find more water. There is no new reservoir that’s going to magically solve these problems. It’s now a question of managing demand.”

When a call comes in from yet another community whose well has run dry, it’s a race against time for the staff at Self-Help Enterprises.

The Visalia, California-based nonprofit has a self-imposed deadline of just 24 hours to drive out to the impacted community with emergency tanks to keep water flowing for showers, laundry and cleaning, as well as with five-gallon jugs of higher-quality water for drinking.

“The team goes all hands-on deck,” Tami McVay, Self-Help’s director of emergency services, told CNN. “Everybody knows what their role is, and they just go get it done. And we move forward to the next one.”

These days, there’s always a next one. Snyder said the summer of 2022 marked “a new level of crisis” as entire small communities of 80 to 100 homes started running out of water, in addition to individual homes.

“It’s been a real struggle because it’s hard to provide a backup source of water to a whole community instead of one household,” she said.

More than 1,400 wells were reported dry last year, according to the state of California, a 40% increase over the same period in 2021. Self-Help staff see this in person on the ground. New families are flowing into their hauled water program, but none are leaving. During the dry, warm-weather months, McVay estimates her nonprofit fields around 100 calls a day, dropping down to about 30 per week in the winter months.

The punishing multi-year drought is what Brad Rippey, a meteorologist at the US Department of Agriculture, calls California’s “latest misery.” California has spent eight of the last 11 years in drought, with the last three years being the driest such period on record, state officials said in October. Human-caused climate change – which is raising global temperatures and making much-needed rain and snow less frequent in the West – is contributing to the severity, Rippey said.

“The impacts are multiplying. You have these droughts piling on top of droughts with cumulative impacts,” including wildfires, he added.

To supplement the dwindling groundwater supply in Tooleville, officials in Tulare County and nonprofits like Self-Help deliver five-gallon water jugs to the residents for drinking and 16,000 gallons of hauled water into tanks for washing their clothes, doing dishes and taking showers.

There’s so much demand in the warm months for the hauled water that a 16,000-gallon delivery lasted some communities just a few hours before needing to be refilled, Snyder said.

“We literally cannot pump the water out of the tanker trucks fast enough to fill the storage tanks,” she added. “We can’t ever get ahead of it; physics is against us. It’s nuts and really stressful.”

California’s extreme heat wave this summer pushed water usage even higher as residents watered grass and farms pumped more for crops. In Tooleville, Cuevas watched as the orange and lemon trees in his yard withered and died. Outdoor watering restrictions meant he couldn’t save his trees, even as some of his neighbors flouted the restrictions with noticeably green lawns.

“Everything just perished,” Cuevas said. “It’s not a good feeling to see other people enjoying [the water], while you’re doing your part.”

Seeing the nearby Friant-Kern Canal every day – which carries melted snowpack water from Northern California to Central Valley farms – is a nagging reminder of what his family doesn’t have.

“It’s terrible,” Cuevas told CNN. “Just joking, I’d say I’ll go out there and put a hose [in it] running right back to my house.”

Tooleville resident Maria Olivera has lived in town since 1974.

Olivera cooks with bottled water.

As Cuevas’s own trees died, commercial farms in the area were still producing – although their future is also uncertain. Farms are also having to drill deeper wells to irrigate orange groves and acres of thirsty pecan and pistachio trees.

With this rush on groundwater, shallow residential wells don’t stand a chance. In West Goshen, a small town that sits outside McCarthy’s district in Tulare County, resident Jesus Benitez told CNN he burned through three well pumps – costing $1,200 a piece – during the warmer months when his neighbor, a farmer who grows alfalfa and corn, started irrigating his crops.

“They’ve got the money to go every time deeper and deeper in the ground; we don’t have that luxury,” Benitez said.

Two town wells in nearby Seville nearly ran dry this summer, said Linda Gutierrez, a lifelong resident who sits on the town’s water board. Across the street from the town’s wells is a pistachio farm, and when they start irrigating, the groundwater level plummets, she said.

But she doesn’t blame the farmers. Like many who live in the area, her husband is a farm worker. There’s a lot of pride in the region’s far-reaching agriculture, and many feel it should be sustained.

“You can’t not have farmers because you need food, but we have to have water in order to survive,” Gutierrez said. “There’s a very tricky balance to establish. Right now, if they don’t irrigate, we have water, but also a year from now we have no food.”

As big of a societal problem as drought and water shortages are, they are also intensely personal. Self-Help’s McVay gets emotional when talking about school children in the area getting beat up because they don’t have clean clothes or ready access to a shower.

“They don’t have water in their homes to take baths, or brush their teeth, or have clean laundry, and they’re getting bullied,” she said. “Being made fun of because they’re taking baths at the local gas station bathroom. It’s not fair – the stress that it causes the parents because [they] start to feel like they’re failing as a parent.”

Multiple local and state elected officials and leaders of nonprofits focusing on water delivery in the San Joaquin Valley said McCarthy isn’t engaged enough on what they consider one of his district’s most dire crises.

McVay said outreach from McCarthy’s office on dry residential wells is “slim to none, and I am not saying that to discredit them at all.”

“I have had more conversations, more engagement and just more wanting to know how they can assist from Congressman Valadao and his office than probably any other on the federal side,” McVay added.

Snyder said Rep. David Valadao, a Republican representing neighboring Kings County as well as portions of Tulare and Kern, and his staff “will show up in a community at the time of a crisis” and are actively engaged on how they can support efforts to get people water.

Other members of Congress, including Democratic Rep. Jim Costa and Republican Connie Conway, who left office earlier this month, have also been more accessible and engaged on the issue, Snyder said.

“Kevin McCarthy, no,” Snyder added.

While McCarthy is popular in his district and influential among California and Central Valley Republicans, California state Sen. Melissa Hurtado, a Democrat who represents parts of the San Joaquin Valley plagued by drought, told CNN there are concerns that McCarthy’s ambition for House speaker has superseded his district’s needs.

“He’s focused on that leadership position instead of actually working on issues to address the impacts of his district,” Hurtado told CNN. “Quietly, the word out there is it’s been a while that he’s actually delivered something for the region, given his focus on the leadership position. Maybe that’s part of his greater vision for helping this region out.”

McCarthy’s office did not respond to questions about how he’ll use his position as House speaker to address climate change-fueled droughts in California and around the nation. Nor did it respond to the critiques about his lack of engagement.

“The Leader has consistently worked in a bipartisan, bicameral fashion to deliver this life-giving resource for the families, agriculture producers and workers, and communities in the Central Valley and throughout California, and our Republican congressional delegation heavily relies on his steadfast leadership and decades of expertise when crafting their own pieces of water legislation,” McCarthy’s spokesperson Martinez told CNN in a statement. “When Democrats have held the majority, they time and time again blocked the progress and innovation of their House GOP colleagues.”

In July, McCarthy spoke on the House floor about Tooleville’s plight, seeking to set up a federal grant program to help connect it and other small towns to larger cities’ water supply.

“In our district, the community of Tooleville has run out of water as the groundwater table drops and aging infrastructure fails or becomes obsolete,” McCarthy said at the time. “Tulare County advises me that if California’s droughts continue, more small and rural communities in our district with older infrastructure could meet the exact same fate.”

McCarthy’s measure authorized a grant program but didn’t contain any funding. And even though the bill passed the House, it died in the Senate, and it’s unclear whether it will come up again in the new Congress.

Connecting Tooleville’s water infrastructure with that of nearby Exeter has been a decadeslong pursuit that is finally close to happening thanks to a state mandate and funding. The project will mean more reliable and cleaner water for residents like Cuevas. But it’s expected to take eight years for the two systems to fully merge.

McCarthy is also co-sponsoring a bill with Valadao that would enlarge certain reservoirs and kickstart construction on a new reservoir in the Sacramento Valley. But some nonprofit leaders and local officials say these solutions would prioritize agriculture over residents.

“We need more solutions beyond storage and dams,” said Susana De Anda, executive director of the San Joaquin Valley-based environmental justice nonprofit Community Water Center. “[McCarthy] lacks understanding of the real critical problems we’re experiencing around the drought and our communities.”

Seeking to attract younger voters concerned about climate change to the Republican Party, McCarthy last year convened a Climate, Energy and Conservation Task Force to develop the party’s messaging and policies around the issue. And House Republican delegations have attended the last two United Nations climate summits.

But all indications suggest that addressing human-caused climate change is not going to be a focal point of McCarthy’s now that he has the speaker’s gavel. McCarthy and House Republicans have shown they don’t want to move away from planet-warming fossil fuels, and few in the party are willing to connect global temperature rise to worsening droughts and extreme weather.

McCarthy dissolved Democrats’ Select Committee on the Climate Crisis, and he has vowed to investigate Department of Energy grants for electric vehicle components, as well as alleged “collusion” between environmental groups and China and Russia to “hurt American Energy,” according to a recent statement.

“Our representatives don’t talk about climate change; it’s a real problem,” De Anda said. “Climate change is real. Our communities are the canaries in the coal mine. We get hit first.”

It’s part of the reason Cuevas is hoping to move away in a couple years. He’s hopeful the water situation will improve by connecting Tooleville to a larger town’s water system; otherwise, he’s afraid he won’t be able to entice another buyer due to the water issues.

“I’m happy I had a chance to buy it, but we are planning to move,” Cuevas told CNN. “Right now, if I try, I ain’t going to get nothing, not even what I paid for the home.”

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January 21, 2023
Opinion: A New Year’s resolution we all need to embrace | CNN

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Editor’s Note: Sophia A. Nelson is a journalist and author of the book “Be the One You Need: 21 Life Lessons I Learned Taking Care of Everyone but Me.” The views expressed in this commentary are her own. View more opinion on CNN.

CNN
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It’s the start of another year, and we are still working our way through a once-in-a-generation, life-changing pandemic almost three years after it began. We’ve all been affected by Covid-19’s scourge of sickness, hospitalization, death, loneliness, isolation, work dislocation and family disruption. Perhaps, like me, you even got sick with the coronavirus and are living with its long-term effects.

When Covid-19 hit, workers in teaching, nursing, hospitality and retail — occupations where women predominate — bore a fair part of the burden associated with the disease. And no group felt this more acutely than Black and brown women.

Women struggle to balance self-care against filling the needs of their families. But for Black women, juggling those competing needs often comes against a backdrop of intergenerational trauma and suppression of their emotions.

In the Black community, women have perfected obsessive selflessness to an art form. We end up exhausted, emotionally drained — and in many cases, unhealthy — because we are conditioned to serve the needs of others and display superhuman strength — to our own detriment. I have lost friends, sorority sisters and mentors to hypertension-induced strokes, heart attacks, diabetes complications and plain old exhaustion from a lack of meaningful self-care.

The effects of environmental stress on Black women are severe. One study found that by the time a Black woman reaches her 50s, the toll of stress on her body has resulted in an additional seven years of biological aging compared with White women. Black women are more likely to die from breast cancer, heart disease and diabetes, too.

Northwestern University clinical psychologist Inger Burnett-Zeigler addressed the downside of viewing the strong Black woman as a “cultural icon” in her book, “Nobody Knows the Trouble I’ve Seen: The Emotional Lives of Black Women.”

“Some Black women do not have the necessary tools to cope with their feelings in a healthy way and, as a result, may engage in unhealthy coping strategies such as eating unhealthy foods, drinking alcohol, using illicit drugs, being sedentary or a workaholic. While these behaviors may offer a Band-aid to the problem, they are not a long-term solution,” she said in an interview discussing the work that was published last year.

In short, for Black and brown women, focusing on self-care is a matter of survival. But some of us needed the additional wake-up call that came from confronting the pandemic.

My own Covid-19 journey started in February 2020 when I came down with an early case before we had testing or vaccines. I contracted the disease while speaking at a conference in Louisiana. I was sick for a week with a high fever, respiratory distress and other complications.

I got a second, milder case in August 2021 after being vaccinated and boosted. I was lucky enough not to have to be hospitalized during either episode, but I still suffer the effects of long Covid-19, including some heart valve damage and residual issues with my right lung. Living with these infirmities means prioritizing the vital self-care I might otherwise have ignored.

By self-care, I don’t mean going to the beach or taking a vacation. That is respite.

The kind of self-care I want to see Black women practice is the kind that liberates the soul. The kind that allows us to be our authentic selves. The kind that frees us to wear our hair how we want, to speak our truths, to seek healthier romantic partners and build better friends. And it’s the kind of self-care that lasts a lifetime.

The good news is that despite the heaviness of our times, we see examples of prominent Black women saying enough is enough — it’s time to put our wellness first. Women such as Olympic gymnast Simone Biles, tennis star Naomi Osaka and actress Taraji P. Henson have spoken openly about the importance of their mental health to their overall well-being.

As a Black woman now in her 50s, it took me years to learn that although my family and friends matter, I matter most of all. I’ve learned that I have a right to joy, to peace and to self-care, too. I wrote about those hard-knock lessons in my fourth book, “Be the One You Need.”

My hope was that by sharing just a few of my own life experiences, I can help educate and inspire a new generation of Black girls and women to embrace lives filled with self-care, hope, joy, physical and emotional wellness.

But even if you’re neither Black nor a woman, these lessons can benefit you as well. Start by asking yourself three important questions: What do I want? What do I need? How am I really feeling? Your inner voice will provide the answers. Trust that you will find the courage to follow through on the wisdom you already possess.

Here are three more things to bear in mind as you focus on your emotional wellness this new year:

1. Self-care is a life strategy for success. It’s about setting healthy boundaries and ensuring that those boundaries are respected by others. It requires that you change you first and that you accept you can never change others.

2. Prioritize your mental and emotional health above all else. You’re no good to anyone if you’re not good to yourself. Your mental and emotional well-being is one of the many “health verticals” you must tend to, just as you might regularly monitor your weight, heart health or blood pressure.

3. “No” is a complete sentence. This one has really saved me a lot of heartache, unspoken resentment and time. I no longer do the things I do not want to do, to please others. I reserve my energy for only those things and people that are worth my energy.

Women in general, and Black women specifically, often find it hard to say no. But it’s what you sometimes must do, even when your kids have endless requests, your boss has demands, and friends who have supported you in the past are in a crisis. And the reason for centering your own needs is implied in the subtitle of my book “Life Lessons I Learned Taking Care of Everyone but Me.” It’s simply not sustainable.

Generations of Black women have watched our mothers, grandmothers and aunts do, give, run, lift, build up, sacrifice, protect and offer up themselves to anyone and everyone in need. This new year, we all have an opportunity to do better for ourselves.

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January 1, 2023