April Health And Fitness Tips.
Enter April Health And Fitness Tips.
April Health And Fitness Tips.
November 24, 2024
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Health - The New York Times, NYT > Health
No commentsNovember 23, 2024RoseHealth - The New York Times, NYT > HealthNo commentsNovember 23, 2024RoseHealth - The New York Times, NYT > HealthNo commentsNovember 23, 2024RoseHealth News, KFF Health NewsNo commentsKFF Health News chief Washington correspondent Julie Rovner discussed President-elect Donald Trump’s announcement that he will nominate former TV host Mehmet Oz to lead the Centers for Medicare & Medicaid Services on WBUR’s “Here & Now” on Nov. 20. Rovner also discussed what it could mean for Robert F. Kennedy Jr. to run the Department of Health and Human Services on NPR’s “All Things Considered” on Nov. 15.
KFF Health News correspondent Cara Anthony discussed the “Silence in Sikeston” project on St. Louis Public Radio’s “St. Louis on the Air” on Nov. 19.
KFF Health News senior correspondent Noam N. Levey discussed medical debt on The Pew Charitable Trusts’ podcast “After the Fact” on Nov. 15.
KFF Health News contributor Andy Miller discussed dental implants on WUGA’s “The Georgia Health Report” on Nov. 15.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
This story can be republished for free (details).
November 22, 2024RoseHealth - The New York Times, NYT > HealthNo commentsNovember 22, 2024RoseHealth News, KFF Health NewsNo commentsMedicare officials are pushing back against a federal watchdog’s call to crack down on home visits by Medicare Advantage health plans — a practice the watchdog says may waste billions of tax dollars every year.
In late October, a Health and Human Services inspector general audit found that the insurers pocketed $7.5 billion in 2023 from diagnosing health conditions that prompted no medical services — about $4.2 billion of it through the health assessments done in patients’ homes.
Assistant Inspector General Erin Bliss told me the plans are raking in billions of dollars without providing any treatment for medical conditions the plans flagged during the visits, including serious diseases such as diabetes and major depression.
But the power to curb billing tied to home visits rests with regulators at the Centers for Medicare and Medicaid Services, who appear unmoved by the OIG’s criticism.
In a statement to KFF Health News by spokesperson Alexx Pons, CMS said it “appreciates the OIG’s review in this area” and will keep studying the issue.
In a formal response published in the audit report, CMS said it disagreed with the watchdog’s call to restrict use of home health assessments in computing how much to pay health plans. People on Medicare “should have access to care that is appropriately provided in the home setting,” CMS wrote.
That’s just fine with the insurance industry. The OIG drew “inaccurate conclusions,” said Heather Soule, a spokesperson for UnitedHealthcare. The insurer is the largest Medicare Advantage contractor and accounted for about two-thirds of the payments tied to home visits and related data mining of patient files cited in the audit.
The home visits are “among the most comprehensive and thorough assessments of a patient’s health and physical environment available in the health-care system, helping to identify and drive needed follow-on care for the vast majority of the patients with whom we engage,” Soule said in the statement.
Medicare Advantage plans serve more than 33 million Americans, more than half of the people eligible for Medicare.
Government spending on the program, which is dominated by a handful of private health insurance companies, is expected to hit $462 billion this year. The industry argues that most Medicare Advantage enrollees are satisfied with the care they receive and typically pay less out-of-pocket than those enrolled in original Medicare.
But critics of the program point to years and years of federal audits, whistleblower lawsuits and other investigations revealing that many health plans exaggerate how sick patients are to boost their payments.
This article is not available for syndication due to republishing restrictions. If you have questions about the availability of this or other content for republication, please contact NewsWeb@kff.org.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
This story can be republished for free (details).
November 22, 2024RoseHealth News, KFF Health NewsNo commentsLetters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.
Relating to Relatives of Lonely Dementia Patients
I was sent the article by Judith Graham on older adults with dementia living alone (“Going It Alone: Millions of Aging Americans Are Facing Dementia by Themselves,” Oct. 15). I appreciate this article. My mom lives alone with dementia. My son lives next door and checks on her, and my daughter comes when she is able to vacuum floors and to scrub the kitchen and bathroom. I handle the bills, clean and change her clothes, wash her clothes, search for mail, and bring in groceries. She refused to allow the home health aide in, which complicates the care schedule. Neighbors watch out for her, including police at the station across the street. It is complex and complicated for caregivers. Applying for Medicaid is a nightmare, as is searching for memory care facilities. The thought of actually moving her is heartbreaking and so stressful. Again: Thank you for sharing that others with dementia are living on their own.
— Gail Daniels, Washington, D.C.
On the social platform X, a reader drew on her own experience:
Having cared for my mom toward the end of her journey with dementia, this is terrifying.For many elders, there is no family to cushion the insults of dementia and cognitive decline.https://t.co/LTZ76Ojgwg
— Shava Nerad – @shava23@bluesky 🌻 (@shava23) October 19, 2024
— Shava Nerad, Arlington, Massachusetts
Bonding — To the Letter
Thanks a million! I read your article “Going It Alone: Historic Numbers of Americans Live by Themselves as They Age” (Sept. 17) in the Las Vegas Review-Journal and related to it on a major level. As a senior living alone, I am experiencing some of the same “social isolation” expressed by your interviewees. Since I love to write, I thought it would be interesting to involve some of the persons mentioned in a nationwide pen pal association. This would place very little demand on their budget (other than postage and stationery), on their time, and with little or no travel involved.
It is breathtakingly exhilarating to receive a letter from a friend or relative, a package from anywhere, and experience the reward of sitting down and reading good news from afar.
I appreciate our advances in technology and I use it rather sparingly. However, I come from a generation that writes in cursive, knows the five elements of letter writing, and understands what a return address is and where it’s positioned on an envelope.
— Gloria Rankin, Las Vegas
A specialist in health economics and policy tweeted praise:
Historic Numbers of Americans Live by Themselves as They Agehttps://t.co/lwpfrhJauWImportant, impactful story by superb @judith_graham
— Paul Hughes-Cromwick (Pooge) (@cromwick) September 17, 2024
— Paul Hughes-Cromwick (Pooge), Ann Arbor, Michigan
On X, a group of interdisciplinary faculty representing Johns Hopkins University shared KFF Health News’ coverage about racial bias in the development and use of pulse oximeters:
In a @KFFHealthNews article, BDP @iwashyna explains how we move forward from the racial bias of our current pulse oximeters.https://t.co/dmhqzoAfmK
— Bloomberg Distinguished Professors (@JHU_BDPs) October 23, 2024
A Slap on the Wrist for Pulse Oximeters
Between 1983 and 1988, I had four sons at Stanford Hospital. I was friends with Eben Kermit, who was a bioengineer. He was developing the original pulse oximeter on babies in the neonatal intensive care unit (“Systemic Sickness: FDA’s Promised Guidance on Pulse Oximeters Unlikely To End Decades of Racial Bias,” Oct. 7). He tested only white babies. That is because white parents could come to the NICU in the daytime, which is when Eben was at work in the NICU. Black parents could come only at night because their work wouldn’t give them time off to care for a very sick baby. Since no one was there to sign consent forms, at night, with the Black parents, no Black children were included. Discrimination against Black parents by their employers is continuing to cascade through the Black community through the exclusion of Black people from the development of medical technology.
— Zoe Joyner Danielson, a toxicology biologist, Woodland, California
This X post came from a consulting and training firm that focuses on health equity issues:
Reforms are needed ASAP—these devices have harmed so many #Black patients.FDA’s Promised Guidance on Pulse Oximeters Unlikely To End Decades of Racial Bias https://t.co/5R9LH5XyTI by @ArthurAllen202 @kffhealthnews CC: @NohaAboelataMD @mlipnick @iculung @djcantillonmd @iwashyna pic.twitter.com/yliCxMdRvG
— HealthBegins (@HealthBegins) October 10, 2024
What’s All This Fuss About Fluoride?
No one seems to address the fact that not everyone drinks water from public water systems (“Does Fluoride Cause Cancer, IQ Loss, and More? Fact-Checking Robert F. Kennedy Jr.’s Claims,” Nov. 18). I see many people buying bottled water by the trunkful, or have a water fountain at home with 5-gallon bottles of purified drinking water, or have reverse osmosis water filtration systems installed at their sink.
So even if RFK Jr. removes fluoride from public water systems, I can’t see that there would be a drastic increase in dental issues. Also, when you get your teeth cleaned at the dentist, they give you a fluoride treatment (unless you opt out). So on this issue of removing fluoride, would this be a drastic issue knowing that many now are not getting fluoridated water?
— Suzann Lebda, Sun Lakes, Arizona
Hitting the Paywall
Why does your newsletter link to articles with paywalls? As an example:
The Oct. 18 aggregation “Former Medicare Chief Warns About Medicare Advantage Pay Rates” links to Stat News, where the article cannot be read without a subscription. If you are doing this as a means to provide subscribers to them, too bad.
In any case, this practice does not represent your organization well since it supports the trend that only those who can afford it get to be informed. I hope you reconsider this practice.
The financial barriers to accessing important information are hurting us as individuals and as a society. It is expensive for most people to have access to a mainstream publication, but it gets cost-prohibitive to have access to multiple points of view, to learn, reason, and make up our own minds. In most cases, the only alternative available is to get “bites of information” from the “free” social media. The results are as one would expect: We become less aware of what is really going on as we are guided into silos of ignorance.
Thank you.
— Carl Loben, Bellevue, Washington
On X, a technology journalist in Spain shared the article about pregnant people being asked by their providers to pay out-of-pocket fees earlier than expected:
Pay first, deliver later: Some pregnant people are being asked to prepay for their baby https://t.co/NLWTeawgnk
— José María López (@gilead1984) November 16, 2024
— José María López, Badalona, Spain
A New Generation of Health Plans Overdue
The recent article “Pay First, Deliver Later: Some Women Are Being Asked To Prepay for Their Baby” (Nov. 15) effectively highlights the emotional and financial uncertainty facing providers and patients. I commend the author for capturing how this uncertainty, rooted in empathy and fairness, must be better understood and addressed.
I write to draw attention to market trends and federal legislation aimed at alleviating this issue. Until recently, health plans considered the out-of-pocket experience as definitionally out-of-scope, leaving patients, and providers, to manage this growing uncertainty on their own.
The evidence shows that it is possible to build a more pragmatic and empathic out-of-pocket experience into a health plan, improving care accessibility and affordability without removing patient responsibility. This approach has been proven, across thousands of employer health plans, to feel better and financially benefit everyone — patients, providers, and plans (employers/insurers).
On Oct. 15, 2024, the Medicare Prescription Payment Plan launched, offering nearly 54 million Americans the option to have their insurer pay their out-of-pocket expenses upfront at the point of service giving members time to review and repay the balance — without interest or fees. If the patient in the article had a health plan with this capability, her OB-GYN would have been paid, on her behalf, by her insurer. She would have received a simple monthly statement to repay in full or over time from the comfort of her home. Everyone benefits and it is a better member experience.
This new, bipartisan, commonsense improvement to one of health care’s most acute pain points is rapidly expanding as employers and insurers realize there is significant actuarial value, provider savings, and member behavior change caused by improving a person’s ability to pay for care.
Brian Whorley, Columbia, Missouri
An associate professor in the health care leadership program at Rockhurst University’s Helzberg School of Management also shared the article on X:
Pay First, Deliver Later: Some Women Are Being Asked To Prepay for Their Baby https://t.co/QEnX8GA3Ih via @kffhealthnews
— Prof. Jim Dockins (@DrDockins) November 15, 2024
— Jim Dockins, Kansas City, Missouri
On Hospital Gatekeepers and Tolls
In regards to the article “Pay First, Deliver Later: Some Women Are Being Asked To Prepay for Their Baby” (Nov. 15): Back in 1992, the hospital where my son was going to be delivered required that the projected copay be paid to them one month before the delivery date or my wife would not be admitted (a Catholic hospital, very charitable).
My wife was born at the same hospital in 1963; at that time, my father-in-law was informed by the hospital that he could not take her home until the bill was paid in full. He contacted a friend who was an attorney who told him to let the hospital know that would be considered kidnapping and that he would be calling the police if they didn’t release her.
— Andrew McGovern, Great River, New York
Taken Advantage Of?
I belong to a Blue Cross Blue Shield Medicare Advantage plan and, for the past several years, it has offered a home assessment with a reward of $25. I have participated in the program in the past but declined this year since I didn’t think there was much value to the program. I am a retired registered nurse, and I felt that the nurse who did my assessment did not do an especially thorough job, and any questions I asked of her, she could not answer. The nurse was also from out of state.
After reading your article on “The Medicare Advantage Influence Machine” (Sept. 30), the reasons for the assessment seem to be more than improving the beneficiary’s health and well-being, which is what I believed. I am relatively healthy and active, so it would not appear that BCBS found any new diagnoses that it could bill Medicare for, but I assume that that is not the case with other seniors.
— Bruce Gilman, Millis, Massachusetts
An economist in Florida had this to say on social media:
Thank you @KFFHealthNews for pointing out the failed bureaucracy @CMS I’ve been talking about for years. You can’t read this and not conclude DC bureaucrats are “captured” and policy makers are beholden to Medicare Advantage lobby money. #WhoWillCarehttps://t.co/rDGg8juoop
— Luke Neumann (@pglukeneumann) September 30, 2024
— Luke Neumann, St. Petersburg, Florida
In Defense of Deloitte
On March 12, 2024, in good faith and with respect for KFF Health News, Deloitte’s health and human services practice leader provided a 90-minute interview with two reporters for a story they said was about “problems with Deloitte’s eligibility systems across the country.”
We agreed to the interview because we had heard from several of our state clients that they, too, had been contacted, and that the questions being raised showed a misunderstanding of integrated eligibility systems, the technology that sustains them, and the complexity of the health and human services programs they support.
The eligibility systems are owned by the states, not Deloitte; they are uniquely built for each state (in some cases, by other vendors decades ago); and we work at the direction of our clients to maintain and enhance these systems to comply with state-specific policies, rules, and processes, and evolving federal regulations.
Two stories subsequently ran: “Medicaid for Millions in America Hinges on Deloitte-Run Systems Plagued by Errors” (June 24) and “Errors in Deloitte-Run Medicaid Systems Can Cost Millions and Take Years To Fix” (Sept. 5).
Many of the issues reported as “widespread” are isolated to specific situations or involve sensitive data that cannot be refuted by Deloitte due to client confidentiality obligations. That said, there are many reasons why someone may lose coverage or no longer be eligible for a benefit they once received.
Not every “issue” a constituent faces is the result of a system “error,” and challenges with individual cases in individual systems are not due to some fundamental problem in the way Deloitte supports state Medicaid programs.
On the issue of contract changes, Deloitte rejected the claim in March that our state clients send us a “change request … when a fix is needed.” We said that was inaccurate and explained that when there are policy or rule changes — or a global pandemic — that require modifications to a state’s technology, change orders are not only necessary but appropriate.
They do not represent errors in a system that need to be fixed.
Throughout the unwinding of the covid-19 public health emergency — as technologies evolved and policies changed — Deloitte worked closely with states to minimize challenges for those going through the Medicaid redetermination process. The innovations and human-centered design processes we helped our clients implement enhanced the digital experience for their constituents and made it easier for caseworkers, staff, and community partners to support the 34 million people in their care.
Our clients understand that large system implementations are challenging due to the complexity of the programs they support, and that all IT systems require ongoing maintenance, periodic enhancements and upgrades to software and hardware, and database management.
That is why so many states continue to select Deloitte to help them maintain their mission-critical systems, and why industry analysts like Forrester and Gartner consistently rank Deloitte as a leader in system integration and business transformation.
— Karen L. Walsh, Government & Public Services, Deloitte Consulting LLP, Harrisburg, Pennsylvania
[Editor’s note: KFF Health News stands by its reporting on Deloitte and the state eligibility determination systems that Deloitte supports.]
An assistant professor at Harvard voiced her opinion on X:
This is such a grim summary of the state of Medicaid eligibility and enrollment systems https://t.co/3hpVnJdPOm pic.twitter.com/Gdi2AF1pyr
— Adrianna McIntyre (@adrianna.bsky.social) (@onceuponA) September 5, 2024
— Adrianna McIntyre, Boston
Far Less Than Meets the Eye
I read your article about the new $2,000 limit for out-of-pocket payments for Medicare Part D (“Medicare Drug Plans Are Getting Better Next Year. Some Will Also Cost More,” Oct. 21). As someone with very high drug costs, I was very excited about this change. However, once I researched the different drug plans available for me and my husband, I realized that the money we spend on drugs that are prescribed by a doctor but not covered by our plan will not count toward the $2,000 limit. Therefore, our cost for necessary drugs will continue to be exorbitant.
I think that there are many seniors who will be very disappointed once they realize this.
— Pia Stampe, Eureka, California
In sharing the article on X, a Florida attorney simply shared their contact information:
"Medicare Drug Plans Are Getting Better Next Year. Some Will Also Cost More:"https://t.co/9uEjVxTSGb Grady H. Williams, Jr., LL.M., Attorneys at Law P.A. 1543 Kingsley Avenue, Building 5 Orange Park, FL 32073 Tel: 904-264-8800 • Fax: 904-264-0155
— Grady H. Williams (@floridaelder) November 9, 2024
— Grady H. Williams, Orange Park, Florida
Shedding Light on Fluorescence in Dental Care
Congratulations on a highly impactful publication (“Dentists Are Pulling ‘Healthy’ and Treatable Teeth To Profit From Implants, Experts Warn,” Nov. 1). The facts presented are harrowing for a retired practitioner with multiple specialties who tried a lifetime to preserve teeth and promote human health.
As you might know, oral biofilm is the biggest enemy of oral health and even general health. Dental clinicians have not been able to visualize and identify the presence of pathogenic oral microbiome until recently. Pathogenic oral bacteria are among the significant generators of hard and soft tissue deterioration, such as tooth decay, gum diseases, and even infection of dental implants. The most trusted and used diagnosis procedure is still the X-ray.
X-rays can identify only established diseases. Unfortunately, radiologic diagnosis is still the most trusted diagnostic tool used and taught in dental education.
Microbiology, the microbiome science, utilizes fluorescence as its major identification procedure. Some of the most aggressive oral bacteria, generators of caries, gum diseases, etc., generate so-called porphyrins, which, once excited by a specific wavelength, emit light at a different wavelength. Highly reliable and simple-to-use technologies have been created recently to support direct visualization and point-of-care identification of this pathogenic bacteria through the above-described procedure. These devices support the diagnostic process and help the dental clinician by guiding the treatment execution and identifying when the treatment goal has been achieved. Dental treatment protocols utilizing “Fluorescence-Enhanced Theragnosis” have become reliable and less invasive.
The high loss of human lives in the ICUs during the pandemic due to ventilator-associated pneumonia could have been dramatically reduced using the above protocol.
Wound-care science has already implemented fluorescence and is undergoing a tremendous protocol change. Tumor surgery celebrates fluorescence-guided surgery as a milestone in its development.
Academic dental education is due for an urgent renewal. We must open the doors and facilitate science translation to benefit humankind!
— Liviu Steier, Needham, Massachusetts
A reader who manages a website predicting the collapse of the American health care system commented on X:
https://t.co/JTFn1h12rc 🙄😠👎Technically, American dentistry was once ranked as the best in the world. Unfortunately, It has a history of mismanagement and negligence. It’s a “reputational good” that’s been flooded with scams. Now it’s payback time. It’s demonstrating the…
— Francis Anthony Toto (@francisatoto) November 2, 2024
— Francis Anthony Toto, San Diego
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
This story can be republished for free (details).
November 21, 2024RoseHealth News, KFF Health NewsNo commentsNearly a year after the Biden administration gave Florida the green light to become the first state to import lower-cost prescription drugs from Canada — a longtime goal of politicians across the political spectrum, including President-elect Donald Trump — the program has yet to begin.
Florida Gov. Ron DeSantis hailed the FDA’s approval of his plan in January, calling it a victory over the drug industry, which opposes importation on the grounds that it would lead to a surge in counterfeit medications.
A Florida health official familiar with the importation program told KFF Health News there was no planned date yet for the state to begin importing drugs. The official asked not to be identified because they weren’t authorized to speak publicly about the program.
Florida applied to create an importation program in November 2020, just months after the Trump administration gave states the option. DeSantis, a Republican, complained publicly for years about the pace of the federal approval process under the Biden administration and in 2022 filed suit against the FDA for what he called a “reckless delay.”
Trump touted his administration’s move to bring medicines over the border in a preelection interview published last month by AARP, the advocacy group for older Americans, which supports allowing Americans to buy drugs from Canada. He vowed to “continue my efforts to protect Americans from unaffordable drug prices” in a second term.
It’s not clear whether his second administration will or can do more to help Florida and other states set up programs, because it’s ultimately up to the states to act. Colorado is the only other state that has an importation plan pending with the FDA.
DeSantis administration officials have refused for months to answer questions from KFF Health News about the program. Alecia Collins, deputy chief of staff for the Florida Agency for Health Care Administration, said in October that officials were traveling and unavailable. In mid-November, she said she still had no answers.
DeSantis press secretary Jeremy Redfern said he had been “slammed” since the first week of November and could not answer questions.
FDA spokesperson Cherie Duvall-Jones said she could not answer whether Florida had submitted documents the agency requires before the state can start importing medicines. She referred all questions to the state.
Drug companies typically sell medications for far less in Canada than in the United States, as a result of Canadian government price controls. But because of safety and efficacy concerns, federal law prohibits consumers from buying drugs from outside U.S. borders except in rare cases.
Politicians ranging from conservatives such as DeSantis to liberals such as Sen. Bernie Sanders of Vermont have long pushed for importing lower-cost prescription drugs from Canada.
In 2000, Congress passed a law allowing states to import prescription drugs from north of the border, with the caveat that it could go forward only if the secretary of the Department of Health and Human Services affirmed it was safe. That didn’t happen until 2020, when Trump’s HHS secretary, Alex Azar, made such a declaration.
Since 2022, Azar has been chairman of the board at LifeScience Logistics, a Dallas-based company that Florida is paying millions of dollars to set up its drug importation program, including warehousing its medicines.
Azar on Nov. 13 refused to answer questions from KFF Health News about drug importation, saying he wasn’t authorized to speak on the matter.
Florida’s program would not directly assist consumers at the pharmacy. It’s instead aimed at lowering costs for the state Medicaid program and for the corrections and health departments.
Matthew Baxter, a senior director at Ontario-based Methapharm Specialty Pharmaceuticals, which has contracted with LifeScience to export drugs, would not say whether Methapharm has sent any medicines over the border.
The pharmaceutical industry and the Canadian government oppose U.S. drug importation. Drug companies say importation would increase the risk of counterfeit drugs appearing on U.S. pharmacy shelves, while the government in Ottawa has warned it won’t allow medicines to be exported if Canadians could experience shortages as a result.
Florida’s predicted savings would also be relatively minor. DeSantis estimated the program would save state agencies up to $180 million in its first year. Florida’s annual Medicaid budget tops $30 billion.
Florida identified 14 drugs, including for cancer and AIDS, that it would attempt to import from Canada for its state agencies.
Camm Epstein, a health policy analyst in Saratoga Springs, New York, said drug importation is a seemingly simple concept that resonates with the public, which is why DeSantis and others have turned to the idea as a response to rising drug prices. “It riles up the crowd,” he said. “Who doesn’t want to pay lower drug costs?”
But bringing drugs over the border is complicated because of the FDA’s many requirements, including finding companies to work with — a Canadian exporter and a U.S. importer — and following a process that ensures the drugs are authentic, Epstein said.
“This was, at best, a boondoggle,” he said.
Florida has spent tens of millions of dollars to stand up its drug importation program. The state has already paid LifeScience Logistics $50 million to set up a warehouse to store the medicines. DeSantis noted the costs in his 2022 lawsuit against the FDA.
“Plaintiffs have paid their retained importer and distributor over $24 million thus far — and increasing at the rate of $1.2 million every month — even though not a single prescription pill has been imported, relabeled, or distributed, solely because of the FDA’s idleness,” the state said in its suit.
Florida’s delay may be due to operational challenges, Epstein said. “Predictably, even if they turned on the spigot there would be no flow, because Canada was not going to permit for the supply,” he said.
Colorado and Florida are among at least nine states that have passed laws allowing for Canadian drug importation. Colorado’s 2022 application to the FDA is still pending. In December 2023, Colorado officials released a report noting the state was unable to find a drugmaker willing to sell it medicines from Canada.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
This story can be republished for free (details).
November 21, 2024RoseHealth News, KFF Health NewsNo commentsA California agency charged with slowing health costs has set a lofty goal for insurers to direct 15% of their spending to primary care by 2034, part of the state’s effort to expand the primary care workforce and give more people access to preventive care services.
The board of the state Office of Health Care Affordability in October set its benchmark well above the industry’s current 7% primary care spending rate, in hopes of improving Californians’ health and reducing the need for costlier care down the road.
“It’s ambitious but achievable,” said Elizabeth Landsberg, director of the state’s Department of Health Care Access and Information, which oversees the affordability agency. “Plans and health systems need time to build the infrastructure to really change the way they’re providing care.”
But California’s target comes just six months after the affordability board set an annual cap of 3.5% for overall growth in health care spending, potentially squeezing insurers from two sides.
“How these two policies will interact is unclear and we believe it is important to not lose sight of our overall goal of reducing the growth of health care costs,” Mary Ellen Grant, a spokesperson for the California Association of Health Plans, said in a statement.
The affordability agency argues health plans are best positioned to promote more spending on preventive care services, since insurers are the ones that negotiate payment with providers. Landsberg said health plans could dangle incentives, such as offering higher reimbursement rates for primary care providers or paying for comprehensive care instead of for individual visits.
If successful, the agency says, the spending target could expand the primary care workforce through the hiring of staff and lead to better health management, disease prevention, and early diagnosis and treatment for more patients across the state.
California faces a shortage of primary care providers, which has limited people’s access to preventive care. Approximately 6 million Californians live in parts of the state where there aren’t enough doctors to meet people’s needs, according to a data analysis by KFF, a health information nonprofit that includes KFF Health News.
A 2021 report by the National Academies of Sciences, Engineering, and Medicine found that while more than 35% of health care visits in the U.S. are to primary care physicians, only about 5% of health spending is on primary care. That’s compared with about 13% for some other developed nations.
“People have high regard for primary care, understand how important it is,” said Kevin Grumbach, a professor of family and community medicine at the University of California-San Francisco who helped develop the state’s primary care target. “They way overestimate how much of their tax dollars are actually going to support primary care.”
Beginning next year, the affordability agency will start collecting data on how much health plans spend annually on primary care, particularly in settings such as community-based clinics, schools, and homeless shelters. Doctors, nurses, and pharmacists are among the providers whose services can be counted toward the goal. But the agency is excluding obstetricians, who sometimes serve as primary care providers for pregnant women, to focus on those offering “coordinated, comprehensive care” for patients.
Health plans will be expected to increase primary care spending from 0.5% to 1% of their total medical expenses each year until 15% is reached in 2034.
At least six states — Colorado, Connecticut, Delaware, Oregon, Rhode Island, and Washington — have already implemented primary care targets with some success. Rhode Island, which set a 10.7% goal, more than doubled its primary care spending from 2008 to 2018, while also reducing overall health spending.
The Biden administration has launched initiatives to improve primary care, but it has not set a primary care target for Medicare.
In California, the affordability agency collects health care spending data that captures nearly 33 million of the state’s 39 million residents. The agency said it will begin to collect primary care spending data in fall 2025, but that information may not be released for two more years.
The state agency lacks enforcement authority in primary care spending, so to get health plans to hit the target, the agency is dangling financial incentives. At a primary care summit at the University of California-Davis in October, Landsberg said the agency could allow insurers to exceed the 3.5% overall growth cap if they show their spending went to boost primary care.
Efrain Talamantes, chief operating officer for AltaMed Health Services, one of the state’s largest federally qualified community health centers, said these payments could help the health center expand services by training and hiring staff.
If health plans comply, the policy should lead to more primary care providers, timelier appointments, and better health outcomes, especially for disadvantaged communities that historically haven’t had good access to care, Talamantes said.
“We should see an improvement where people are able to access their primary care the same day,” he said.
As discussions continue, the state is working on targets to increase spending on behavioral health, another underinvested service. A vote on that measure could come next summer.
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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November 21, 2024RoseHealth News, KFF Health NewsNo commentsPresident-elect Donald Trump’s return to the White House could embolden Republicans who want to weaken or repeal the Affordable Care Act, but implementing such sweeping changes would still require overcoming procedural and political hurdles.
Trump, long an ACA opponent, expressed interest during the campaign in retooling the health law. In addition, some high-ranking Republican lawmakers — who will now have control over both the House and the Senate — have said revamping the landmark 2010 legislation known as Obamacare would be a priority. They say the law is too expensive and represents government overreach.
The governing trifecta sets the stage for potentially seismic changes that could curtail the law’s Medicaid expansion, raise the uninsured rate, weaken patient protections, and increase premium costs for millions of people.
“The Republican plans — they don’t say they are going to repeal the ACA, but their collection of policies could amount to the same thing or worse,” said Sarah Lueck, vice president for health policy at the Center on Budget and Policy Priorities, a research and policy institute. “It could happen through legislation and regulation. We’re on alert for anything and everything. It could take many forms.”
Congressional Republicans have held dozens of votes over the years to try to repeal the law. They were unable to get it done in 2017 after Trump became president, even though they held both chambers and the White House, in large part because some GOP lawmakers wouldn’t support legislation they said would cause such a marked increase in the uninsured rate.
Similar opposition to revamping the law could emerge again, especially because polls show the ACA’s protections are popular.
While neither Trump nor his GOP allies have elaborated on what they would change, House Speaker Mike Johnson said last month that the ACA needs “massive reform” and would be on the party’s agenda should Trump win.
Congress could theoretically change the ACA without a single Democratic vote, using a process known as “reconciliation.” The narrow margins by which Republicans control the House and Senate mean just a handful of “no” votes could sink that effort, though.
Many of the more ambitious goals would require Congress. Some conservatives have called for changing the funding formula for Medicaid, a federal-state government health insurance program for low-income and disabled people. The idea would be to use budget reconciliation to gain lawmakers’ approval to reduce the share paid by the federal government for the expansion population. The group that would be most affected is made up largely of higher-income adults and adults who don’t have children rather than “traditional” Medicaid beneficiaries such as pregnant women, children, and people with disabilities.
A conservative idea that would let individuals use ACA subsidies for plans on the exchange that don’t comply with the health law would likely require Congress. That could cause healthier people to use the subsidies to buy cheaper and skimpier plans, raising premiums for older and sicker consumers who need more comprehensive coverage.
“It’s similar to an ACA repeal plan,” said Cynthia Cox, a vice president and the director of the Affordable Care Act program at KFF, a health information nonprofit that includes KFF Health News. “It’s repeal with a different name.”
Congress would likely be needed to enact a proposal to shift a portion of consumers’ ACA subsidies to health savings accounts to pay for eligible medical expenses.
Trump could also opt to bypass Congress. He did so during his previous tenure, when the Department of Health and Human Services invited states to apply for waivers to change the way their Medicaid programs were paid for — capping federal funds in exchange for more state flexibility in running the program. Waivers have been popular among both blue and red states for making other changes to Medicaid.
“Trump will do whatever he thinks he can get away with,” said Chris Edelson, an assistant professor of government at American University. “If he wants to do something, he’ll just do it.”
Republicans have another option to weaken the ACA: They can simply do nothing. Temporary, enhanced subsidies that reduce premium costs — and contributed to the nation’s lowest uninsured rate on record — are set to expire at the end of next year without congressional action. Premiums would then double or more, on average, for subsidized consumers in 12 states who enrolled using the federal ACA exchange, according to data from KFF.
That would mean fewer people could afford coverage on the ACA exchanges. And while the number of people covered by employer plans would likely increase, an additional 1.7 million uninsured individuals are projected each year from 2024 to 2033, according to federal estimates.
Many of the states that would be most affected, including Texas and Florida, are represented by Republicans in Congress, which could give some lawmakers pause about letting the subsidies lapse.
The Trump administration could opt to stop defending the law against suits seeking to topple parts of it. One of the most notable cases challenges the ACA requirement that insurers cover some preventive services, such as cancer screenings and alcohol use counseling, at no cost. About 150 million people now benefit from the coverage requirement.
If the Department of Justice were to withdraw its petition after Trump takes office, the plaintiffs would not have to observe the coverage requirement — which could inspire similar challenges, with broader implications. A recent Supreme Court ruling left the door open to legal challenges by other employers and insurers seeking the same relief, said Zachary Baron, a director of Georgetown University’s Center for Health Policy and the Law.
In the meantime, Trump could initiate changes from his first day in the Oval Office through executive orders, which are directives that have the force of law.
“The early executive orders will give us a sense of policies that the administration plans to pursue,” said Allison Orris, a senior fellow at the Center on Budget and Policy Priorities. “Early signaling through executive orders will send a message about what guidance, regulations, and policy could follow.”
In fact, Trump relied heavily on these orders during his previous term: An October 2017 order directed federal agencies to begin modifying the ACA and ultimately increased consumer access to health plans that didn’t comply with the law. He could issue similar orders early on in his new term, using them to start the process of compelling changes to the law, such as stepped-up oversight of potential fraud.
The administration could early on take other steps that work against the ACA, such as curtailing federal funding for outreach and help signing up for ACA plans. Both actions depressed enrollment during the previous Trump administration.
Trump could also use regulations to implement other conservative proposals, such as increasing access to health insurance plans that don’t comply with ACA consumer protections.
The Biden administration walked back Trump’s efforts to expand what are often known as short-term health plans, disparaging the plans as “junk” insurance because they may not cover certain benefits and can deny coverage to those with a preexisting health condition.
The Trump administration is expected to use regulation to reverse Biden’s reversal, allowing consumers to keep and renew the plans for much longer.
But drafting regulations has become far more complicated following a Supreme Court ruling saying federal courts no longer have to defer to federal agencies facing a legal challenge to their authority. In its wake, any rules from a Trump-era HHS could draw more efforts to block them in the courts.
Some people with ACA plans say they’re concerned. Dylan Reed, a 43-year-old small-business owner from Loveland, Colorado, remembers the days before the ACA — and doesn’t want to go back to a time when insurance was hard to get and afford.
In addition to attention-deficit/hyperactivity disorder and anxiety, he has scleroderma, an autoimmune disease associated with joint pain and numbness in the extremities. Even with his ACA plan, he estimates, he pays about $1,000 a month for medications alone.
He worries that without the protections of the ACA it will be hard to find coverage with his preexisting conditions.
“It’s definitely a terrifying thought,” Reed said. “I would probably survive. I would just be in a lot of pain.”
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November 20, 2024RoseHealth News, KFF Health NewsNo commentsAlmost all people have health insurance in Vermont, a state famed for its maple syrup and Ben & Jerry’s ice cream, yet residents pay the nation’s highest insurance premiums for individual coverage and endure months-long waits for care — and most hospitals here are losing money, according to state reports and interviews with residents and industry officials.
For more than 15 years, federal and state policymakers have focused on increasing the number of people insured, which they expected would shore up hospital finances and make care more available and affordable.
“Vermont’s struggles are a wake-up call that insurance is only one piece of the puzzle to ensuring access to care,” said Keith Mueller, a rural health expert at the University of Iowa.
Regulators and consultants say the state’s small, aging population of about 650,000 makes spreading insurance risk difficult. That demographic challenge is compounded by geography, as many Vermonters live in rural areas, where it’s difficult to attract more health workers to address shortages.
Unlike most states, Vermont regulates hospital and insurance prices through an independent agency, the Green Mountain Care Board. Until recently, the board typically approved whatever price changes companies wanted, said Julie Wasserman, a health consultant in Vermont.
In September, Bruce Hamory, a consultant hired by the board, recommended changes including potentially converting four rural hospitals into outpatient facilities and consolidating specialty services at others.
He cautioned that any fix would require sacrifices from everyone, including patients. “There is no simple single policy solution.”
Lynne Drevik, who runs an inn and spa in northern Vermont, said her doctor told her in April that she needed knee replacement surgeries — but the earliest appointment would be in January for one knee and next April for the other.
Drevik said it hurts to climb the stairs in her 19th century farmhouse. “My life is on hold here, and it’s hard to make any plans.”
Andy Kehler often worries about the cost of providing health insurance to the 85 workers at Jasper Hill Farm, the cheesemaking business he co-owns in northern Vermont. The company pays half the cost of workers’ health insurance premiums because that’s all it can afford, he said.
“It’s an issue every year for us, and it looks like there is no end in sight,” he said.
Recent data shows the University of Vermont Health Network controls about two-thirds of the state’s hospital market, and its main facility, the University of Vermont Medical Center in Burlington, has some of the highest prices nationwide.
Hospital officials contend their prices are average for the industry.
But for 2025, the Green Mountain Care Board required the Burlington hospital to cut the prices it bills private insurers by 1 percent.
The nonprofit system says it is navigating its own challenges, including a lack of housing to recruit workers and a shortage of mental health providers, nursing homes and long-term care services, which often creates delays in discharging patients, adding to costs.
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November 20, 2024RoseHealth News, KFF Health NewsNo commentsAfter their younger son was bitten by a rattlesnake and ended up in the pediatric intensive care unit, a San Diego couple received a huge bill. Listen to hear why antivenom is so expensive.
This spring, a San Diego toddler spent two days in a pediatric intensive care unit after a rattlesnake bit his hand in his family’s backyard.
The bills that followed were staggering, with the lifesaving antivenom the 2-year-old needed accounting for more than two-thirds of the total cost — $213,000.
Why is antivenom so expensive? One explanation is the markup hospitals add to balance overhead costs and make money. Another explanation is a lack of meaningful competition. There are only two rattlesnake antivenoms approved by the Food and Drug Administration.
Stacie Dusetzina, a professor of health policy at Vanderbilt University Medical Center, said it can be difficult to sort out drug pricing because a hospital bill is often an instrument insurers and hospitals use to negotiate prices. Patients such as the Pfeffers often get stuck in the middle.
“When you see the word ‘charges,’ that’s a made-up number. That isn’t connected at all, usually, to what the actual drug cost,” Dusetzina said.
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November 20, 2024RoseHealth - The New York Times, NYT > HealthNo commentsNovember 19, 2024RoseHealth - The New York Times, NYT > HealthNo commentsNovember 19, 2024RoseHealth - The New York Times, NYT > HealthNo commentsNovember 19, 2024RoseHealth - The New York Times, NYT > HealthNo commentsNovember 18, 2024RoseHealth News, KFF Health NewsNo commentsBOISE, Idaho — Physicians are expected to take the stand in Idaho’s capital on Tuesday to argue that the state’s near-total prohibition of abortion care is jeopardizing women’s health, forcing them to carry fetuses with deadly anomalies, and preventing doctors from intervening in potentially fatal medical emergencies.
Their testimony is scheduled to lead off the second week of a closely watched trial concerning one of the nation’s strictest abortion bans. The case, brought by four women, two physicians, and a group of medical professionals, seeks to limit the extent of the state’s ban, which prohibits abortion in almost all circumstances except to prevent a pregnant woman’s death, to stave off “substantial and irreversible impairment of a major bodily function,” or if the pregnancy was a result of a woman or girl being raped.
Over three days in district court last week, the women who brought the case shared emotional testimony about serious pregnancy complications that forced them out of state for medical care. That testimony drew objections from James Craig, an attorney with Idaho’s Office of the Attorney General, who interrupted the women frequently arguing that the details of their stories were not relevant.
Craig pushed back on assertions that Idaho’s criminal abortion laws are endangering women’s health care, while also casting abortion procedures in a negative light. Craig called abortion “barbaric and gruesome” in an opening statement.
“Abortion laws prevent unborn children from being exposed to pain,” he said.
At one point in the trial, Craig suggested that women could use any medical condition to sidestep the law, describing a scenario in which a pregnant woman who stepped on a rusty nail could claim she was at risk of infection and thus entitled to an abortion.
If the court finds in favor of the women, Craig said, “women [would] have a right to kill their unborn baby anytime it’s disabled, anytime they have an infection.”
During the plaintiffs’ testimony, as the women described what happened to their bodies during their pregnancies, Craig’s repeated objections drew reprimands from the 4th Judicial District Court judge overseeing the case, Jason Scott.
The patient plaintiffs’ testimony drew a warmer response from Scott, who said the women’s “circumstances are very worthy of sympathy.”
The case has drawn national attention to Idaho’s ban, one of the first enacted after the U.S. Supreme Court’s 2022 decision in Dobbs v. Jackson Women’s Health Organization. As it proceeds, abortion rights advocates are watching to see whether court challenges — including in other Republican-led states, such as Tennessee, where a similar case is ongoing — will be successful.
The plaintiffs in the case are not seeking to overturn the Idaho ban but rather to enact medical exceptions to the law. Their prospects are unclear, though a similar challenge in Texas did not fare well.
As the trial played out in a Boise courtroom, Jillaine St. Michel sat with her husband as they tended to their 10-month-old son. St. Michel had faced a pregnancy in which her fetus developed in devastating ways — a lack of leg and arm bones, a missing bladder, fused kidneys. She was barred from ending her pregnancy.
“We were told in the state of Idaho an abortion was not legal, and my case was no exception,” she said.
Instead, the family drove to Seattle for an abortion, she said, to spare the fetus she carried from further torment.
“The state talks about how barbaric it is, they keep using that term,” St. Michel said. “The idea of allowing your child to experience suffering beyond what is necessary, to me that feels barbaric. To put myself through that when that is not something I desired, that feels barbaric. To have that ripple down into my ability to parent my existing child, that feels barbaric.”
Earlier this year, the Texas Supreme Court ruled against 20 women and two OB-GYNs, upholding that state’s criminal law that allows abortion only to prevent a pregnant patient’s death. The court added one clarification ruling that abortions would be considered a crime when the amniotic sac breaks before 37 weeks of pregnancy, known as preterm premature rupture of membranes, because the condition can cause rapid and irreversible infection. That exception is not currently allowed in Idaho, and physicians who testified in the first week of the trial said they’d been forced to put their pregnant patients into cars and planes to receive abortions out of state.
In Idaho, a previous legal challenge to the state’s near-total abortion ban was rejected by the Idaho Supreme Court. In the case brought by Planned Parenthood, the justices wrote in a January 2023 ruling that the Idaho Constitution contains no right to an abortion, and that Idaho’s laws criminalizing abortion are constitutional.
This latest challenge, Adkins v. State of Idaho, comes on the heels of Donald Trump’s presidential victory. His Supreme Court appointments made way for the anti-abortion movement’s most vaunted goal of eliminating a woman’s constitutional right to abortion.
Advocates for abortion rights say that a loss in the case would close off options for challenging bans.
“If this isn’t successful, it’s not really clear if there are really additional places to go for help,” said Gail Deady, a senior staff attorney at the Center for Reproductive Rights, a legal advocacy organization representing the plaintiffs.
Kayla Smith, one of the plaintiffs, sobbed during her testimony as she recalled suffering from preeclampsia during her pregnancy with her first child. When medication could not control the condition, physicians were concerned that the blood pressure disorder could cause Smith to have a stroke or seizure, so they induced birth early, and Smith delivered a daughter, who is now 4 years old.
She told the court her second pregnancy seemed normal until a routine anatomy scan showed her son had multiple lethal heart defects. She and her husband had named him Brooks.
Idaho’s abortion ban had taken effect two days earlier and no longer allowed a physician to allow women such as Smith to end a pregnancy involving lethal fetal anomalies.
Her husband recalled the moment when their doctor, Kylie Cooper, delivered the diagnosis. “I remember finally asking just her if Brooks was going to be able to survive, and Dr. Cooper, she broke down. And the three of us just cried. And I understood that we were helpless in Idaho at that point,” James Smith said.
Despite a frantic search, the Smiths could not find a fetal surgeon who would operate on Brooks. His heart could not be fixed.
“My son wasn’t going to survive,” Kayla said in an interview. “We wouldn’t bring a baby home. And we also didn’t want him to suffer, so we just decided to do the most compassionate thing for him and also for me.”
Idaho’s criminal abortion laws required either that Kayla stay pregnant until her condition deteriorated and an abortion would be needed to prevent her death, or that she give birth to Brooks, who would not survive.
“I was not willing to watch my son suffer and gasp for air,” she said about the couple’s decision to end the pregnancy.
The Smiths drove with their toddler to Seattle, where physicians induced labor at about 20 weeks into her pregnancy, and Kayla and James were able to hold Brooks, who did not survive.
Attorneys for the state of Idaho are expected to call one witness this week, Ingrid Skop, an OB-GYN anti-abortion advocate.
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November 18, 2024RoseHealth News, KFF Health NewsNo commentsPresident-elect Donald Trump’s incoming administration could try to remove fluoride from drinking water, according to Robert F. Kennedy Jr.
Kennedy, who was tapped last week by Trump to lead the Department of Health and Human Services, called fluoride an “industrial waste” and linked it to cancer and other diseases and disorders while campaigning for Trump.
“On January 20, the Trump White House will advise all U.S. water systems to remove fluoride from public water. Fluoride is an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease,” Kennedy wrote Nov. 2 on X. Kennedy linked to a video from an attorney who recently successfully sued the Environmental Protection Agency to take additional measures to regulate fluoride in drinking water.
Kennedy, who has long advocated ending water fluoridation, persisted with his pledge following Trump’s election win. When asked before the election whether his administration would remove fluoride from drinking water, Trump said, “Well, I haven’t talked to him about it yet, but it sounds OK to me. You know it’s possible.”
Kennedy is an influential vaccine skeptic whose campaign of conspiracy theories earned PolitiFact’s 2023 “Lie of the Year.”
Longtime research has found that adding fluoride to U.S. drinking water is a safe way to boost children’s oral health. Since 2015, the recommended level in the U.S. has been 0.7 milligrams per liter. Public health organizations, including the American Dental Association, the American Academy of Pediatrics, and the Centers for Disease Control and Prevention, support the practice.
Recent studies, however, have shown possible links between fluoride and bone problems and children’s IQs, particularly when fluoride is above the U.S. recommended levels.
“There is evidence that fluoride exposure has been associated with the diseases [and] disorders that RFK listed, but with caveats,” said Ashley Malin, who is an assistant professor in the University of Florida’s Epidemiology Department and has studied fluoride’s effects in pregnant women.
Malin referred to studies showing that higher fluoride exposure, particularly during pregnancy, is associated with reduced child IQ, and that prenatal exposure also is linked to decreased intellectual functioning and executive function. For high exposure in pregnancy, the studies showed symptoms associated with other neurobehavioral issues, such as attention-deficit/hyperactivity disorder.
However, many of these studies took place in countries other than the U.S. and looked at fluoride in drinking water at sometimes twice the United States’ recommended level. Also, some of the other ailments that Kennedy listed, such as an association with bone cancer, have less robust evidence and need more study.
“Aside from fluoride’s impacts on neurodevelopment, I think that there is more that we don’t know about health effects of low-level fluoride exposure than what we do know, particularly for adult health outcomes,” Malin said.
David Bellinger, a Harvard Medical School neurology professor and professor in Harvard School of Public Health’s Environmental Health Department, said the risk-benefit calculation of added fluoride differs depending on whether typical fluoride exposure levels cause health problems, or if problems occur only when recommended levels are exceeded.
“In toxicology, ‘the dose makes the poison’ is a long-standing principle,” he said. “So a general statement that fluoride is associated with diseases X, Y, and Z is not very helpful unless the dose that might be responsible is specified.”
PolitiFact contacted Kennedy through his Children’s Health Defense organization but received no reply. The organization sued PolitiFact and Meta related to a 2020 fact check. That lawsuit was dismissed by a federal court. The dismissal was upheld on appeal, and the case is pending a possible appeal to the U.S. Supreme Court.
What Is Fluoride and What Are Its Benefits?
Fluoride is a mineral naturally occurring in soil, water, and some foods that helps prevent tooth decay and cavities. It strengthens tooth enamel that acid from bacteria, plaque, and sugar can wear away.
Water fluoridation has been happening in the U.S. since 1945.
The federal Public Health Service first recommended fluoridation of tap water in 1962, but the decision still lies with states and municipalities. Around 72% of the U.S. population, or about 209 million people, had access to fluoridated water in 2022, the CDC reported. Fluoride also has been added to oral care products such as toothpaste and mouth rinse.
In 2015, U.S. health officials lowered the recommended amount of fluoride in drinking water to 0.7 milligrams per liter, saying a higher level was less necessary given other sources of fluoride, and that the lowered amount would still help protect teeth without staining them.
Pediatric dentists note that applying fluoride with toothpaste and rinses is beneficial, but small amounts circulating in the body via water consumption helps younger children who still have their baby teeth, because it can benefit the developing permanent teeth.
The American Dental Association says studies have shown that fluoride in community water systems prevents at least 25% of tooth decay in children and adults and that “for more than 75 years, the best scientific evidence has consistently shown that fluoridation is safe and effective.”
The association says on its website: “It’s similar to fortifying other foods and beverages — for example, fortifying salt with iodine, milk with vitamin D, orange juice with calcium, and bread with folic acid.”
According to the CDC, health experts and scientists from the U.S. and other countries have so far “not found convincing scientific evidence linking community water fluoridation with any potential adverse health effect or systemic disorder such as an increased risk for cancer, Down syndrome, heart disease, osteoporosis and bone fracture, immune disorders, low intelligence, renal disorders, Alzheimer’s disease, or allergic reactions.”
The agency says risks of water fluoridation are limited to dental fluorosis, which can alter dental enamel and cause white flecks, spots, lines, or brown stains on the teeth when too much fluoride is consumed.
Do Studies Show Fluoride Posing Any Other Risks?
Some studies have said that excess fluoride exposure, often at higher levels than the recommended U.S. limit, can harm infants’ and young children’s developing brains and that higher levels of fluoride exposure during pregnancy were associated with declines in children’s IQs.
A study published in May that Malin led with University of Southern California and Indiana University researchers suggested that fluoride exposure during pregnancy was linked to an increased risk of childhood neurobehavioral problems and said more studies were “urgently needed to understand and mitigate the impacts in the entire U.S. population.”
Experts noted prenatal fluoride exposure is most strongly linked to children’s IQ loss, and said timing of fluoride consumption might need to be considered when making recommendations.
A federal review of dozens of studies published in August by the Department of Health and Human Services’ National Toxicology Program concluded that higher levels of fluoride exposure were linked to lower IQs in children. But the report was based primarily on studies in countries such as Canada, China, India, Iran, Mexico, and Pakistan and involved fluoride levels at or above 1.5 milligrams per liter, twice the recommended U.S. limit. The authors said more research is needed to understand whether lower exposure has any adverse effects.
In the report, researchers said they found no evidence that fluoride exposure adversely affected adult cognition.
Bellinger, of Harvard, pointed to the review as an example of how the amount of fluoride matters. He noted how researchers concluded that a very small percentage of people in the U.S. are exposed to levels that correlate with IQ loss.
“Second, the fact that there are now multiple pathways of exposure to fluoride besides fluoridated water (toothpaste and other dental products, etc.) makes it really difficult to attribute a particular adverse effect to the fluoride added to the water,” he wrote via email. “It is the cumulative exposure from all sources that contribute to any adverse health effects.”
In September, a federal judge ordered the Environmental Protection Agency to further regulate fluoride in drinking water because of the potential risk that higher levels could affect children’s intellectual development.
U.S. District Judge Edward Chen wrote that the court’s finding didn’t “conclude with certainty that fluoridated water is injurious to public health,” saying it’s unclear whether the amount of fluoride typically added to water is causing children’s IQs to drop. But he wrote that there was enough risk to warrant investigation and that the EPA must act to further regulate it. The ruling did not specify what actions the agency should take, and the EPA is reviewing the decision.
After the ruling, the American Association of Pediatrics issued a statement that fluoride in drinking water is safe for children and said the policy is based on a robust foundation of evidence.
Besides dental fluorosis, experts say that fluoride exposure over many years above the U.S. recommended amount can cause skeletal fluorosis, a rare condition that causes weaker bones, stiffness, and joint pain. Although the Public Health Service recommends a fluoride concentration of 0.7 milligrams per liter for community water systems, the EPA, under the Safe Drinking Water Act, sets enforceable standards for drinking-water quality. Currently, to prevent skeletal fluorosis, the EPA requires that water systems not exceed 4 milligrams of fluoride per liter of water.
Malin said she and her research team are investigating a potential link between fluoride and bone fractures. She said that although several studies have found high fluoride exposure associated with increased risk of bone fractures, and some have linked fluoride with thyroid disease, rigorous, U.S.-based studies haven’t been done.
The CDC concluded that recent research found no link between cancer risk and high levels of fluoride in drinking water.
The American Cancer Society reviewed a possible link between water fluoridation and cancer risk. An organization spokesperson pointed PolitiFact to its review and said it has no data showing a definitive answer.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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November 17, 2024RoseHealth - The New York Times, NYT > HealthNo commentsNovember 17, 2024RoseHealth - The New York Times, NYT > HealthNo commentsNovember 16, 2024RoseHealth - The New York Times, NYT > HealthNo commentsNovember 16, 2024RoseHealth News, KFF Health NewsNo commentsKFF Health News contributor Andy Miller discussed the Trump presidency and health care on WUGA’s “The Georgia Health Report” on Nov. 8.
KFF Health News correspondent Brett Kelman discussed dental implants on KCBS on Nov. 4.
KFF Health News California correspondent Christine Mai-Duc discussed an abortion clinic lawsuit on KCBS on Oct. 31.
KFF Health News South Dakota correspondent Arielle Zionts discussed the Purchased/Referred Care program for Native American patients on “Native America Calling” on Oct. 24.
KFF Health News senior fellow and editor-at-large for public health Céline Gounder shared tips for preventing cardiovascular disease on CBS’ “CBS Mornings” on Oct. 24. Gounder also joined “CBS News 24/7” to discuss McDonald’s Quarter Pounder hamburgers linked to an E. coli outbreak and “CBS Mornings” to discuss a frozen waffle recall due to a potential listeria contamination, both on Oct. 22.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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November 15, 2024RoseHealth - The New York Times, NYT > HealthNo commentsNovember 15, 2024RoseHealth - The New York Times, NYT > HealthNo commentsNovember 15, 2024RoseHealth News, KFF Health NewsNo commentsThe United States has made almost no progress in closing racial health disparities despite promises, research shows. The government, some critics argue, is often the underlying culprit.
KFF Health News undertook a yearlong examination of how government decisions undermine Black health — reviewing court and inspection records and government reports, and interviewing dozens of academic researchers, doctors, politicians, community leaders, grieving moms, and patients.
During the past two decades there have been 1.63 million excess deaths among Black Americans relative to white Americans. That represents a loss of more than 80 million years of life, according to a 2023 JAMA study.
The video features senior correspondents Fred Clasen-Kelly and Renuka Rayasam, along with Morris Brown, a family care physician in Kingstree, South Carolina.
Learn more about the “Systemic Sickness” series here.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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November 14, 2024RoseHealth News, KFF Health NewsNo commentsMany scientists at the federal health agencies await the second Donald Trump administration with dread as well as uncertainty over how the president-elect will reconcile starkly different philosophies among the leaders of his team.
Trump has promised he would allow Robert F. Kennedy Jr. to “go wild” on medicines, food, and health. With that, a radical antiestablishment medical movement with roots in past centuries could threaten the achievements of a science-based public health order painstakingly built since World War II, some of these scientists fear.
If Kennedy makes good on his vision for transforming public health, childhood vaccine mandates could wither. New vaccines might never win approval, even as the FDA allows dangerous or inefficient therapies onto the market. Agency websites could trumpet unproven or debunked health ideas. And if Trump’s plan to weaken civil service rights goes through, anyone who questions these decisions could be summarily fired.
“Never has anybody like RFK Jr. gotten anywhere close to the position he may be in to actually shape policy,” said Lewis Grossman, a law professor at American University and the author of “Choose Your Medicine,” a history of U.S. public health.
Kennedy and an adviser Calley Means, a health care entrepreneur, say dramatic changes are needed because of the high levels of chronic disease in the United States. Government agencies have corruptly tolerated or promoted unhealthy diets and dangerous drugs and vaccines, they say.
Means and Kennedy did not respond to requests for comment. Four conservative members of the first Trump health bureaucracy spoke on condition of anonymity. They eagerly welcomed the former president’s return but voiced few opinions about specific policies. Days after last week’s election, RFK Jr. announced that the Trump administration would immediately fire and replace 600 National Institutes of Health officials. He set up a website seeking crowdsourced nominees for federal appointments, with a host of vaccination foes and chiropractors among the early favorites.
At meetings last week at Mar-a-Lago involving Elon Musk, Tucker Carlson, Donald Trump Jr., Kennedy, and Means, according to Politico, some candidates for leading health posts included Jay Bhattacharya, a Stanford University scientist who opposed covid lockdowns; Florida Surgeon General Joseph Ladapo, who opposes mRNA covid vaccines and rejected well-established disease control practices during a measles outbreak; Johns Hopkins University surgeon Marty Makary; and Means’ sister, Stanford-trained surgeon and health guru Casey Means.
All are mavericks of a sort, though their ideas are not uniform. Yet the notion that they could elbow aside a century of science-based health policy is profoundly troubling to many health professionals. They see Kennedy’s presence at the heart of the Trump transition as a triumph of the “medical freedom” movement, which arose in opposition to the Progressive Era idea that experts should guide health care policy and practices.
It could represent a turning away from the expectation that mainstream doctors be respected for their specialized knowledge, said Howard Markel, an emeritus professor of pediatrics and history at the University of Michigan, who began his clinical career treating AIDS patients and ended it after suffering a yearlong bout of long covid.
“We’ve gone back to the idea of ‘every man his own doctor,’” he said, referring to a phrase that gained currency in the 19th century. It was a bad idea then and it’s even worse now, he said.
“What does that do to the morale of scientists?” Markel asked. The public health agencies, largely a post-WWII legacy, are “remarkable institutions, but you can screw up these systems, not just by defunding them but by deflating the true patriots who work in them.”
FDA Commissioner Robert Califf told a conference on Nov. 12 that he worried about mass firings at the FDA. “I’m biased, but I feel like the FDA is sort of at peak performance right now,” he said. At a conference the next day, CDC Director Mandy Cohen reminded listeners of the horrors of vaccine-preventable diseases like measles and polio. “I don’t want to have to see us go backward in order to remind ourselves that vaccines work,” she said.
Exodus From the Agencies?
With uncertainty over the direction of their agencies, many older scientists at the NIH, FDA, and Centers for Disease Control and Prevention are considering retirement, said a senior NIH scientist who spoke on the condition of anonymity for fear of losing his job.
“Everybody I talk to sort of takes a deep breath and says, ‘It doesn’t look good,’” the official said.
“I hear of many people getting CVs ready,” said Arthur Caplan, a professor of bioethics at New York University. They include two of his former students who now work at the FDA, Caplan said.
Others, such as Georges Benjamin, executive director of the American Public Health Association, have voiced wait-and-see attitudes. “We worked with the Trump administration last time. There were times things worked reasonably well,” he said, “and times when things were chaotic, particularly during covid.” Any wholesale deregulation efforts in public health would be politically risky for Trump, he said, because when administrations “screw things up, people get sick and die.”
At the FDA, at least, “it’s very hard to make seismic changes,” former FDA chief counsel Dan Troy said.
But the administration could score easy libertarian-tinged wins by, for example, telling its new FDA chief to reverse the agency’s refusal to approve the psychedelic drug MDMA from the company Lykos. Access to psychedelics to treat post-traumatic stress disorder has grabbed the interest of many veterans. Vitamins and supplements, already only lightly regulated, will probably get even more of a free pass from the next Trump FDA.
‘Medical Freedom’ or ‘Nanny State‘
Trump’s health influencers are not monolithic. Analysts see potential clashes among Kennedy, Musk, and more traditional GOP voices. Casey Means, a “holistic” MD at the center of Kennedy’s “Make America Healthy Again” team, calls for the government to cut ties with industry and remove sugar, processed food, and toxic substances from American diets. Republicans lampooned such policies as exemplifying a “nanny state” when Mike Bloomberg promoted them as mayor of New York City.
Both the libertarian and “medical freedom” wings oppose aspects of regulation, but Silicon Valley biotech supporters of Trump, like Samuel Hammond of the Foundation for American Innovation, have pressed the agency to speed drug and device approvals, while Kennedy’s team says the FDA and other agencies have been “captured” by industry, resulting in dangerous and unnecessary drugs, vaccines, and devices on the market.
Kennedy and Casey Means want to end industry user fees that pay for drug and device rules and support nearly half the FDA’s $7.2 billion budget. It’s unclear whether Congress would make up the shortfall at a time when Trump and Musk have vowed to slash government programs. User fees are set by laws Congress passes every five years, most recently in 2022.
The industry supports the user-fee system, which bolsters FDA staffing and speeds product approvals. Writing new rules “requires an enormous amount of time, effort, energy, and collaboration” by FDA staff, Troy said. Policy changes made through informal “guidance” alone are not binding, he added.
Kennedy and the Means siblings have suggested overhauling agricultural policies so that they incentivize the cultivation of organic vegetables instead of industrial corn and soy, but “I don’t think they’ll be very influential in that area,” Caplan said. “Big Ag is a powerful entrenched industry, and they aren’t interested in changing.”
“There’s a fine line between the libertarian impulse of the ‘medical freedom’ types and advocating a reformation of American bodies, which is definitely ‘nanny state’ territory,” said historian Robert Johnston of the University of Illinois-Chicago.
Specific federal agencies are likely to face major changes. Republicans want to trim the NIH’s 27 research institutes and centers to 15, slashing Anthony Fauci’s legacy by splitting the National Institute of Allergy and Infectious Diseases, which he led for 38 years, into two or three pieces.
Numerous past attempts to slim down the NIH have failed in the face of campaigns by patients, researchers, and doctors. GOP lawmakers have advocated substantial cuts to the CDC budget in recent years, including an end to funding gun violence, climate change, and health equity research. If carried out, Project 2025, a policy blueprint from the conservative Heritage Foundation, would divide the agency into data-collecting and health-promoting arms. The CDC has limited clout in Washington, although former CDC directors and public health officials are defending its value.
“It would be surprising if CDC wasn’t on the radar” for potential change, said Anne Schuchat, a former principal deputy director of the agency, who retired in 2021.
The CDC’s workforce is “very employable” and might start to look for other work if “their area of focus is going to be either cut or changed,” she said.
Kennedy’s attacks on HHS and its agencies as corrupted tools of the drug industry, and his demands that the FDA allow access to scientifically controversial drugs, are closely reminiscent of the 1970s campaign by conservative champions of Laetrile, a dangerous and ineffective apricot-pit derivative touted as a cancer treatment. Just as Kennedy championed off-patent drugs like ivermectin and hydroxychloroquine to treat covid, Laetrile’s defenders claimed that the FDA and a profit-seeking industry were conspiring to suppress a cheaper alternative.
The public and industry have often been skeptical of health regulatory agencies over the decades, Grossman said. The agencies succeed best when they are called in to fix things — particularly after bad medicine kills or damages children, he said.
The 1902 Biologics Control Act, which created the NIH’s forerunner, was enacted in response to smallpox vaccine contamination that killed at least nine children in Camden, New Jersey. Child poisonings linked to the antifreeze solvent for a sulfa drug prompted the modern FDA’s creation in 1938. The agency, in 1962, acquired the power to demand evidence of safety and efficacy before the marketing of drugs after the thalidomide disaster, in which children of pregnant women taking the anti-nausea drug were born with terribly malformed limbs.
If vaccination rates plummet and measles and whooping cough outbreaks proliferate, babies could die or suffer brain damage. “It won’t be harmless for the administration to broadly attack public health,” said Alfredo Morabia, a professor of epidemiology at Columbia University and the editor-in-chief of the American Journal of Public Health. “It would be like taking away your house insurance.”
Sam Whitehead, Stephanie Armour, and David Hilzenrath contributed to this report.
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