Newly formed nonprofit can help with heath care copays, prescription payments and heath insurance denials

Last year the two companies awarded $200k to patients who
needed financial health care help. (Photo by J. Trierweiler)

Uninsured Americans or those with health insurance coverage who are facing sky-high bills or insurance denials might be able to turn to a newly merged nonprofit for assistance.

The Patient Advocate Foundation and the Patient Access Network Foundation joined together and are now operating as the Patient Advocate Foundation. Peter Loftus of The Wall Street Journal reports, "The merger created a nonprofit with more than $800 million in assets to help patients pay for drug copays and appeal health-plan coverage denials."

For many Americans dealing with expiring Affordable Care Act subsidies, job loss or employment that doesn't offer health care benefits, the merger offers a safety net. Loftus writes, "The nonprofits said the combination will allow them to better serve low- and middle-income patients facing rising healthcare costs, including many who have lost insurance coverage."

Patient Advocate Foundation Chief Executive Alan Balch told the Journal, "More people are struggling to pay for care and basic needs than ever before, and the safety net’s being stretched thinner and thinner."

Before the merger, the two nonprofits focused on different health care challenges faced by many Americans. The PAN Foundation helped patients "defray co-pays and other out-of-pocket costs for prescription drugs," Loftus explains. The Patient Advocate Foundation assisted patients who needed to file appeals for health care insurance denials.

In 2025, the two companies made "$273 million in direct payments to patients," Loftus adds. "They awarded financial assistance to nearly 200,000 people during that period."

As one company, the Patient Advocate Foundation will need patients to complete only one application to access all its services. 

The price of hospital services is driving health care costs and insurance premiums to climb nationwide

Patients and employers are impacted by increases health premiums. 
(Graphic by wildpixel/iStock/Getty+ via Conversation CC)

The American public may perceive hospitals as part of their community’s care network, but in reality, many hospitals and specialty clinics are businesses that strive to make a profit. 

As more medical systems in communities of all sizes have consolidated, hospital pricing has become the biggest driver of rising medical costs and steep health care insurance premium hikes.

“Health insurance premiums in the U.S. significantly increased between 1999 and 2024, outpacing the rate of worker earnings by three times, according to our newly published research in The Journal of the American Medical Association Network Open,” write economic experts Vivian Ho and Salpy Kanimian from Rice University in Houston, Texas, for The Conversation. 

Using federal information and data from the Kaiser Family Foundation, Ho and Kanimian found that “the cost of hospital services increased the most, while the cost of physician services and prescription drugs rose more slowly.”

Many hospitals, including those with nonprofit designations, often aggressively price their services and care well above their costs, Ho and Kanimian point out.

“One study found that for nonprofit health systems, the greatest pay increases between 2012 and 2019 went to hospital CEOs who grew the profits and size of their organizations the most,” Ho and Kanimian explain. In contrast, any emphasis on charity care by those systems was not linked to CEO pay. 

Ho and Kanimian suggest a way to help “ensure that nonprofit hospitals make the health of their local communities a top priority by requiring their boards to disclose their executive compensation guidelines for salary and bonuses, similar to the information that for-profit health care companies disclose to their stockholders.” Such a shift could help communities push for better care and lower costs for patients as determinants of executive pay and bonuses. 

Some economists suggest that “hospital prices should be regulated. This approach involves capping prices for health care services at the most expensive hospitals and restricting price growth for all hospitals,” Ho and Kanimian write.

What does it mean when cuts from the 'One Big Beautiful Bill Act' close a rural town's only health care clinic?

The OBBBA cuts billions in federal spending on rural
health care over the next 10 years. (Wikipedia photo)

After the only health care clinic in rural Churchville, Virginia, closed, residents in this 200-person community are struggling to adjust.

"Gone are the days of seniors walking down the road from their house to see the town doctor," reports Eva McKend of CNN News. "Augusta Medical Group cited the health care provisions in the One Big Beautiful Bill Act for closing the rural clinics in Churchville and two other locations."

Even when the clinic's closure means some residents have to drive an hour to Charlottesville to see doctors, community members are reluctant to say anything negative about President Trump or his signature OBBBA legislation.

Across from the town's coffee shop, and just a few feet away from the shuttered clinic, a bold banner waves with the words "Thank you, TRUMP, Save America Again."

Democrats are planning to make health care a "defining issue nationally in next year’s midterms," McKend writes. "But the environment in Churchville illustrates the challenges the party faces, particularly in rural communities."

Dale White, a Churchville resident and church administrator, says the "concerns about the clinic are overblown," McKend writes. White told her, "These are old-time rural farming folks, and they’ve been going to get medical care in Staunton and Fishersville, Waynesboro and Charlottesville since they can remember."

Many rural hospitals, clinics and providers that serve Medicaid patients were struggling to stay afloat before the OBBBA cuts. McKend reports, "The policy research organization KFF estimates that Trump’s bill will cut federal Medicaid spending in rural communities by $137 billion over the next decade."

Given the new federal budget cuts, more affordable medical care for many Americans seems unlikely

Many Americans will pay more for health care in
the coming months. (Adobe Stock image)

Americans who hoped to see their medical costs decrease during the next four years are likely to be disappointed, as federal-level decisions aimed at cutting or reducing benefits take effect and other expenses are passed off to states and the public.

"Millions of people are expected to lose health insurance in the coming years as a result of the tax cut legislation, leaving them with fewer protections from large bills if they get sick or suffer an accident," reports Noam N. Levey of KFF Health News.

President Donald Trump "promised a rosier future while campaigning last year, pledging to 'make America affordable again' and 'expand access to new Affordable Healthcare,'" Levey writes. "Polls suggest voters were looking for relief."

People who purchase health insurance on state marketplaces can expect to see substantial increases over the next year, which may cause more people to drop coverage or opt for higher-deductible plans. Certain Medicaid enrollees may be required to cover copays up to $35.

For consumers who can’t pay their medical bills, there are fewer guardrails. Levey writes, "(In July), the Trump administration secured permission from a federal court to roll back regulations that would have removed medical debt from consumer credit reports."

Arika Sánchez, who oversees health care policy at the nonprofit New Mexico Center on Law and Poverty, sees how negative credit report "dings" can hurt a family struggling to survive. She told Levey, "When families get stuck with medical debt, it hurts their credit scores, makes it harder to get a car, a home, or even a job. Medical debt wrecks people’s lives.”

Overall, medical debt is a national problem and not a partisan issue. "About 6 in 10 adults — Democrats and Republicans — say they are worried about being able to afford health care, according to one recent survey," Levey explains. 

Rural hospitals are receiving help from Microsoft to address cybersecurity risks

Most cyberattacks in rural hospitals are due to human error.
(Photo by the National Cancer Institute, Unsplash)

Cyberattacks are targeted at rural hospitals due to their lack of resources, old computers and a high probability of human error.

Liz Carey at the Daily Yonder reported that, according to a Microsoft study, cyberattacks are a real threat to rural hospitals. “In 2022, 44 attacks in Texas exposed nearly 6 million patient records.”

In an interview with the Daily Yonder, Alan Morgan, president and CEO of the National Rural Health Association, addressed the issue of cybersecurity costs.

“It is important to note that large, well-financed national health systems have to date failed to prevent cyber-attacks on their organizations, so for a small rural hospital, with far fewer resources, the issue is even more daunting.”

Microsoft’s Cybersecurity for Rural Hospitals Program is providing more than 550 participating rural hospitals in America with free cybersecurity assessments, training and discounts on security products.

“Officials with Microsoft said the goal of the cybersecurity program is to address not only immediate risks facing the hospitals, but to encourage broader systemic challenges as well,” Carey wrote.

Southern states spend millions on new clinics to serve rural residents. It's one way to avoid federal Medicaid expansion.

Clemson Rural Health serves rural Walhalla, S.C.
(Clemson University photo via KFF Health News)

Southern states made rural health a focus, but the sector's trendiness hasn't translated into Medicaid expansion plans. "State lawmakers nationwide are spending millions of dollars to address a rural health care crisis long in the making," reports Lauren Sausser of KFF Health News. For more than a decade most Southern states have refused billions in federal funds that would provide public health insurance coverage to more low-income adults."

Among the 10 states that refused Medicaid expansion, some have developed their own approaches to addressing rural health disparities with state dollars. Clemson Rural Health in South Carolina is a small primary care clinic run by Clemson University that "attempts to fill [rural health care] gaps by providing primary care. . .for uninsured patients free of charge or at reduced rates," Sausser explains. Clemson's clinic receives the largest part of its funding from the state Department of Health and Human Services.

Jonathan Oberlander, a professor and health policy scholar at the University of North Carolina, said "he doesn’t expect to see any of the remaining states rushing to fully expand Medicaid," Sausser writes. "Oberlander said conservative lawmakers often consider projects such as building new rural clinics more politically palatable than expanding Medicaid coverage."

Other southern states have followed suit. "The University of Georgia established a new medical school, partly to send more physicians into underserved and rural areas," Sausser adds. "The Georgia General Assembly kicked in half the cost of a new $100 million building for medical education and research in Athens. . . .The Tennessee General Assembly passed a budget last year that included $81 million for a variety of rural health initiatives." 

An FDA proposed rule would force food manufacturers to add a 'nutritional info box' to the front of their packaging

The 'nutritional info box' would focus on saturated
fat, sodium and added sugars.

Warning labels for grocery items with salt, added sugar or saturated fat may become the federal government's newest tool aimed at educating U.S. consumers about their grocery choices. "Under a new rule proposed by the Food and Drug Administration, food manufacturers would be required to put new labels on the front of packages flagging key nutrition information," reports Jesse Newman of The Wall Street Journal. The current administration believes bold labeling could help Americans make healthier food choices.

Most packaged foods sold in the U.S. already have nutritional information on the back or side of the box. "The new labels, dubbed a 'nutrition info box,' would go on the front of packages," Newman explains. The box would flag foods as "high, medium or low in salt, added sugar and saturated fat, which the FDA has warned can lead to chronic diseases when consumed in excess."

Most food companies oppose labeling foods with warnings, "The Consumer Brands Association, which represents big food manufacturers, said the rule doesn’t reflect the latest research," Newman reports. "The group said studies show the most effective labels include calories and nutrients to encourage, along with nutrients to limit."

Robert F. Kennedy Jr., who is the incoming Trump administration's prospective next head of U.S. health policy, "has been outspoken about his view that U.S. food companies are partly to blame for sickening Americans," Newman writes. "Consumer advocacy groups and public health organizations cheered the rule." Some groups hope the Trump administration will support more specific labeling, which is used in Chile and Mexico.

The FDA is accepting public comments on its proposal until May 16. Newman adds, "If the rule is finalized after that, food manufacturers would be required to add the new labels to most packaged food products three to four years after it takes effect."

Food industry groups warned they could sue to overturn labeling mandates. Newman adds, "Such labels, they said, could threaten First Amendment rights — because companies could consider them a form of forced speech — and only Congress has the authority to require them."

Understanding what pharmacy benefit managers are reveals flaws and solutions in U.S. drug pricing and selling system

Not all PBM savings are passed along to members.
(Adobe Stock photo)

Despite a deluge of news information discussing the unfair pricing practices of pharmacy benefit managers, what they are and what they do may still be a mystery. James B. Rebitzer, an economics professor at Boston University, provides some answers in his Q&A for The Conversation.

What are pharmacy benefit managers?
During the 1960s, PBMs "became essential middlemen [companies] between drugmakers and the many insurers, employers and government entities who purchase drugs on behalf of their members. . . . These companies negotiate price, affordability and access to prescription drugs. They do this by operating and designing formularies, which are lists of drugs that insurers cover.

Formularies assign drugs to different tiers that determine what patients must pay out of pocket to access the drug. . . . Tier placement determines how affordable a medication is to consumers and the effective drug price that insurers pay. . . .The price at which the PBM obtains the drug for its clients is the net price – the list price minus the drugmaker’s discount. . . . If a drugmaker increases its rebate, the net price falls, even if the publicly posted list prices remain high. This is why focusing on list prices to determine the cost of a drug can be misleading."

Are PBMs working to decrease their clients' costs or increase their profits?
Both. "If the contest for formulary placement works as it should, competition compels drugmakers to offer substantial discounts off the published list price. As a result, insurers and consumers benefit from a reduced net price for drugs. However, formulary competition can be undermined in various ways. . . . Competition within the formulary can also be distorted when drugmakers post very high list prices. This artificially inflates rebates for PBMs without lowering net prices for insurers and other parties."

How does market competition figure into PBM activity?
"The current regulatory environment in the U.S. tolerates overly large PBMs that engage in anticompetitive practices to accumulate excessive profits. Without strong competitors, dominant PBMs are free to charge their customers high fees and keep a larger portion of drugmaker rebates for themselves. . . . In theory, this problem should be self-correcting. . . . High profits should attract new competitors into the industry." But the chances for scrappy upstarts to survive are also limited by the industry's current PBMs' dominance.

Who are the villians?
The concentration of power is the problem. "If we didn’t have PBMs, we would need to invent them – or something like them – to obtain reasonable prices on patented drugs. But the concentration of market power among a few companies threatens to dissipate the value they create. A more competitive and transparent market for PBM services will help keep that contest fair and transparent – to the benefit of customers and society. . . . In that sense, PBMs aren’t the villain. Too much market power in too few hands is the problem, and that’s something more competition, sensible regulation and vocal consumers might fix."

Millions of children have lost their health care coverage; 'procedural' or 'red tape' problems are to blame

Babies and children are missing needed check-ups
because of coverage loss. (Adobe Stock photo)

Government red tape has caused millions of children to lose their health care coverage. Joyce Frieden of MedPage Today reports, "A total of 4.16 million fewer children were enrolled in Medicaid or CHIP at the end of last year compared with the month before each state began its Medicaid and CHIP 'unwinding' process, a report from Georgetown University's Center for Children and Families found.

While some families most likely moved to different coverage, many did not. Joan Alker, the center's executive director, told Frieden, "Federal researchers estimate that three-quarters of children who will or have lost Medicaid during the unwinding will remain eligible for Medicaid but are losing coverage for procedural or 'red tape' reasons. Nationwide, a shockingly high 70% of people losing Medicaid are doing so for procedural reasons."

Some states dropped more children enrollees than others. "Texas, Florida, Georgia, and California saw the largest numeric declines in Medicaid/CHIP child enrollment," Frieden writes. "[That reduction] accounts for half of the total national decline, the researchers said. . . . Eight states -- Montana, Idaho, South Dakota, Arkansas, New Hampshire, Utah, Alaska, and Colorado -- disenrolled so many children in 2023 that they had fewer children enrolled at the end of the year than prior to the pandemic in early 2020."

Coverage loss has become a daily barrier to care in pediatrician offices. Kimberly Avila Edwards, a pediatrician from Texas, told Frieden, "Parents are checking in for their child's appointment, only to learn that their child is no longer covered due to a paperwork issue. These situations are all avoidable, but they are now the daily reality in pediatric offices across the country."

Alker told Frieden, "States should make efforts to reach out to families with trusted community partners and resources to re-enroll eligible children, and consider systems reforms to make the process go more smoothly."

To help address coverage loss, Edwards is "advising parents whose children have been disenrolled to 'Please be proactive -- if you receive a notice, act quickly and respond in the time frame provided,'" Frieden reports. "'Secondly, [we're] asking them to seek assistance from community health centers or patient advocates and contact their local Medicaid agency.'"

These centers offer specialized care for aging adults that allows them to live at home instead of in nursing homes

PACE centers offer multiple types of care under one
roof. (National PACE Association photo)

As people age, most don't want to live in nursing homes. But when faced with extensive medical needs, many older adults end up in institutionalized care. While some older adults may need that degree of attention, a lesser-known option known as PACE (Program of All-Inclusive Care for the Elderly) is gaining popularity as a cheaper, healthier alternative to nursing homes. "PACE has long flown under the national radar as an elder care option," reports Anna Claire Vollers of Stateline. "PACE centers provide government-funded medical care and social services to people older than 55 whose complex medical needs qualify them for nursing home care, but who can live at home with the right sort of help."

Given the preference of most individuals and their families to avoid nursing homes, considering a PACE center is a logical step. Vollers writes, "By 2030, one in five Americans will be over age 65, and most older adults say they would prefer to remain living in their homes for as long as possible. . . . . [The program has] recently attracted significant interest from lawmakers because it can keep people at home and may cost less than nursing home care."

The PACE model offers companies and health care systems a way to meet clients' health needs without lengthy inpatient stays. Each center provides a range of medical treatments, including physical therapy, vision and dental care, counseling and lab work. Centers also offer opportunities to get out of the house and socialize by providing a dining hall for meals and gathering areas for puzzles and games. Vollers reports, "Center social workers can help clients obtain needed items such as walkers and at-home wheelchair ramps."

Robert Greenwood, senior vice president for communications and member engagement at the National PACE Association, told Vollers, "It's definitely gaining momentum. In the last couple of years, we've had maybe six or seven new PACE programs open a year. In the last couple of months, we've had about four PACE programs open each month. There are 50 organizations in the pipeline for the next two years."

So far, PACE centers have had bipartisan support. Vollers reports, "Tennessee state Rep. Caleb Hemmer, a Democrat representing Nashville, and state Sen. Bo Watson, a Republican representing Hamilton County (which includes Chattanooga), are cosponsoring legislation that would expand PACE across the state." Hemmer told Stateline, "Even I was amazed when I visited. You walk in, and it’s nice and clean, it smells good, and there are activities for people. It’s a place I would want to send a loved one.”

For examples of PACE care in rural communities, click here and here.  To discover more about PACE, click here.

Private equity-owned health care is guided by expansion and profits; many are calling for more regulation

As Americans age, the home health care sector will
continue to grow. (Photo by G.A. Pflueger, Unsplash)

Home health care businesses may go by nurturing names, such as "Senior Helpers" or "At Home Angels," but the much industry is funded by private equity investors looking to make hefty profits, reports Anna Claire Vollers of Stateline. "Proponents of private equity investment in health care say the infusion of capital helps smaller companies expand into new markets." But skeptics point to places where care companies suddenly pulled out of entire regions when profits waned, leaving elderly people at home with no care.

Private equity-owned health care companies exist to make money for investors. "Private equity firms pool investments from pension funds, endowments, sovereign wealth funds and wealthy individuals to buy controlling stakes in companies," Voller explains. "In health care, critics say, that business model can diminish the quality of care, increase costs and narrow access for patients — particularly in more lightly regulated industries such as home care and hospice care."

Home health care is an appealing business venture because it doesn't face the same level of scrutiny as hospitals and nursing homes, the profit margins are robust, and there's an aging population where "around 10,000 baby boomers turn 65 every day," Voller reports. There will be "millions of people who will need care in the coming years," which will guarantee strong business growth. Plus, insurance companies encourage their customers to use home health care, which again, bolsters profits.

Even with all those benefits, private equity firms tend to pile debt on their companies to fund expansion. "Private equity firms typically aim to acquire a company and boost profits before selling it within five to seven years," Voller reports. "They often purchase companies with borrowed money, using the company's assets as collateral for the loans."

Mary Bugbee, senior research and campaign coordinator for health care at the Private Equity Stakeholder Project, a research and advocacy group, told Voller, "We leave a lot to the whims of the market and allow private players to dictate access to and quality of health care."

State policy and lawmakers are looking at home health care companies as businesses needing more regulatory oversight. "Improving transparency, requiring certain health care staff-to-patient ratios and boosting wages for health care workers can also help protect patients and communities," Voller reports. 

Out-of-pocket prescription expenses can be painful -- here are some steps to control costs

Retail drug prices vary. Shopping around can
save money. (Photo by Jake Dockins, WSJ)

Ringing in the new year can mean the costly reset of health insurance deductibles, but understanding new caps and limits on prescriptions can make out-of-pocket expenses more manageable. "The Inflation Reduction Act of 2022 contained some of the most sweeping drug-price provisions ever enacted," reports Peter Loftus of The Wall Street Journal. Beyond the law's changes, there are several steps people can take to "put a lid on drug costs."

Beginning in 2023, insulin costs were capped at $35 per month for Medicare recipients. Loftus explains, "You can check the websites of the three main insulin manufacturers — Eli Lilly, Novo Nordisk and Sanofi — to see if the price of your insulin is being cut." If you carry private insurance, the cap does not apply.

The reduction act also "expanded the list of vaccines that seniors enrolled in Medicare Part D can receive at no cost," Loftus reports. Details are available here.

Check with your provider to see if swapping out your costly brand-name drug for a generic is an option. Loftus adds, "There's also a newer category of drugs called biosimilars, which are close copies of brand-name biologic drugs such as Humira, the high-selling drug for autoimmune diseases. . . . Here is the growing list of approved biosimilars."

Take time to compare costs. "Prices for the same drug can vary widely depending on where you buy it," Loftus writes. "For generics, check out the growing number of online discount prescription services. The Mark Cuban Cost Plus Drug Co. offers generic drugs at a 15% markup plus pharmacy and shipping fees by cutting out pharmacy middlemen and negotiating directly with manufacturers. Amazon.com offers various pharmacy services, including one that provides eligible medications for $5 a month, found here."

To read about when to consider skipping insurance and to find links to more savings options, you can read Loftus's full article here.

Opinion: Amid hospital closures and soaring costs, medical centers should offer affordable care, not luxuries

Some hospitals look more like 5-star hotels.
(Photo by Jared Rice, Unsplash)

An anticipated "getaway" or "a journey of a lifetime" is often tied to a vacation that offers time away from the stress of daily life. But these traveling words are now being used to rebrand disease treatments. "Spin doctors are marketing getting sick as an adventure," writes Elisabeth Rosenthal in her opinion for KFF Health News. "It's not."

Rosenthal has always enjoyed travel and, for a time, lived in Rome. Her more recent "trips" were nothing like a vacation or living abroad. "I'm told, I've been on a journey. Two journeys, actually: First, a 'traumatic brain injury journey,' experienced at Johns Hopkins Hospital after I banged my head and developed trouble with my balance and gait," she writes. "More recently, I've been a traveling companion on my husband's 'cancer journey' at Memorial Sloan Kettering in New York City."

While her care was excellent, the profoundly severe element of many illnesses "has been rebranded in American health care as a kind of adventure," Rosenthal adds. "Experts speak of stroke journeys. Hospital systems invite people on kidney transplant journeys. The language has trickled down into advertising: Take a hair loss journey or a weight loss journey (newly popular because of Wegovy and similar drugs). The heart failure journey even comes with a map."

"A map?" Rosenthal asks. You don't visit anywhere exotic during disease treatment, and none of the treatments are glamorous. She writes. "In recent years, tight budgets, staffing shortages, and burnout have hit American hospitals. At the same time, many health centers in the U.S. — including the most prestigious ones, and even some community hospitals — have morphed into seven-star hotels. New hospital buildings, such as recent projects at the University of Michigan hospital system . . . . A hospital might now boast about its views, high-thread-count sheets, or food provided by a Michelin-starred chef."

In a nation where rural hospitals face towering debts and closures, and many Americans opt to delay treatment because of cost, "Is it worth it?" Rosenthal wonders. "Room charges in many hospitals can exceed $1,000 a night. . . . A hospital's function is to diagnose and to heal at a price that sick people can afford. I dream of a no-frills Target- or Ikea-like hospital for care. . . . The best hospitals in Europe are utilitarian structures resembling urban high schools."

Rosenthal suggests: "Instead of providing free coffee and a piano in a soaring, art-filled marble lobby, how about focusing on the very basic things that health systems in the U.S. should do, but — in my experience — in many cases do not, like making it easier for patients to schedule appointments? Shortening the now lengthy wait times to see physicians who take insurance plans? Or paying for adequate staffing on nights and weekends? Or ending those two-day stays in emergency rooms when all inpatient beds are full?"

When to get which vaccine and how to get insurance to pay for it has some Americans ditching vaccines

Illustration by Molly Ferguson, Stat

If it's too hard to understand or to get done, many people will opt out -- as is the case with adults attempting to get vaccines.

"Alison Buttenheim was floored by a sign she saw in her doctor’s office when she went to get the first jab of the two-dose shingles vaccine to protect her against painful flare-ups of varicella zoster," reports Helen Braswell of Stat. "The notice read: 'Medicare patients cannot receive Tdap or zoster vaccines here. They need to obtain [them] at their pharmacy. If they receive it here, they need to pay out of pocket.' In this instance, patients could receive vaccines covered by Medicare as treatment, but not as a preventative measure. For instance, if a person stepped on a nail, Medicare would pay for their tetanus shot; however, if a patient is getting a tetanus booster to maintain protection, Medicare would not cover it.

Buttenheim, a professor of nursing at the University of Pennsylvania who studies vaccine acceptance and hesitancy, "knows that any amount of difficulty in the immunization process can deter people from getting vaccinated. She couldn’t believe her eyes," Branswell explains. "To stay abreast of what to get and when and where to get it almost requires would-be vaccine recipients to have advanced degrees. Buttenheim recently found herself shelling out $160 for her latest Covid booster. She told Branswell, "We’re absolutely making it too hard."

Branswell reports, "Some of that may be due to vaccine hesitancy but more of it is likely due to the sheer difficulty of knowing what to get, when to get it, and how to get insurance coverage for the various shots, said Saad Omer, a vaccine expert who is dean of the Peter O’Donnell Jr. School of Public Health at the University of Texas Southwestern." Omer told Branswell: “Beyond the cacophony of pro-vaccine and anti-vaccine arguments on X (formerly know as Twitter), most of the country doesn’t actively think about vaccines, period."

Opinion: We could end poverty. 'Why don't we do it?'

Census Bureau graph

In 2021, U.S. poverty hit the resounding record low of 7.8% -- a good thing, but only a reprieve. Once pandemic benefits ended and inflation shot upward, the number of Americans living in poverty soared, with the Supplemental Poverty Measure posting a near 60% increase, with 11.4% of U.S. citizens living in poverty in 2022. "And it's all because politicians allowed proven income support programs to expire," writes Lakeisha McVey in her opinion for OtherWords.com.

"I'm an expert on poverty. I've lived it most of my life in Iowa. I studied it as a Bill Emerson National Hunger Fellow in rural West Virginia and in Washington, D.C., and now I help people experiencing poverty across the country tell their own stories to change policy.

"People can pull themselves up by their bootstraps, get an education, and work multiple jobs. But in the face of rising prices, low wages, high rents, and a broken healthcare system, it's often not enough. Without a safety net and a level playing field for families, financial security is often out of reach.

"When I was growing up in Des Moines, my mom had a stable job with the state, but her pay wasn't enough for a real home for my two siblings and me. Iowa, like every state, has a low-income housing crisis. And families of color like mine experience greater challenges obtaining affordable housing. We bounced around shelters, churches and motel rooms.

"Despite a stigma about accepting public assistance, we benefited from SNAP (aka 'food stamps') and the Women, Infants and Children program. But like other low-income families, we had to navigate the 'benefits cliff.' When my mother made just $10 more, we'd lose the benefits we needed for sufficient, regular meals.

"My father suffered from opioid addiction. When he was eventually able to get stable employment and rejoin our family, we finally got an apartment where the schools were decent. But a brain aneurysm suddenly took his life, and we ended up back on the opposite side of the city where the underfunded schools offered less opportunity.

"I wanted to stay in my school, so I spent four hours a day commuting on public buses and on foot. I knew I needed to get into college to be able to help my family financially. Now I have a steady job, and so does my husband.

"But everyday struggles don't end. The brokenness of our healthcare system burst into my life again when our baby was born with a fatal condition. The medical costs ran nearly $1 million in just the first few months of his tragically short life. . . . What could prepare someone for that?

"Thankfully, my employer pays 100% of my health insurance. That's a rarity. If I'd been out of work or worked elsewhere, we would've gone bankrupt as we suffered the most tragic thing that could ever happen to us as parents.

"These are just a few of the structural obstacles low-income people face every day. But there are solutions. The advocates I work with reported enormous relief after politicians finally agreed to invest in helping children and families during the Covid-19 crisis.

"The expanded Child Tax Credit cut child poverty nearly in half. Expanded food programs through SNAP lifted more than 3 million people out of poverty and staved off an expected spike in hunger. Housing subsidies kept nearly 2.5 million people out of poverty and in their homes. And Medicaid enrollment protections reduced the number of uninsured people by 1.5 million.

"The year those programs were implemented, the Supplemental Poverty Measure fell to 7.8% — its lowest ever level. But when politicians rejected continuing this vital help for families, it increased by a record amount. This is a failure for families across the country. We need to renew and expand those programs as soon as possible. . . . Poverty is solvable. We know what works. Why don't we do it?"

Lakeisha McVey is a bereaved mother, social justice advocate and leader of the Experts on Poverty Program at RESULTS.

Many people track the number of steps they take each day, but can increasing the amount lead to weight loss?

Step counting is a good way to measure activity.
(Photo by Arek Adeoye, Unsplash)

Kennesaw State professor Bob Buresh and his team of researchers have been trying to determine if increasing the number of steps you take day can help with the obesity problem in the United States. A condensed version of their findings published in The Conversation is shared below.

"Over the last decade, smartphones have become ubiquitous not just for sending texts and staying abreast of news but also for monitoring daily activity levels. Among the most common, and arguably the most meaningful, tracking method for daily physical activity is step counting.  . . . Counting steps is far more than a fad. The Department of Health and Human Services dedicated a sizable portion of its most recent physical activity guidelines to documenting the relationship between daily step counts and several chronic diseases.

"Unfortunately, the guidelines have little to say about how step counts might be used to aid in weight management, an outcome of critical importance given the high rates of overweight and obesity in the U.S. In the early 1980s, fewer than 14% of adults in the U.S. were classified as having obesity. Today, just over 40 years later, the prevalence of obesity is greater than 40% in the adult population, and current trends suggest that almost half of adults in the U.S. will be obese by 2030.

"I am a professor of exercise science at Georgia's Kennesaw State University, and our lab has been conducting studies examining relationships among step counts and a number of health outcomes.
While the evidence is clear that increasing numbers of adults are living in a chronic energy surplus that leads to weight gain, a key question is – why? What has changed so dramatically since 1980 that could explain why obesity rates have tripled? Although the American diet is likely a key contributor, a wealth of research points to a reduction in physical activity as a major culprit behind the expanding waistlines – and step counts are an excellent indicator of physical activity.

"Step counts may – or may not – lead to weight loss: A number of recent studies have looked at whether increasing step counts can lead to weight loss over a certain period of time. One large-scale study called a meta-analysis concluded that increasing physical activity by way of step counts was effective for attaining modest weight loss. However, many, if not most, studies examining the effect of exercise on weight loss report modest outcomes, with results that are variable and often disappointing.

"When it comes to health, it is important to remember that body weight does not tell the whole story. In fact, body composition is much more predictive of health status than body weight. Someone who weighs more than another person may be in better health if they have more muscle mass and a lower percentage of body fat than the other person who weighs less but has a higher proportion of body fat.

"Parsing the numbers: We have used our data to develop a model that predicts average daily step counts per unit of fat mass from body fat percentage. We believe that this model can be used to determine how much people would need to walk to achieve a specific amount of weight and body fat reduction.

"A person's body fat percentage is every bit as important as their weight. That's because how much muscle you have affects how hungry you get, as well as how many calories you burn. Muscle mass requires energy to maintain, and this requirement leads to increased appetite, which means taking in more calories." 

The Conversation is a platform for journalism by academics.

Proposal for more nursing-home staff seen as unattainable by many owners; resident advocates say it's not enough

Nursing homes may not be ready for 'tsunami' of baby boomers.
(Photo by G.A. Pflueger, Unsplash)

Nursing homes have struggled for decades to find a sustainable business model that provides optimal staffing numbers for resident care. Now federal officials have released "a proposed rule requiring the nation’s nursing homes to hire minimum numbers of front-line caregivers, a long-anticipated response to decades of complaints about neglect and abuse in an industry that critics say is unprepared for the tsunami of seniors heading its way from the baby boom," reports Christopher Rowland of The Washinton Post.

The Centers for Medicare and Medicaid Services proposed "minimum nurse staffing standards . . . per resident for registered nurses and . . . nurse aides," as well as a requirement to have a registered nurse at the nursing home around the clock. Many industry stakeholders consider the proposal futile. Rowland explains, "Without a supply of prospective workers, it will be impossible to meet the requirements of minimum staffing, the industry has argued. They also contend that Medicaid reimbursement rates need to be significantly increased if more workers are required in facilities." Nathan Schema, president and chief executive officer of the Evangelical Lutheran Good Samaritan Society, which operates a large chain of nonprofit nursing homes, told Rowland: "I just can’t understand how CMS is effectively trying to fix the roof while the house is on fire. It’s the beginning of the end for small-town nursing homes."

Rowland adds, "A fifth of nursing homes would have to hire registered nurses to meet the requirement, the government estimates." LeadingAge, the largest association for nonprofit nursing homes, told USA Today that the proposed regulation would be impossible for many nursing homes to meet. “There are simply no people to hire—especially nurses,” said Katie Smith Sloan, the group's president and CEO. “America’s under-funded, long-ignored long-term care sector is in a workforce crisis.” Sloan said nursing homes would have to “reduce admissions or even close” if the rule takes effect.

"While the industry reacted negatively to the proposed rule’s release, the guidelines also disappointed advocates for better treatment of residents in chronically short-staffed nursing homes, who contend the rule does not go far enough and enshrines substandard levels of care," Rowland reports. "Advocates for better quality care in nursing homes say the industry’s high staff turnover rates point to the true problem: insufficient pay and poor working conditions."

Nine states halt Medicaid 'procedural' terminations; other states have plans to address flaws in the process

Photo by Jon Tyson, Unsplashed

The end of the pandemic meant the resumption of eligibility verification for Medicaid, which has proved a difficult transition for some, and many beneficiaries are losing coverage, mainly because they haven't responded to recertification efforts.

Under pressure from the Centers for Medicare and Medicaid Services, nine states have "agreed to pause procedural terminations as they address potential violations of Medicaid renewal requirements," reports Dorothy Mills-Gregg of Inside CMS. And 35 states have approved mitigation plans "that must address various issues, particularly with renewal forms and with confirming Medicaid eligibility ex parte, to comply with federal renewal requirements." The states are Delaware, Idaho, Iowa, Maine, Minnesota, Mississippi, New York, West Virginia and Wyoming.

"Nearly 20 states did not let their beneficiaries renew using all modalities -- phone, mail, in-person or online -- and eight states requested more information on their requests for renewal than is needed to determine eligibility," Mills-Greg writes. "To fix these potential violations. . . some states have agreed to provide simplified forms, add instructions explaining what information is required or pre-populate renewal forms. . . . Plans can also include extending call center hours, letting individuals or organizations help beneficiaries submit renewals."

Mills-Greg reports that 26 states "entered a mitigation plan in part because they were not conducting renewals ex parte, which is where a beneficiary's eligibility is confirmed administratively with third-party data, like participation in the Supplemental Nutrition Assistance Program. Experts say renewing coverage via ex parte reduces paperwork, potentially saving enrollees from losing Medicaid coverage because of a missing form or they didn't return a renewal request on time."

California, Colorado, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Montana, New Hampshire, New Mexico, North Dakota, Rhode Island and Tennessee had "no identified violations of federal renewal requirements," Mills-Greg reports.

A state's political identity does not determine compliance with federal Medicaid requirements or the need for a mitigation plan. Arielle Kane, Families USA director of Medicaid initiatives, told Mills-Gregg: "It's not a political problem; it's a problem with the enrollment systems; it's a problem with our infrastructure; it's a problem with, you know, how we track people -- all of these things -- then I think it almost maybe will de-stigmatize it a little bit and help us get to solutions."

With hospital closures and need for reliable funding, rural America's emergency medical services seek new solutions

Rural ambulance in Sweetwater, Wyoming
(Photo by Kim Raff, The New York Times)

You can call 911, but in some rural places, no one can come immediately, no matter your emergency. "Nearly 4.5 million people across the U.S. live in an 'ambulance desert' – 25 minutes or more from an ambulance station – and more than half of those are residents of rural counties," reports Nada Hassanein of USA Today, citing a study by the Maine Rural Health Research Center and the Rural Health Research Centers. "As rural hospitals shutter across the nation, dwindling emergency medical services also must travel far to the nearest hospital or trauma center. Experts and those in the field say Emergency Medical Services need a more systematic funding model to support rural and poorer urban communities."

Lead study author Yvonne Jonk, deputy director of the center, told Hassanein, "This is a really extreme problem, and we need to figure out solutions. People think that when you call 911, that someone's coming in. Most people don't realize that their communities don't actually have adequate coverage." Hassanein reports, "Four of 5 counties across the nation have at least one ambulance desert, according to Jonk's analysis of 41 states and data from 2021 and 2022."

The inability of many rural areas to have and staff an emergency response team has several reasons. From the truck to the equipment to professional dispatchers and emergency medical technicians, an ambulance service is an expense most areas are expected to cover but can't. Hassanein writes, "The McDermitt Paiute-Shoshone Tribe reservation stretches along the Nevada-Oregon border near Idaho and has no ambulance or hospital. . . . Tribal chairwoman Maxine Redstar said the community used to have an ambulance service, but it couldn't afford to keep it going. . . . Weather, wildlife and long, dark winding gravel roads make getting to the scene difficult." Redstar told Hassanein: "When you call an ambulance, it comes from Winnemucca, which is an hour away."

For many rural areas, funding an ambulance service can be a major obstacle. "Few states designate EMS as an essential service. In the U.S., EMS are mainly funded by local governments, and not all states allocate supplemental funds toward the services,"Hassanein reports. "Amid patchwork funding, communities rely on varied revenue sources to fund ambulance services, said Lindsey Narloch, project manager at Rural EMS Counts, a North Dakota EMS improvement project. That often doesn't cover expensive equipment, medication and staff salaries. Counties end up having to pay most of the cost."

Having and staffing an EMS services may require a new model. Hassanein explains, "Gary Wingrove, president of The Paramedic Foundation, noted that critical access hospitals, which are medical centers in rural, underserved communities often with a high number of uninsured residents, are paid more than other hospitals if their care delivery cost is higher than the standard Medicare payment."  Wingrove told Hussanein: "We have to take a hard look at our financing of rural ambulance services. And to me, it just makes a lot of sense if we create a system like the critical access hospitals have for the rural ambulance services."

Rural hospitals keep closing their maternity units, leaving many women far from care and their babies at more risk

Hills outside of Toppenish, Washington. Ambulances are often slow to arrive on the Yakama Indian Reservation, which spreads over a million acres. (Photo by Ruth Fremson, The New York Times)

Suspensions of obstetric services in rural hospitals "appear to have accelerated" in the last year, "as hospitals from Maine to California have jettisoned maternity units, mostly in rural areas where the population has dwindled and the number of births has declined," reports Roni Caryn Rabin of The New York Times. "A study of hospital administrators carried out before the pandemic found that 20 percent of them said they did not expect to be providing labor and delivery services in five years’ time."

The closings are predicted to continue. "From 2015 to 2019, there were at least 89 obstetric-unit closures in rural hospitals across the country. By 2020, about half of rural community hospitals did not provide obstetrics care, according to the American Hospital Association," Rabin writes. "In the past year, the closures appear to have accelerated, as hospitals from Maine to California have jettisoned maternity units, mostly in rural areas where the population has dwindled and the number of births has declined."

Hospital closures leave pregnant women feeling vulnerable and betrayed. Rabin reports from Toppenish, Washington, where "frustration and fear erupted at a recent City Council meeting, which drew such a large crowd that it spilled into the hallway outside the chambers." Astria Toppenish Hospital "had committed to keeping certain services, including labor and delivery, available for at least a decade after acquiring the hospital," Rabin writes. "Now the hospital said it could not afford to do so, and the state has taken no action." Leslie Swan, a Native American doula, told Rabin, “There will be lives lost — people need to know that."

Toppenish is on the Yakama Indian Reservation, but is "the canary in the coal mine" for other rural hospitals' obsttric units, Cassie Sauer, president and chief executive of the Washington State Hospital Association, told Rabin, who writes, "The closure in Toppenish mirrors national trends as financially strained hospitals come to a harsh conclusion: Childbirth doesn’t pay, at least not in low-income communities."

Obstetric units are expensive. They "must be staffed 24 hours a day, seven days a week, with a team of specialized nurses and backup services, including pediatrics and anesthesia," Rabin reports. "In Washington State, Medicaid would pay $6,344 for a childbirth, about one-third of the $18,193 paid by private plans, according to an analysis by the Health Care Cost Institute. . . In wealthier communities, private insurance helps offset low Medicaid payments to hospitals. But in rural areas where poverty is more entrenched, there are too few privately insured patients."

Rabin recounts the downward spiral of U.S. maternal care: "The United States is already the most dangerous developed country in the world for women to give birth, with more than one death for every 5,000 live deliveries. . . . Recent figures show that the problems are particularly acute in minority communities and especially among Native American women, whose risk of dying of pregnancy-related complications is three times as high as that of white women. . . . According to the March of Dimes, the maternal health nonprofit, seven million women of childbearing age reside in counties where there is no hospital-based obstetric care, no birthing center, no obstetrician-gynecologist and no certified nurse midwife, or where those services are at least a 30-minute drive away."

That has effects on mothers and babies, the Centers for Disease Control says: "Severe maternal morbidity includes unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman’s health. Using the most recent list of indicators, SMM has been steadily increasing in recent years and affected more than 50,000 women in the United States in 2014."