O:9:"MagpieRSS":22:{s:6:"parser";i:0;s:12:"current_item";a:0:{}s:5:"items";a:10:{i:0;a:12:{s:5:"title";s:65:"ER Doctors Vow to Pursue Case Against Envision Even in Bankruptcy";s:4:"link";s:94:"https://northdenvernews.com/er-doctors-vow-to-pursue-case-against-envision-even-in-bankruptcy/";s:2:"dc";a:1:{s:7:"creator";s:12:"James Python";}s:7:"pubdate";s:31:"Sat, 13 May 2023 02:15:10 +0000";s:8:"category";s:6:"Latest";s:4:"guid";s:94:"https://northdenvernews.com/er-doctors-vow-to-pursue-case-against-envision-even-in-bankruptcy/";s:11:"description";s:1700:"
If Envision Healthcare files for bankruptcy, a group of emergency room doctors would seek permission to continue their federal lawsuit that claims the private equity-backed company is violating California?s ban on corporate control of medical practices. ?I anticipate that we would ask the bankruptcy judge to let our case proceed,? said David Millstein, an attorney […]";s:7:"content";a:1:{s:7:"encoded";s:10259:"

If Envision Healthcare files for bankruptcy, a group of emergency room doctors would seek permission to continue their federal lawsuit that claims the private equity-backed company is violating California?s ban on corporate control of medical practices.

?I anticipate that we would ask the bankruptcy judge to let our case proceed,? said David Millstein, an attorney representing the Milwaukee-based American Academy of Emergency Medicine Physician Group. ?Among other things, Envision?s practices violate the law, are continuing, and need to be addressed.?

Still, the future of the lawsuit is uncertain since it?s unclear how a judge might rule.

On May 9, The Wall Street Journal reported that Envision planned to file for Chapter 11 bankruptcy protection, possibly as early as this weekend. That would allow the company, based in Nashville, Tennessee, to reduce its debt while reorganizing its business. The Journal said Envision failed to report quarterly financial results by a March 31 deadline and missed an interest payment in April.

Envision spokesperson Aliese Polk declined to comment.

The emergency doctors? lawsuit does not ask for monetary damages, so the Milwaukee group would presumably not have a financial claim against Envision. Instead, the doctors are seeking a declaration by the court that the company?s alleged use of shell business structures to retain de facto ownership of ER staffing groups is illegal. A trial in San Francisco had been scheduled to start next January, but the date has been pushed back.

The doctors believe that a victory in their case would lead to a ban on that business strategy across California ? not just in ERs run by Envision but also by TeamHealth, another private equity-owned medical staffing firm, and in other medical services the two companies provide, including anesthesiology, hospital-based medicine, and gynecology.

Many doctors, nurses, consumer advocates, and even some lawmakers, hope a legal victory would spur prosecutors and regulators in other states to take the issue of medical practices controlled by corporations more seriously.

Envision runs 467 emergency departments across the country and TeamHealth operates 511, according to Ivy Clinicians, a startup job search website for emergency physicians. Together, the two companies control more than 17% of emergency departments, the data shows.

Envision was acquired by the investment firm KKR in 2018 for $9.9 billion, making it the largest private equity deal in health care during that decade. The deal saddled Envision with about $7 billion in debt. Last September, analysts at S&P Global Ratings estimated that the company?s debt was 29 times its earnings in 2022, a staggeringly high figure that raised alarms about its ability to pay its obligations.

At the same time, Envision?s revenue picture has deteriorated. The federal No Surprises Act, which protects patients from unexpected bills sent by out-of-network providers, sapped a key source of revenue. The pandemic shrank patient volumes, and burnout among health care workers fueled staffing shortages that have jacked up labor costs. A fierce battle with insurance giant UnitedHealthcare over payments for patient care also hit Envision.

?The financial profile of the company is just not strong enough to manage the debt they have on the balance sheet, and I think that?s really what the bottom line is,? said David Peknay, a director at S&P Global Ratings.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

";}s:7:"post-id";s:5:"53402";s:7:"summary";s:1700:"
If Envision Healthcare files for bankruptcy, a group of emergency room doctors would seek permission to continue their federal lawsuit that claims the private equity-backed company is violating California?s ban on corporate control of medical practices. ?I anticipate that we would ask the bankruptcy judge to let our case proceed,? said David Millstein, an attorney […]";s:12:"atom_content";s:10259:"

If Envision Healthcare files for bankruptcy, a group of emergency room doctors would seek permission to continue their federal lawsuit that claims the private equity-backed company is violating California?s ban on corporate control of medical practices.

?I anticipate that we would ask the bankruptcy judge to let our case proceed,? said David Millstein, an attorney representing the Milwaukee-based American Academy of Emergency Medicine Physician Group. ?Among other things, Envision?s practices violate the law, are continuing, and need to be addressed.?

Still, the future of the lawsuit is uncertain since it?s unclear how a judge might rule.

On May 9, The Wall Street Journal reported that Envision planned to file for Chapter 11 bankruptcy protection, possibly as early as this weekend. That would allow the company, based in Nashville, Tennessee, to reduce its debt while reorganizing its business. The Journal said Envision failed to report quarterly financial results by a March 31 deadline and missed an interest payment in April.

Envision spokesperson Aliese Polk declined to comment.

The emergency doctors? lawsuit does not ask for monetary damages, so the Milwaukee group would presumably not have a financial claim against Envision. Instead, the doctors are seeking a declaration by the court that the company?s alleged use of shell business structures to retain de facto ownership of ER staffing groups is illegal. A trial in San Francisco had been scheduled to start next January, but the date has been pushed back.

The doctors believe that a victory in their case would lead to a ban on that business strategy across California ? not just in ERs run by Envision but also by TeamHealth, another private equity-owned medical staffing firm, and in other medical services the two companies provide, including anesthesiology, hospital-based medicine, and gynecology.

Many doctors, nurses, consumer advocates, and even some lawmakers, hope a legal victory would spur prosecutors and regulators in other states to take the issue of medical practices controlled by corporations more seriously.

Envision runs 467 emergency departments across the country and TeamHealth operates 511, according to Ivy Clinicians, a startup job search website for emergency physicians. Together, the two companies control more than 17% of emergency departments, the data shows.

Envision was acquired by the investment firm KKR in 2018 for $9.9 billion, making it the largest private equity deal in health care during that decade. The deal saddled Envision with about $7 billion in debt. Last September, analysts at S&P Global Ratings estimated that the company?s debt was 29 times its earnings in 2022, a staggeringly high figure that raised alarms about its ability to pay its obligations.

At the same time, Envision?s revenue picture has deteriorated. The federal No Surprises Act, which protects patients from unexpected bills sent by out-of-network providers, sapped a key source of revenue. The pandemic shrank patient volumes, and burnout among health care workers fueled staffing shortages that have jacked up labor costs. A fierce battle with insurance giant UnitedHealthcare over payments for patient care also hit Envision.

?The financial profile of the company is just not strong enough to manage the debt they have on the balance sheet, and I think that?s really what the bottom line is,? said David Peknay, a director at S&P Global Ratings.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

";s:14:"date_timestamp";i:1683944110;}i:1;a:12:{s:5:"title";s:95:"?A System in Crisis?: Dysfunctional Federal Disability Programs Force the Poor to Pass Up Money";s:4:"link";s:121:"https://northdenvernews.com/a-system-in-crisis-dysfunctional-federal-disability-programs-force-the-poor-to-pass-up-money/";s:2:"dc";a:1:{s:7:"creator";s:12:"James Python";}s:7:"pubdate";s:31:"Fri, 12 May 2023 14:02:30 +0000";s:8:"category";s:6:"Latest";s:4:"guid";s:121:"https://northdenvernews.com/a-system-in-crisis-dysfunctional-federal-disability-programs-force-the-poor-to-pass-up-money/";s:11:"description";s:333:"Brenda Powell had suffered a stroke and was in debilitating pain when she called the Social Security Administration last year to seek disability benefits. The former Louisiana state office worker struggled at times to write her name or carry a glass of water. Powell, then 62, believed she could no longer work, and she was […]";s:7:"content";a:1:{s:7:"encoded";s:19725:"

Brenda Powell had suffered a stroke and was in debilitating pain when she called the Social Security Administration last year to seek disability benefits.

The former Louisiana state office worker struggled at times to write her name or carry a glass of water. Powell, then 62, believed she could no longer work, and she was worried about how to pay for medical care with only a $433 monthly pension.

Although the Social Security Administration agreed that Powell?s condition limited the work she could do, the agency rejected her initial application for Supplemental Security Income. She had the choice to appeal that decision, which could take months or years to resolve, or take early retirement. The latter option would give her $302 a month now but might permanently reduce the full Social Security retirement payment she would be eligible for at age 66 and 10 months.

?I didn?t know what to do. These decisions are not easy,? said Powell, who lives in Alexandria, Louisiana, about 200 miles northwest of New Orleans. She decided to appeal the decision but take early retirement in the meantime.

?I had to have more money to pay my bills,? she said. ?I had nothing left over for gas.?

Every year, tens of thousands of people who are disabled and unable to work consider taking early retirement benefits from Social Security. The underfunded federal disability system acknowledges that it is stymied by delays and dysfunction, even as over 1 million people await a decision on their benefits application.

The United States, which has one of the least generous disability programs among developed Western nations, denies most initial claims, leaving applicants to endure a lengthy appeals process.

At the same time, Social Security agents may neglect to explain the financial downside of taking retirement benefits too early, said attorneys who help patients file disability claims. The result is a growing population of vulnerable people who feel stuck between a proverbial rock and a hard place ? to live with little money while they wait it out or agree to a significantly lower payment for the rest of their lives.

?They don?t have the luxury of waiting,? said Charles T. Hall, a disability attorney based in Raleigh, North Carolina. ?The vast majority of people need the money now, and you can get early retirement benefits in two months or less.?

In a nation where more than a quarter of residents have a disability, Social Security Disability Insurance and Supplemental Security Income programs are intended to provide financial help to people who cannot work.

Retirement experts generally recommend senior citizens tap into their Social Security benefits as late as they can, to maximize the amount of money they receive from the federal government. For someone born after 1960, taking benefits at age 62 ? the earliest age people are eligible ? instead of 67 reduces each monthly payment by as much as 30% for the rest of a person?s life, said Richard Johnson, a senior fellow and the director of the Program on Retirement Policy at the Urban Institute, a nonprofit research organization.

Someone who applies for Supplemental Security Income, or early retirement, would get $914 a month if they can prove they are older than 65, blind, or have a disabling medical condition. Social Security Disability Insurance pays an average monthly benefit of $1,483 to those who suffered a disabling injury or illness and paid a federal tax that was deducted from their paychecks in the past.

Social Security agents will inform people of their ability to obtain early retirement benefits. But they might not explain the downsides, said Sam Byker, CEO and founder of Atticus, a California-based group that connects people seeking disability benefits with attorneys around the country. His organization found that among a sample of 765 clients ages 62-66 seeking Social Security Disability Insurance, 44% were already receiving early retirement.

Disability takes too long, and the decision about who gets approved can seem arbitrary, Byker said. ?It cannot be counted on,? he said.

An initial decision on an application for disability benefits can take an average of over seven months, according to a March letter signed by more than 100 members of Congress.

Most callers to the Social Security Administration are unable to reach an agent, and people seeking local field office assistance with an application can wait at least a month for an appointment, the letter said.

More than 1,200 Social Security Administration field offices exist across the country, like this one in Charlotte, North Carolina. People seeking assistance with disability applications can wait at least a month for an appointment. (Fred Clasen-Kelly / KFF Health News)
A sign at a Social Security Administration field office in Charlotte, North Carolina, encourages visitors to consider calling the agency for assistance if they don?t have an appointment. Most callers to the agency are unable to reach an agent, federal lawmakers say. (Fred Clasen-Kelly / KFF Health News)

Earlier this year, acting Social Security Commissioner Kilolo Kijakazi warned in a letter to congressional leaders that months-long delays in processing disability applications and phone assistance are likely to worsen in 2023, even as officials vow to improve service over time.

In a written statement, Social Security Administration spokesperson Darren Lutz acknowledged that wait times are ?far too long,? citing inconsistent and insufficient funding, staffing shortages, and other challenges. The agency refused to make officials available for a phone call to discuss the issue in more detail.

Caught in the tangle of dysfunction are disabled people with little or no income, who often take early retirement because they are struggling to pay for basics like housing, food, and medicine. In some cases, people end up homeless or die waiting for their disability benefits, lawyers told KFF Health News.

The problems can hit especially hard in the South and Appalachia, since those regions tend to have an older workforce than most other parts of the country, more workers in manufacturing, and people with lower educational attainment who tend to rely more on disability benefits.

?It is a system in crisis,? said Ida Comerford, a managing partner for the Kenneth Hiller law firm, which handles disability cases in New York, Michigan, and Illinois. ?This is not going to cut it. It is the worst I?ve ever seen it.?

The Social Security Administration said its workers are required to notify applicants about all the benefits they could receive and provide enough details for them to make an informed decision.

For someone who has no income and no ability to cover their expenses, it might make sense to take early retirement benefits, said Kurt Czarnowski, a former Social Security Administration regional communications director who now works as a retirement consultant.

If a person has a medical condition that suggests a shorter life span, Czarnowski said, it is probably wise to consider taking the smaller payments now instead of waiting for bigger checks later.

But there is a huge financial advantage for those who can wait, Czarnowski said.

People born after 1960 can collect full retirement benefits at age 67. In addition, each year they wait to collect Social Security between ages 67 and 70, their monthly check increases by 8%.

?Ultimately, it is a longevity decision,? Czarnowski said.

Hall also said he advises certain clients to take early retirement benefits while applying for disability. If the person wins their disability case, they can still collect full retirement benefits instead of the reduced amount, he said.

But Byker, of Atticus, said that strategy comes with risk. Most applicants need an attorney to help obtain disability through the lengthy appeals process. But lawyers are less likely to take a client who is already receiving early retirement benefits because that scenario significantly reduces the amount of money they can make on a case, he said.

More than 60% of applications for Supplemental Security Income are rejected, according to the Center on Budget and Policy Priorities, a nonprofit research organization. About two-thirds of applications for Social Security Disability Insurance are denied, the group says.

Six months after she applied, the Social Security Administration notified Powell in a February letter that her Supplemental Security Income claim had been denied. The letter said that while medical evidence shows her condition limits her ability to hold a job, she can do work in keeping with her skills as a finance assistant.

Lutz, the Social Security spokesperson, said in a written statement that privacy laws preclude the agency from answering questions about Powell?s case. Lutz said the agency uses a ?stringent definition of disability.?

Powell has hired an attorney and filed an appeal, but she doesn?t know when the case will be resolved.

?I don?t want to say ?poor, poor me,?? Powell said. ?It has not been easy. I don?t wish this on nobody.?

";}s:7:"post-id";s:5:"53377";s:7:"summary";s:333:"Brenda Powell had suffered a stroke and was in debilitating pain when she called the Social Security Administration last year to seek disability benefits. The former Louisiana state office worker struggled at times to write her name or carry a glass of water. Powell, then 62, believed she could no longer work, and she was […]";s:12:"atom_content";s:19725:"

Brenda Powell had suffered a stroke and was in debilitating pain when she called the Social Security Administration last year to seek disability benefits.

The former Louisiana state office worker struggled at times to write her name or carry a glass of water. Powell, then 62, believed she could no longer work, and she was worried about how to pay for medical care with only a $433 monthly pension.

Although the Social Security Administration agreed that Powell?s condition limited the work she could do, the agency rejected her initial application for Supplemental Security Income. She had the choice to appeal that decision, which could take months or years to resolve, or take early retirement. The latter option would give her $302 a month now but might permanently reduce the full Social Security retirement payment she would be eligible for at age 66 and 10 months.

?I didn?t know what to do. These decisions are not easy,? said Powell, who lives in Alexandria, Louisiana, about 200 miles northwest of New Orleans. She decided to appeal the decision but take early retirement in the meantime.

?I had to have more money to pay my bills,? she said. ?I had nothing left over for gas.?

Every year, tens of thousands of people who are disabled and unable to work consider taking early retirement benefits from Social Security. The underfunded federal disability system acknowledges that it is stymied by delays and dysfunction, even as over 1 million people await a decision on their benefits application.

The United States, which has one of the least generous disability programs among developed Western nations, denies most initial claims, leaving applicants to endure a lengthy appeals process.

At the same time, Social Security agents may neglect to explain the financial downside of taking retirement benefits too early, said attorneys who help patients file disability claims. The result is a growing population of vulnerable people who feel stuck between a proverbial rock and a hard place ? to live with little money while they wait it out or agree to a significantly lower payment for the rest of their lives.

?They don?t have the luxury of waiting,? said Charles T. Hall, a disability attorney based in Raleigh, North Carolina. ?The vast majority of people need the money now, and you can get early retirement benefits in two months or less.?

In a nation where more than a quarter of residents have a disability, Social Security Disability Insurance and Supplemental Security Income programs are intended to provide financial help to people who cannot work.

Retirement experts generally recommend senior citizens tap into their Social Security benefits as late as they can, to maximize the amount of money they receive from the federal government. For someone born after 1960, taking benefits at age 62 ? the earliest age people are eligible ? instead of 67 reduces each monthly payment by as much as 30% for the rest of a person?s life, said Richard Johnson, a senior fellow and the director of the Program on Retirement Policy at the Urban Institute, a nonprofit research organization.

Someone who applies for Supplemental Security Income, or early retirement, would get $914 a month if they can prove they are older than 65, blind, or have a disabling medical condition. Social Security Disability Insurance pays an average monthly benefit of $1,483 to those who suffered a disabling injury or illness and paid a federal tax that was deducted from their paychecks in the past.

Social Security agents will inform people of their ability to obtain early retirement benefits. But they might not explain the downsides, said Sam Byker, CEO and founder of Atticus, a California-based group that connects people seeking disability benefits with attorneys around the country. His organization found that among a sample of 765 clients ages 62-66 seeking Social Security Disability Insurance, 44% were already receiving early retirement.

Disability takes too long, and the decision about who gets approved can seem arbitrary, Byker said. ?It cannot be counted on,? he said.

An initial decision on an application for disability benefits can take an average of over seven months, according to a March letter signed by more than 100 members of Congress.

Most callers to the Social Security Administration are unable to reach an agent, and people seeking local field office assistance with an application can wait at least a month for an appointment, the letter said.

More than 1,200 Social Security Administration field offices exist across the country, like this one in Charlotte, North Carolina. People seeking assistance with disability applications can wait at least a month for an appointment. (Fred Clasen-Kelly / KFF Health News)
A sign at a Social Security Administration field office in Charlotte, North Carolina, encourages visitors to consider calling the agency for assistance if they don?t have an appointment. Most callers to the agency are unable to reach an agent, federal lawmakers say. (Fred Clasen-Kelly / KFF Health News)

Earlier this year, acting Social Security Commissioner Kilolo Kijakazi warned in a letter to congressional leaders that months-long delays in processing disability applications and phone assistance are likely to worsen in 2023, even as officials vow to improve service over time.

In a written statement, Social Security Administration spokesperson Darren Lutz acknowledged that wait times are ?far too long,? citing inconsistent and insufficient funding, staffing shortages, and other challenges. The agency refused to make officials available for a phone call to discuss the issue in more detail.

Caught in the tangle of dysfunction are disabled people with little or no income, who often take early retirement because they are struggling to pay for basics like housing, food, and medicine. In some cases, people end up homeless or die waiting for their disability benefits, lawyers told KFF Health News.

The problems can hit especially hard in the South and Appalachia, since those regions tend to have an older workforce than most other parts of the country, more workers in manufacturing, and people with lower educational attainment who tend to rely more on disability benefits.

?It is a system in crisis,? said Ida Comerford, a managing partner for the Kenneth Hiller law firm, which handles disability cases in New York, Michigan, and Illinois. ?This is not going to cut it. It is the worst I?ve ever seen it.?

The Social Security Administration said its workers are required to notify applicants about all the benefits they could receive and provide enough details for them to make an informed decision.

For someone who has no income and no ability to cover their expenses, it might make sense to take early retirement benefits, said Kurt Czarnowski, a former Social Security Administration regional communications director who now works as a retirement consultant.

If a person has a medical condition that suggests a shorter life span, Czarnowski said, it is probably wise to consider taking the smaller payments now instead of waiting for bigger checks later.

But there is a huge financial advantage for those who can wait, Czarnowski said.

People born after 1960 can collect full retirement benefits at age 67. In addition, each year they wait to collect Social Security between ages 67 and 70, their monthly check increases by 8%.

?Ultimately, it is a longevity decision,? Czarnowski said.

Hall also said he advises certain clients to take early retirement benefits while applying for disability. If the person wins their disability case, they can still collect full retirement benefits instead of the reduced amount, he said.

But Byker, of Atticus, said that strategy comes with risk. Most applicants need an attorney to help obtain disability through the lengthy appeals process. But lawyers are less likely to take a client who is already receiving early retirement benefits because that scenario significantly reduces the amount of money they can make on a case, he said.

More than 60% of applications for Supplemental Security Income are rejected, according to the Center on Budget and Policy Priorities, a nonprofit research organization. About two-thirds of applications for Social Security Disability Insurance are denied, the group says.

Six months after she applied, the Social Security Administration notified Powell in a February letter that her Supplemental Security Income claim had been denied. The letter said that while medical evidence shows her condition limits her ability to hold a job, she can do work in keeping with her skills as a finance assistant.

Lutz, the Social Security spokesperson, said in a written statement that privacy laws preclude the agency from answering questions about Powell?s case. Lutz said the agency uses a ?stringent definition of disability.?

Powell has hired an attorney and filed an appeal, but she doesn?t know when the case will be resolved.

?I don?t want to say ?poor, poor me,?? Powell said. ?It has not been easy. I don?t wish this on nobody.?

";s:14:"date_timestamp";i:1683900150;}i:2;a:12:{s:5:"title";s:67:"Marihuana legal es más potente que nunca pero no está bien regulada";s:4:"link";s:96:"https://northdenvernews.com/marihuana-legal-es-mas-potente-que-nunca-pero-no-esta-bien-regulada/";s:2:"dc";a:1:{s:7:"creator";s:12:"James Python";}s:7:"pubdate";s:31:"Thu, 11 May 2023 18:48:47 +0000";s:8:"category";s:6:"Latest";s:4:"guid";s:96:"https://northdenvernews.com/marihuana-legal-es-mas-potente-que-nunca-pero-no-esta-bien-regulada/";s:11:"description";s:333:"La marihuana y otros productos que contienen THC, el principal ingrediente psicoactivo de la planta, se han vuelto más potentes y peligrosos a medida que la legalización los ha vuelto más accesibles. Décadas atrás, el contenido de THC de la hierba solía ser inferior al 1,5%. Hoy, algunos productos tienen más de un 90%. La […]";s:7:"content";a:1:{s:7:"encoded";s:35673:"

La marihuana y otros productos que contienen THC, el principal ingrediente psicoactivo de la planta, se han vuelto más potentes y peligrosos a medida que la legalización los ha vuelto más accesibles.

Décadas atrás, el contenido de THC de la hierba solía ser inferior al 1,5%. Hoy, algunos productos tienen más de un 90%.

La euforia de antańo ha dado paso a algo más alarmante. Cientos de miles de personas llegan a salas de emergencias por crisis relacionadas con la marihuana, y millones sufren trastornos psicológicos vinculados al consumo de cannabis, según investigaciones federales.

Pero los organismos reguladores no están a la altura.

En los estados que permiten la venta y el consumo de la marihuana y sus derivados, la protección al consumidor no es consistente.

?En muchos estados, los productos tienen una etiqueta de advertencia y poco más por parte de las entidades reguladoras?, dijo Cassin Coleman, vicepresidente del comité de asesoramiento científico de la Asociación Nacional de la Industria del Cannabis.

En general, el gobierno federal no ha intervenido. Sigue prohibiendo la marihuana como sustancia catalogada en la Lista 1 ?como droga sin uso médico aceptado y con un alto riesgo de abuso? en virtud de la Ley de Sustancias Controladas (CSA). Pero en lo que respecta a la venta de cannabis, que muchos estados han legalizado, no regula características como la pureza o la potencia.

La Administración de Drogas y Alimentos (FDA) ?básicamente se ha cruzado de brazos y no ha cumplido con su deber de proteger la salud pública?, afirmó Eric Lindblom, de la Facultad de Derecho de la Universidad de Georgetown que anteriormente trabajó en el Centro para Productos del Tabaco de la FDA.

La marihuana se ha transformado profundamente desde que generaciones de estadounidenses la usaron por primera vez.

El cannabis se cultiva para suministrar dosis mucho más altas de THC. En 1980, el contenido de THC de la marihuana confiscada era inferior al 1,5%. Hoy en día, muchas variedades de flores de cannabis ?la materia vegetal que se puede fumar en un porro? tienen más de un 30% de THC.

Recientemente, en un dispensario de California el menú incluía una variedad con un 41% de THC.

La legalización también ha abierto la puerta a productos que se extraen de la marihuana pero que no siquiera parecidos: concentrados de THC aceitosos, cerosos o cristalinos que se calientan e inhalan mediante el vapeo o el dab, utilizando dispositivos parecidos a un soplete.

Los concentrados actuales pueden tener más de un 90% de THC. Algunos se anuncian como THC casi puro.

Pocos personifican la expansión de la marihuana de forma tan clara como John Boehner, ex presidente de la Cámara de Representantes de Estados Unidos. El republicano de Ohio se opuso durante mucho tiempo a la marihuana y, en 2011, se declaró ?inalterablemente contrario? a su legalización.

Ahora forma parte del consejo directivo de Acreage Holdings, un productor de derivados de la marihuana.

A photo of a man holding an amber sheet of crystallized THC concentrate in gloved hands up to the light.
Una lámina de una forma concentrada de THC, recién sacada del horno. (Brennan Linsley / AP)
A photo of a glass container filled with liquid marijuana concentrate.
THC se conserva en un recipiente de vidrio luego de ser extraído para su uso en productos de vapeo y alimentos. (Erin Clark / The Boston Globe via Getty Images)

Y Acreage Holdings ilustra la evolución del sector. Su marca Superflux comercializa un producto para vapear ??resina pura en un formato cómodo e instantáneo?? y concentrados como ?budder?, ?sugar?, ?shatter? y ?wax?. La empresa anuncia su concentrado de ?THCa cristalino? como ?lo último en potencia?.

Según el Instituto Nacional sobre el Abuso de Drogas, las concentraciones más elevadas entrańan mayores riesgos. ?Los riesgos de dependencia física y adicción aumentan con la exposición a altas concentraciones de THC, y las dosis más altas de THC tienen más probabilidades de producir ansiedad, agitación, paranoia y psicosis?, se explica en su sitio web.

En 2021, 16,3 millones de personas en Estados Unidos ?el 5,8% de las personas de 12 ańos en adelante? habían sufrido un trastorno por consumo de marihuana en el último ańo, según una encuesta publicada en enero por el Departamento de Salud y Servicios Humanos (HHS).

Esta cifra es muy superior a la suma de los trastornos por consumo de cocaína, heroína, metanfetamina, estimulantes de venta bajo receta, como Adderall, o analgésicos recetados, como fentanilo y OxyContin.

Otras drogas son más peligrosas que la marihuana, y la mayoría de las personas afectadas por su consumo padecieron un caso leve. Pero aproximadamente 1 de cada 7 ?más de 2,6 millones de personas? padecieron un caso grave, según la encuesta federal.

La mayoría de los médicos equiparan el término ?trastorno grave por consumo de sustancias? con la adicción, seńaló Wilson Compton, subdirector del Instituto Nacional sobre el Abuso de Drogas.

El trastorno por consumo de cannabis ?puede ser devastador?, afirmó Smita Das, psiquiatra de Stanford y presidenta de un consejo sobre adicciones de la Asociación Americana de Psiquiatría.

Das dijo que ha visto vidas destrozadas por el cannabis: personas de éxito que han perdido familias y trabajos. ?Se encuentran en una situación en la que no saben cómo han llegado, porque sólo era un porro, sólo era cannabis, y no se suponía que el cannabis les creara adicción?, explicó Das.

Entre los diagnósticos médicos atribuidos a la marihuana figuran la ?dependencia del cannabis con trastorno psicótico con delirios? y el síndrome de hiperémesis cannabinoide, una forma de vómito persistente.

Se estima que unas 800,000 personas realizaron visitas a emergencias relacionadas con la marihuana en 2021, según un estudio del gobierno publicado en diciembre de 2022.

Derecho a desintoxicación.

Un padre de Colorado pensó que era cuestión de tiempo para que el cannabis matara a su hijo.

En la primavera de 2021, el adolescente pasó un semáforo en rojo, chocó contra otro auto ?resultando heridos él y el otro conductor? y huyó del lugar, según recordó el padre en una entrevista.

En los restos del accidente, el padre encontró porros, envases vacíos de un concentrado de THC de alta potencia conocido como ?wax? y un vaporizador de THC.

En el teléfono móvil de su hijo descubrió mensajes de texto y decenas de referencias al ?dabbing? y a la hierba. El adolescente dijo que había estado fumando antes del accidente y que intentó suicidarse.

Semanas después, la policía ordenó su ingreso involuntario en un hospital para una evaluación psiquiátrica. Según un informe policial, creía que lo perseguían francotiradores de un cártel de drogas.

El médico que evaluó al adolescente le diagnosticó ?abuso de cannabis?.

?Deja de consumir dabs o wax, ya que pueden volverte extremadamente paranoico?, escribió el médico. ?Vete directamente al programa de desintoxicación que elijas?.

Según el relato del padre, en los dos últimos ańos el adolescente sufrió varias retenciones involuntarias, docenas de encuentros con la policía, repetidos encarcelamientos y una serie de estadías en centros de tratamiento hospitalario.

A veces parecía fuera de la realidad, y enviaba mensajes de texto diciendo que Dios le hablaba y le daba superpoderes.

Los dańos también fueron económicos. Los reclamos al seguro médico por su tratamiento ascendieron a casi $600,000 y los gastos de la familia llegaron a casi $40,000 hasta febrero.

En las entrevistas para este artículo, el padre habló bajo condición de anonimato para no perjudicar la recuperación de su hijo.

Está convencido de que la enfermedad mental de su hijo fue el resultado del consumo de drogas. Dijo que los síntomas remitían cuando su hijo dejaba de consumir THC y volvían cuando usaba de nuevo.

Su hijo tiene ahora 20 ańos, ha dejado la marihuana y le va bien, dijo el padre, y ańadió: “No me cabe la menor duda de que el consumo de cannabis fue lo que le causó la psicosis, los delirios y la paranoia”.

Regulación estatal desigual

Ahora, el uso médico de la marihuana es legal en 40 estados y el Distrito de Columbia, y el uso recreativo o para adultos es legal en 22 estados más el Distrito de Columbia, según MJBizDaily, una publicación especializada.

Al principio de la pandemia de covid-19, mientras gran parte de Estados Unidos cerró sus negocios, los dispensarios de marihuana siguieron abiertos. Muchos estados los declararon negocios esenciales.

Pero sólo dos estados que permiten el uso para adultos, Vermont y Connecticut, han puesto límites al contenido de THC ?30% para la flor de cannabis y 60% para los concentrados de THC? y eximen de los límites a los cartuchos precargados, dijo Gillian Schauer de la Asociación de Reguladores de Cannabis, un grupo de reguladores estatales.

Algunos estados limitan el número de onzas o gramos que los consumidores pueden comprar. Sin embargo, incluso un poco de marihuana puede equivaler a mucho THC, apuntó Rosalie Liccardo Pacula, profesora de políticas de salud, economía y derecho en la Universidad del Sur de California.

Algunos estados sólo permiten el uso médico de productos con bajo contenido de THC; por ejemplo, en Texas, las sustancias que no contienen más de un 0,5% de THC en peso. Y algunos estados exigen etiquetas de advertencia. En Nueva Jersey, los productos de cannabis con más de un 40% de THC deben declarar: “Este es un producto de alta potencia y puede aumentar el riesgo de psicosis”.

La normativa sobre marihuana de Colorado tiene más de 500 páginas. Sin embargo, se enfatizan los límites de las protecciones al consumidor: “Este producto se ha producido sin supervisión reglamentaria en materia de salud, seguridad o eficacia”.

Determinar las normas adecuadas puede no ser sencillo. Por ejemplo, las etiquetas de advertencia podrían proteger a la industria de la marihuana de su responsabilidad, al igual que hicieron con las empresas tabacaleras durante ańos. Poner un tope a la potencia podría limitar las opciones de las personas que toman dosis elevadas para aliviar problemas médicos.

En general, en el ámbito estatal, la industria del cannabis ha frenado los esfuerzos reguladores argumentando que unas normas onerosas dificultarían la competencia entre las empresas legítimas y las ilícitas, explicó Pacula.

Pacula y otros investigadores han pedido al gobierno federal que intervenga.

Meses después de terminar su mandato como comisionado de la FDA, Scott Gottlieb hizo un llamamiento similar.

Al quejarse de que los estados habían llegado “muy lejos mientras el gobierno federal permanecía al margen”, Gottlieb pidió “un esquema nacional uniforme para el THC que proteja a los consumidores.”

Eso fue en 2019 y poco ha cambiado desde entonces.

A photo of glass dab rigs used to consume THC concentrate backed by colorful lights.
Pipas que se pueden usar para inhalar productos con concentrados de THC en la sala de un dispensario de marihuana.(Carlos Avila Gonzalez / San Francisco Chronicle via Getty Images)

żDónde está la FDA?

La FDA supervisa los alimentos, los medicamentos recetados, los de venta libre y los dispositivos médicos. Regula el tabaco, la nicotina y los vapes de nicotina. Supervisa las etiquetas de advertencia del tabaco. En interés de la salud y la seguridad públicas, también regula los productos botánicos, productos médicos que pueden incluir material vegetal.

Sin embargo, cuando se trata de la marihuana para fumar, los concentrados de THC derivados del cannabis que se vapean o dabean y los comestibles infundidos con THC, la FDA parece estar muy al margen.

La marihuana medicinal que se vende en los dispensarios no está aprobada por la FDA. La agencia no ha avalado su seguridad o eficacia ni ha determinado la dosis adecuada. No inspecciona las instalaciones donde se producen los productos ni evalúa el control de calidad.

La agencia sí invita a los fabricantes a someter los productos del cannabis a ensayos clínicos y a su proceso de aprobación de medicamentos.

El sitio web de la FDA seńala que el THC es el ingrediente activo de dos medicamentos aprobados por la FDA para el tratamiento del cáncer. Aparentemente, sólo por eso la sustancia está bajo la jurisdicción de la FDA.

La FDA tiene “todo el poder que necesita para regular de forma mucho más eficaz los productos de cannabis legalizados por los estados”, afirmó Lindblom, ex funcionario de la agencia.

Al menos públicamente, la FDA no le ha prestado atención a los concentrados de THC derivados del cannabis o la hierba fumada en porros, sino más bien en otras sustancias: una variante del THC derivada del cáńamo, que el gobierno federal ha legalizado, y un derivado diferente del cannabis llamado cannabidiol o CBD, que se ha comercializado como terapéutico.

“La FDA se ha comprometido a vigilar el mercado, identificar los productos de cannabis que plantean riesgos y actuar, dentro de nuestras competencias, para proteger al público”, declaró Courtney Rhodes, vocera de la FDA.

“Muchos, la mayoría de los productos con THC se ajustan a la definición de marihuana, que es una sustancia controlada. La Drug Enforcement Administration (DEA) regula la marihuana en virtud de la Ley de Sustancias Controladas (CSA). Le remitimos a la DEA para preguntas sobre la regulación y aplicación de las disposiciones de la CSA”, escribió Rhodes en un correo electrónico.

La DEA, dependiente del Departamento de Justicia, no respondió a las preguntas formuladas para este artículo.

En cuanto al Congreso, quizá su medida más importante haya sido limitar la aplicación de la prohibición federal.

“Hasta ahora, la respuesta federal a las acciones estatales para legalizar la marihuana ha consistido, sobre todo, en permitir que los estados apliquen sus propias leyes sobre la droga”, seńaló un informe de 2022 del Servicio de Investigación del Congreso.

En octubre, el presidente Joe Biden ordenó al secretario de Salud y Servicios Humanos y al fiscal general que revisaran la postura del gobierno federal respecto a la marihuana: si debería seguir clasificada entre las sustancias más peligrosas y estrictamente controladas.

En diciembre, Biden firmó un proyecto de ley que ampliaba la investigación sobre la marihuana y obligaba a las agencias federales a estudiar sus efectos. La ley dice que las agencias tienen un ańo para publicar sus conclusiones.

Algunos defensores de la marihuana dicen que el gobierno federal podría desempeńar un papel más constructivo.

“La NORML no opina que el cannabis sea inocuo, sino que la mejor forma de mitigar sus riesgos potenciales es mediante la legalización, la regulación y la educación pública”, afirmó Paul Armentano, subdirector del grupo antes conocido como Organización Nacional para la Reforma de las Leyes sobre la Marihuana (NORML).

“Los productos tienen que someterse a pruebas de pureza y potencia”, ańadió, y “el gobierno federal podría ejercer cierta supervisión en la concesión de licencias a los laboratorios que prueban esos productos”.

Mientras tanto, según Coleman, asesor de la Asociación Nacional de la Industria del Cannabis, los estados se quedan “teniendo que actuar como si fueran USDA + FDA + DEA, todo al mismo tiempo”.

żY dónde deja eso a los consumidores? Algunos, como Wendy E., jubilada en sus 60 ańos, luchan contra los efectos de la marihuana.

Wendy, que habló con la condición de que no se revelara su nombre, empezó a fumar marihuana en la secundaria en los ańos 70 y la convirtió en su estilo de vida durante décadas.

Luego, cuando su estado la legalizó, la compró en dispensarios “y enseguida me di cuenta de que la potencia era mucho mayor que la que yo había consumido tradicionalmente”, contó. “Parecía haber aumentado de manera exponencial”.

En 2020, explicó, la marihuana legal ?mucho más fuerte que la hierba ilícita de su juventud? la llevó a obsesionarse con el suicidio.

Antes, la mujer que se define como “hippie de la madre tierra” encontraba camaradería pasando un porro con sus amigos. Ahora asiste a reuniones de Marihuana Anónimos, con otras personas que se recuperan de esta adicción.

";}s:7:"post-id";s:5:"53348";s:7:"summary";s:333:"La marihuana y otros productos que contienen THC, el principal ingrediente psicoactivo de la planta, se han vuelto más potentes y peligrosos a medida que la legalización los ha vuelto más accesibles. Décadas atrás, el contenido de THC de la hierba solía ser inferior al 1,5%. Hoy, algunos productos tienen más de un 90%. La […]";s:12:"atom_content";s:35673:"

La marihuana y otros productos que contienen THC, el principal ingrediente psicoactivo de la planta, se han vuelto más potentes y peligrosos a medida que la legalización los ha vuelto más accesibles.

Décadas atrás, el contenido de THC de la hierba solía ser inferior al 1,5%. Hoy, algunos productos tienen más de un 90%.

La euforia de antańo ha dado paso a algo más alarmante. Cientos de miles de personas llegan a salas de emergencias por crisis relacionadas con la marihuana, y millones sufren trastornos psicológicos vinculados al consumo de cannabis, según investigaciones federales.

Pero los organismos reguladores no están a la altura.

En los estados que permiten la venta y el consumo de la marihuana y sus derivados, la protección al consumidor no es consistente.

?En muchos estados, los productos tienen una etiqueta de advertencia y poco más por parte de las entidades reguladoras?, dijo Cassin Coleman, vicepresidente del comité de asesoramiento científico de la Asociación Nacional de la Industria del Cannabis.

En general, el gobierno federal no ha intervenido. Sigue prohibiendo la marihuana como sustancia catalogada en la Lista 1 ?como droga sin uso médico aceptado y con un alto riesgo de abuso? en virtud de la Ley de Sustancias Controladas (CSA). Pero en lo que respecta a la venta de cannabis, que muchos estados han legalizado, no regula características como la pureza o la potencia.

La Administración de Drogas y Alimentos (FDA) ?básicamente se ha cruzado de brazos y no ha cumplido con su deber de proteger la salud pública?, afirmó Eric Lindblom, de la Facultad de Derecho de la Universidad de Georgetown que anteriormente trabajó en el Centro para Productos del Tabaco de la FDA.

La marihuana se ha transformado profundamente desde que generaciones de estadounidenses la usaron por primera vez.

El cannabis se cultiva para suministrar dosis mucho más altas de THC. En 1980, el contenido de THC de la marihuana confiscada era inferior al 1,5%. Hoy en día, muchas variedades de flores de cannabis ?la materia vegetal que se puede fumar en un porro? tienen más de un 30% de THC.

Recientemente, en un dispensario de California el menú incluía una variedad con un 41% de THC.

La legalización también ha abierto la puerta a productos que se extraen de la marihuana pero que no siquiera parecidos: concentrados de THC aceitosos, cerosos o cristalinos que se calientan e inhalan mediante el vapeo o el dab, utilizando dispositivos parecidos a un soplete.

Los concentrados actuales pueden tener más de un 90% de THC. Algunos se anuncian como THC casi puro.

Pocos personifican la expansión de la marihuana de forma tan clara como John Boehner, ex presidente de la Cámara de Representantes de Estados Unidos. El republicano de Ohio se opuso durante mucho tiempo a la marihuana y, en 2011, se declaró ?inalterablemente contrario? a su legalización.

Ahora forma parte del consejo directivo de Acreage Holdings, un productor de derivados de la marihuana.

A photo of a man holding an amber sheet of crystallized THC concentrate in gloved hands up to the light.
Una lámina de una forma concentrada de THC, recién sacada del horno. (Brennan Linsley / AP)
A photo of a glass container filled with liquid marijuana concentrate.
THC se conserva en un recipiente de vidrio luego de ser extraído para su uso en productos de vapeo y alimentos. (Erin Clark / The Boston Globe via Getty Images)

Y Acreage Holdings ilustra la evolución del sector. Su marca Superflux comercializa un producto para vapear ??resina pura en un formato cómodo e instantáneo?? y concentrados como ?budder?, ?sugar?, ?shatter? y ?wax?. La empresa anuncia su concentrado de ?THCa cristalino? como ?lo último en potencia?.

Según el Instituto Nacional sobre el Abuso de Drogas, las concentraciones más elevadas entrańan mayores riesgos. ?Los riesgos de dependencia física y adicción aumentan con la exposición a altas concentraciones de THC, y las dosis más altas de THC tienen más probabilidades de producir ansiedad, agitación, paranoia y psicosis?, se explica en su sitio web.

En 2021, 16,3 millones de personas en Estados Unidos ?el 5,8% de las personas de 12 ańos en adelante? habían sufrido un trastorno por consumo de marihuana en el último ańo, según una encuesta publicada en enero por el Departamento de Salud y Servicios Humanos (HHS).

Esta cifra es muy superior a la suma de los trastornos por consumo de cocaína, heroína, metanfetamina, estimulantes de venta bajo receta, como Adderall, o analgésicos recetados, como fentanilo y OxyContin.

Otras drogas son más peligrosas que la marihuana, y la mayoría de las personas afectadas por su consumo padecieron un caso leve. Pero aproximadamente 1 de cada 7 ?más de 2,6 millones de personas? padecieron un caso grave, según la encuesta federal.

La mayoría de los médicos equiparan el término ?trastorno grave por consumo de sustancias? con la adicción, seńaló Wilson Compton, subdirector del Instituto Nacional sobre el Abuso de Drogas.

El trastorno por consumo de cannabis ?puede ser devastador?, afirmó Smita Das, psiquiatra de Stanford y presidenta de un consejo sobre adicciones de la Asociación Americana de Psiquiatría.

Das dijo que ha visto vidas destrozadas por el cannabis: personas de éxito que han perdido familias y trabajos. ?Se encuentran en una situación en la que no saben cómo han llegado, porque sólo era un porro, sólo era cannabis, y no se suponía que el cannabis les creara adicción?, explicó Das.

Entre los diagnósticos médicos atribuidos a la marihuana figuran la ?dependencia del cannabis con trastorno psicótico con delirios? y el síndrome de hiperémesis cannabinoide, una forma de vómito persistente.

Se estima que unas 800,000 personas realizaron visitas a emergencias relacionadas con la marihuana en 2021, según un estudio del gobierno publicado en diciembre de 2022.

Derecho a desintoxicación.

Un padre de Colorado pensó que era cuestión de tiempo para que el cannabis matara a su hijo.

En la primavera de 2021, el adolescente pasó un semáforo en rojo, chocó contra otro auto ?resultando heridos él y el otro conductor? y huyó del lugar, según recordó el padre en una entrevista.

En los restos del accidente, el padre encontró porros, envases vacíos de un concentrado de THC de alta potencia conocido como ?wax? y un vaporizador de THC.

En el teléfono móvil de su hijo descubrió mensajes de texto y decenas de referencias al ?dabbing? y a la hierba. El adolescente dijo que había estado fumando antes del accidente y que intentó suicidarse.

Semanas después, la policía ordenó su ingreso involuntario en un hospital para una evaluación psiquiátrica. Según un informe policial, creía que lo perseguían francotiradores de un cártel de drogas.

El médico que evaluó al adolescente le diagnosticó ?abuso de cannabis?.

?Deja de consumir dabs o wax, ya que pueden volverte extremadamente paranoico?, escribió el médico. ?Vete directamente al programa de desintoxicación que elijas?.

Según el relato del padre, en los dos últimos ańos el adolescente sufrió varias retenciones involuntarias, docenas de encuentros con la policía, repetidos encarcelamientos y una serie de estadías en centros de tratamiento hospitalario.

A veces parecía fuera de la realidad, y enviaba mensajes de texto diciendo que Dios le hablaba y le daba superpoderes.

Los dańos también fueron económicos. Los reclamos al seguro médico por su tratamiento ascendieron a casi $600,000 y los gastos de la familia llegaron a casi $40,000 hasta febrero.

En las entrevistas para este artículo, el padre habló bajo condición de anonimato para no perjudicar la recuperación de su hijo.

Está convencido de que la enfermedad mental de su hijo fue el resultado del consumo de drogas. Dijo que los síntomas remitían cuando su hijo dejaba de consumir THC y volvían cuando usaba de nuevo.

Su hijo tiene ahora 20 ańos, ha dejado la marihuana y le va bien, dijo el padre, y ańadió: “No me cabe la menor duda de que el consumo de cannabis fue lo que le causó la psicosis, los delirios y la paranoia”.

Regulación estatal desigual

Ahora, el uso médico de la marihuana es legal en 40 estados y el Distrito de Columbia, y el uso recreativo o para adultos es legal en 22 estados más el Distrito de Columbia, según MJBizDaily, una publicación especializada.

Al principio de la pandemia de covid-19, mientras gran parte de Estados Unidos cerró sus negocios, los dispensarios de marihuana siguieron abiertos. Muchos estados los declararon negocios esenciales.

Pero sólo dos estados que permiten el uso para adultos, Vermont y Connecticut, han puesto límites al contenido de THC ?30% para la flor de cannabis y 60% para los concentrados de THC? y eximen de los límites a los cartuchos precargados, dijo Gillian Schauer de la Asociación de Reguladores de Cannabis, un grupo de reguladores estatales.

Algunos estados limitan el número de onzas o gramos que los consumidores pueden comprar. Sin embargo, incluso un poco de marihuana puede equivaler a mucho THC, apuntó Rosalie Liccardo Pacula, profesora de políticas de salud, economía y derecho en la Universidad del Sur de California.

Algunos estados sólo permiten el uso médico de productos con bajo contenido de THC; por ejemplo, en Texas, las sustancias que no contienen más de un 0,5% de THC en peso. Y algunos estados exigen etiquetas de advertencia. En Nueva Jersey, los productos de cannabis con más de un 40% de THC deben declarar: “Este es un producto de alta potencia y puede aumentar el riesgo de psicosis”.

La normativa sobre marihuana de Colorado tiene más de 500 páginas. Sin embargo, se enfatizan los límites de las protecciones al consumidor: “Este producto se ha producido sin supervisión reglamentaria en materia de salud, seguridad o eficacia”.

Determinar las normas adecuadas puede no ser sencillo. Por ejemplo, las etiquetas de advertencia podrían proteger a la industria de la marihuana de su responsabilidad, al igual que hicieron con las empresas tabacaleras durante ańos. Poner un tope a la potencia podría limitar las opciones de las personas que toman dosis elevadas para aliviar problemas médicos.

En general, en el ámbito estatal, la industria del cannabis ha frenado los esfuerzos reguladores argumentando que unas normas onerosas dificultarían la competencia entre las empresas legítimas y las ilícitas, explicó Pacula.

Pacula y otros investigadores han pedido al gobierno federal que intervenga.

Meses después de terminar su mandato como comisionado de la FDA, Scott Gottlieb hizo un llamamiento similar.

Al quejarse de que los estados habían llegado “muy lejos mientras el gobierno federal permanecía al margen”, Gottlieb pidió “un esquema nacional uniforme para el THC que proteja a los consumidores.”

Eso fue en 2019 y poco ha cambiado desde entonces.

A photo of glass dab rigs used to consume THC concentrate backed by colorful lights.
Pipas que se pueden usar para inhalar productos con concentrados de THC en la sala de un dispensario de marihuana.(Carlos Avila Gonzalez / San Francisco Chronicle via Getty Images)

żDónde está la FDA?

La FDA supervisa los alimentos, los medicamentos recetados, los de venta libre y los dispositivos médicos. Regula el tabaco, la nicotina y los vapes de nicotina. Supervisa las etiquetas de advertencia del tabaco. En interés de la salud y la seguridad públicas, también regula los productos botánicos, productos médicos que pueden incluir material vegetal.

Sin embargo, cuando se trata de la marihuana para fumar, los concentrados de THC derivados del cannabis que se vapean o dabean y los comestibles infundidos con THC, la FDA parece estar muy al margen.

La marihuana medicinal que se vende en los dispensarios no está aprobada por la FDA. La agencia no ha avalado su seguridad o eficacia ni ha determinado la dosis adecuada. No inspecciona las instalaciones donde se producen los productos ni evalúa el control de calidad.

La agencia sí invita a los fabricantes a someter los productos del cannabis a ensayos clínicos y a su proceso de aprobación de medicamentos.

El sitio web de la FDA seńala que el THC es el ingrediente activo de dos medicamentos aprobados por la FDA para el tratamiento del cáncer. Aparentemente, sólo por eso la sustancia está bajo la jurisdicción de la FDA.

La FDA tiene “todo el poder que necesita para regular de forma mucho más eficaz los productos de cannabis legalizados por los estados”, afirmó Lindblom, ex funcionario de la agencia.

Al menos públicamente, la FDA no le ha prestado atención a los concentrados de THC derivados del cannabis o la hierba fumada en porros, sino más bien en otras sustancias: una variante del THC derivada del cáńamo, que el gobierno federal ha legalizado, y un derivado diferente del cannabis llamado cannabidiol o CBD, que se ha comercializado como terapéutico.

“La FDA se ha comprometido a vigilar el mercado, identificar los productos de cannabis que plantean riesgos y actuar, dentro de nuestras competencias, para proteger al público”, declaró Courtney Rhodes, vocera de la FDA.

“Muchos, la mayoría de los productos con THC se ajustan a la definición de marihuana, que es una sustancia controlada. La Drug Enforcement Administration (DEA) regula la marihuana en virtud de la Ley de Sustancias Controladas (CSA). Le remitimos a la DEA para preguntas sobre la regulación y aplicación de las disposiciones de la CSA”, escribió Rhodes en un correo electrónico.

La DEA, dependiente del Departamento de Justicia, no respondió a las preguntas formuladas para este artículo.

En cuanto al Congreso, quizá su medida más importante haya sido limitar la aplicación de la prohibición federal.

“Hasta ahora, la respuesta federal a las acciones estatales para legalizar la marihuana ha consistido, sobre todo, en permitir que los estados apliquen sus propias leyes sobre la droga”, seńaló un informe de 2022 del Servicio de Investigación del Congreso.

En octubre, el presidente Joe Biden ordenó al secretario de Salud y Servicios Humanos y al fiscal general que revisaran la postura del gobierno federal respecto a la marihuana: si debería seguir clasificada entre las sustancias más peligrosas y estrictamente controladas.

En diciembre, Biden firmó un proyecto de ley que ampliaba la investigación sobre la marihuana y obligaba a las agencias federales a estudiar sus efectos. La ley dice que las agencias tienen un ańo para publicar sus conclusiones.

Algunos defensores de la marihuana dicen que el gobierno federal podría desempeńar un papel más constructivo.

“La NORML no opina que el cannabis sea inocuo, sino que la mejor forma de mitigar sus riesgos potenciales es mediante la legalización, la regulación y la educación pública”, afirmó Paul Armentano, subdirector del grupo antes conocido como Organización Nacional para la Reforma de las Leyes sobre la Marihuana (NORML).

“Los productos tienen que someterse a pruebas de pureza y potencia”, ańadió, y “el gobierno federal podría ejercer cierta supervisión en la concesión de licencias a los laboratorios que prueban esos productos”.

Mientras tanto, según Coleman, asesor de la Asociación Nacional de la Industria del Cannabis, los estados se quedan “teniendo que actuar como si fueran USDA + FDA + DEA, todo al mismo tiempo”.

żY dónde deja eso a los consumidores? Algunos, como Wendy E., jubilada en sus 60 ańos, luchan contra los efectos de la marihuana.

Wendy, que habló con la condición de que no se revelara su nombre, empezó a fumar marihuana en la secundaria en los ańos 70 y la convirtió en su estilo de vida durante décadas.

Luego, cuando su estado la legalizó, la compró en dispensarios “y enseguida me di cuenta de que la potencia era mucho mayor que la que yo había consumido tradicionalmente”, contó. “Parecía haber aumentado de manera exponencial”.

En 2020, explicó, la marihuana legal ?mucho más fuerte que la hierba ilícita de su juventud? la llevó a obsesionarse con el suicidio.

Antes, la mujer que se define como “hippie de la madre tierra” encontraba camaradería pasando un porro con sus amigos. Ahora asiste a reuniones de Marihuana Anónimos, con otras personas que se recuperan de esta adicción.

";s:14:"date_timestamp";i:1683830927;}i:3;a:12:{s:5:"title";s:77:"PBMs, the Brokers Who Control Drug Prices, Finally Get Washington?s Attention";s:4:"link";s:103:"https://northdenvernews.com/pbms-the-brokers-who-control-drug-prices-finally-get-washingtons-attention/";s:2:"dc";a:1:{s:7:"creator";s:12:"James Python";}s:7:"pubdate";s:31:"Thu, 11 May 2023 14:43:43 +0000";s:8:"category";s:6:"Latest";s:4:"guid";s:103:"https://northdenvernews.com/pbms-the-brokers-who-control-drug-prices-finally-get-washingtons-attention/";s:11:"description";s:1690:"
For two decades, patients and physicians eagerly awaited a lower-cost version of the world?s bestselling drug, Humira, while its maker, AbbVie, fought off potential competitors by building a wall of more than 250 patents around it. When the first Humira biosimilar ? essentially a generic version ? finally hit the market in January, it came […]";s:7:"content";a:1:{s:7:"encoded";s:22980:"

For two decades, patients and physicians eagerly awaited a lower-cost version of the world?s bestselling drug, Humira, while its maker, AbbVie, fought off potential competitors by building a wall of more than 250 patents around it.

When the first Humira biosimilar ? essentially a generic version ? finally hit the market in January, it came with an unpleasant surprise. The biosimilar?s maker, Amgen, launched two versions of the drug, which treats a host of conditions including rheumatoid arthritis. They were identical in every way but this: One was priced at about $1,600 for a two-week supply, 55% off Humira?s list price. But the other was priced at around $3,300, only about 5% off. And OptumRx, one of three powerhouse brokers that determine which drugs Americans get, recommended option No. 2: the more expensive version.

As Murdo Gordon, an Amgen executive vice president, explained in an earnings call, the higher price enabled his company to give bigger rebates, or post-sale discounts, to Optum and other intermediaries. Most of that money would be passed on to insurers, and patients, he said. Gordon did not mention that the higher-priced option would leave some patients paying much more out-of-pocket, undermining the whole rationale for generic drugs.

The Optum-Amgen announcements perfectly elucidated why, after years of thundering against drugmakers, Congress and the administration have now focused on regulating the deal-makers known as pharmacy benefit managers, or PBMs. Sen. Bernie Sanders? health committee grilled a panel of PBM and pharmaceutical executives Wednesday in preparation for a vote on PBM legislation, expected Thursday.

The three biggest PBMs ? OptumRx, CVS Caremark, and Express Scripts ? control about 80% of prescription drug sales in America and are the most profitable parts of the health conglomerates in which they?re nestled. CVS Health, the fourth-largest U.S. corporation by revenue on Fortune?s list, owns CVS Caremark and the insurer Aetna; UnitedHealth Group, a close fifth, owns Optum; and Cigna, ranking 12th, owns Express Scripts. While serving as middlemen among drugmakers, insurers, and pharmacies, the three corporations also own the highest-grossing specialty drug and mail-order pharmacies.

?John D. Rockefeller would be happy to be alive today,? said David Balto, a former Federal Trade Commission attorney who represents clients suing PBMs. ?He could own a PBM and monopolize economic power in ways he never imagined.?

Drug manufacturers claim that exorbitant PBM demands for rebates force them to set high list prices to earn a profit. Independent pharmacists say PBMs are driving them out of business. Physicians blame them for unpredictable, clinically invalid prescribing decisions. And patients complain that PBMs? choices drain their pocketbooks.

With PBMs driving prices, competition has had the opposite effect from what economic theory predicted Medicare patients would spend out-of-pocket on drugs, one large study showed. Over a five-year period, patients were paying 50% more for branded drugs that had competitors than for those that didn?t.

All this makes the PBMs ripe targets for politicians of both parties. Yet the complexity and obscurity of their role in the drug marketplace have skeptics wondering whether legislation advancing in the House and Senate will actually help patients or lower prices at the pharmacy counter.

?We may try to make things better and actually make things worse,? Sen. Rand Paul (R-Ky.) said at Wednesday?s hearing.

The PBMs pass along most of their rebates to health plans, which will bear a larger share of patient drug costs in coming years under Medicare changes that are part of the 2022 Inflation Reduction Act. It?s likely that pressure on insurers will be passed along to PBMs and result in even more aggressive limits on physician prescription decisions, said Troyen Brennan, an adjunct Harvard University professor who was chief medical officer for CVS Health from 2008 to 2022.

Several congressional bills target drug company rebates to PBMs and what?s known as ?spread pricing? ? the extra money PBMs collect from insurers over what they pay pharmacies for drugs.

But those aren?t the big PBM revenue sources anymore, Brennan said. PBMs today mostly make money by owning mail-order and specialty pharmacies and from the government?s 340B program, created to help hospitals that treat a disproportionately elderly and poor population. Medicare requires drugmakers to provide big discounts to participating hospitals and the growing rosters of affiliated physician groups they own, and some of those discounts end up with PBMs.

Employers and the federal government decide where most of the rebate money goes, PBM leaders testified Wednesday ? and health plans decide what out-of-pocket costs their covered members will pay.

In other words, drug companies blame PBMs for high drug counter prices, PBMs blame insurers, and insurers blame the drug companies, all part of a health care system that hinges on an unspoken bargain: Make life comfortable for some ? mostly the upper and middle classes ? at the expense of lower-income and poorly insured people who get what they get.


 PBMs? extraction of money from patients in the name of ?copayments? at the pharmacy counter ?reintroduces medical underwriting? that was stripped away by the Affordable Care Act, Craig Garthwaite, a health care researcher at Northwestern?s Kellogg School of Management, told a Senate panel last year. Insurers can no longer pick and choose whom to insure, as they could before the landmark 2010 health law. But they are finding ways to make the sickest pay.

?People with expensive conditions are paying more for insurance so healthy people can pay less,? he said.

PBMs Evolve From Minnows to Whales

In 1967, a year before the first PBM was founded, spending on prescription drugs outside of a hospital in the U.S. totaled around $3.3 billion, compared with more than $600 billion in net payments last year. By 2005, when Medicare expanded to include coverage of outpatient drugs, government and private insurers depended on PBMs? negotiating power to keep rising drug prices in check.

The Federal Trade Commission and Justice Department allowed the largest PBMs to gobble up competitors and merge with insurers during the Bush and Obama administrations on the grounds that bolstering their powers might rein in prices. The FTC fought state investigations of anti-competitive behavior, saying that pressure on PBMs would benefit consumers.

The FTC under President Joe Biden has switched course, at least partly because of the arrival of Chair Lina Khan, a vigorous proponent of antitrust policy who launched an investigation of the PBMs last June.

It came partly at the request of independent pharmacists, who rely on PBM reimbursements for the drugs they purchase and provide consumers. Thousands of pharmacists complained to the FTC that PBMs force them to accept unfairly low reimbursements ? then slam them with opaque rules requiring them to pay back some of the money months later. Pharmacists returned $12.6 billion to PBMs in 2021, according to a recent Medicare Payment Advisory Commission report.

During a recent week, said Ashley Seyfarth, who owns Kare Drug in Aztec, New Mexico, a PBM reclaimed money from one prescription because the paperwork was faxed. It clawed back cash from another sale because Kare had kept the drug on the shelf an extra day, beyond the PBM?s time limit, to accommodate a patient delayed getting to the store.

And her reimbursements are ?beyond low,? Seyfarth said. She laughed when asked whether contract terms with the PBMs were negotiable. ?You aren?t negotiating anything,? she said. ?It?s take it or leave it.?

PBMs ?have the right to audit whether contract terms are agreed to,? Angela Banks, vice president of policy at the Pharmaceutical Care Management Association, the PBM trade group, said at a recent conference. ?A lot of the complaints about PBMs come from two parties from whom we are extracting money: manufacturers and pharmacists.?

PBM pricing decisions are often murky. According to a recent study, in 2018 Medicare spent $2.6 billion more through PBMs for a year?s worth of 184 generic drugs than they would have cost at Costco. Doctors and hospitals find PBM formularies baffling, with dozens of variations depending on a patient?s health plan.

When Philadelphia-area internist Amy Davis writes a prescription, she has no idea what the pharmacy will bill her patients, she said, or whether a PBM has decided the drug needs prior authorization. Sometimes she doesn?t find out until a patient returns months later saying they skipped the drug because it was too expensive.

?We physicians are completely in the dark,? she said. ?And it?s designed that way.?

The PBMs? growing use of proprietary pharmacies, including mail-order operations, can interfere with the care of patients like Jasmine St. Clair, a 45-year-old restaurant manager and mother of six in Mount Juliet, Tennessee.

In October 2021, St. Clair?s treatment for a rare, non-smoking-related lung cancer was delayed three weeks after PBM giant Express Scripts insisted her prescription be filled by Accredo, the mail-order pharmacy it owns.

In the meantime, her fatigue and lower-back and neck pain became so bad ?I couldn?t pick up my daughter, who was 2,? St. Clair said. ?And I was really getting scared.?

After St. Clair started the four-pills-twice-a-day regimen, her tumor rapidly shrank. But in January, her husband?s insurance changed and the medications didn?t arrive on time. When she called Accredo to see what was wrong, ?they said, ?You owe $8,000. Would you like to pay by card???

The pharmacy attached to her oncology practice straightened out the payment issue and ensured her continued use of the drug, St. Clair said. Her oncologist, Johnetta Blakely, said these are daily occurrences in her practice.

?The problem with the PBMs and the specialty pharmacies they own is that they are so complicated and intertwined it?s hard to figure out what the heck they are doing,? Blakely said. ?All this bureaucratic stuff is a distraction and takes away from things I could be doing, like asking Jasmine about her kids.?

What?s the Remedy?

Bipartisan House and Senate bills would require PBMs to reimburse pharmacies serving Medicaid patients based on an authorized price list, rather than using standards that allegedly allow PBMs to lowball pharmacies. The Congressional Budget Office has estimated the bills would save the federal government $1 billion over 10 years. Another Senate bill would require PBMs to report more of their earnings to the FTC, and would ban deceptive and unfair fees.

But PBMs have shown themselves adept at finding ways around regulation. A federal rule scheduled to take effect next year would curtail PBM ?clawbacks? on independent pharmacies. But PBM contracts sent out to pharmacies in recent weeks get around that by lowering reimbursement fees and putting a percentage of their payments to pharmacies into a kind of escrow, said Douglas Hoey, CEO of the National Community Pharmacists Association.

When the Trump administration considered banning brand-name drug rebates in 2017, PBMs set up companies in Ireland and Switzerland to take over the negotiations and purchases. Doing so offered a tax advantage and allowed the PBMs to avoid scrutiny of the quantity and nature of those deals. Recently, Express Scripts set up another company to purchase generic drugs, in the Cayman Islands.

And PBMs appear adept at moving money from one pocket to another. ?Yesterday?s rebates are today?s fees and potentially tomorrow?s something else,? said John O?Brien, CEO of the pharmaceutical industry-funded research group, the National Pharmaceutical Council.

Every arrangement that PBMs make with manufacturers, employers, and insurers is secret and proprietary, said Barak Richman, a Duke University Law School professor. This makes it nearly impossible to examine what kind of deals PBMs are making.

Antitrust law could be brought to bear on the PBMs, Richman said. And the Biden administration has shown an eagerness to possibly reverse mergers that have increased PBM clout. The Justice Department has taken similar steps.

But federal officials will have to move fast to slow the PBMs. Insurers that don?t have PBMs as part of their business have been shrinking in recent years because of the growing clout and buying power of the companies.

?I predict that any health insurer that doesn?t have a PBM is going to disappear in 10 years,? said Neeraj Sood, a professor at the University of Southern California Sol Price School of Public Policy. ?Otherwise, there is no way to compete with the big three.?

";}s:7:"post-id";s:5:"53342";s:7:"summary";s:1690:"
For two decades, patients and physicians eagerly awaited a lower-cost version of the world?s bestselling drug, Humira, while its maker, AbbVie, fought off potential competitors by building a wall of more than 250 patents around it. When the first Humira biosimilar ? essentially a generic version ? finally hit the market in January, it came […]";s:12:"atom_content";s:22980:"

For two decades, patients and physicians eagerly awaited a lower-cost version of the world?s bestselling drug, Humira, while its maker, AbbVie, fought off potential competitors by building a wall of more than 250 patents around it.

When the first Humira biosimilar ? essentially a generic version ? finally hit the market in January, it came with an unpleasant surprise. The biosimilar?s maker, Amgen, launched two versions of the drug, which treats a host of conditions including rheumatoid arthritis. They were identical in every way but this: One was priced at about $1,600 for a two-week supply, 55% off Humira?s list price. But the other was priced at around $3,300, only about 5% off. And OptumRx, one of three powerhouse brokers that determine which drugs Americans get, recommended option No. 2: the more expensive version.

As Murdo Gordon, an Amgen executive vice president, explained in an earnings call, the higher price enabled his company to give bigger rebates, or post-sale discounts, to Optum and other intermediaries. Most of that money would be passed on to insurers, and patients, he said. Gordon did not mention that the higher-priced option would leave some patients paying much more out-of-pocket, undermining the whole rationale for generic drugs.

The Optum-Amgen announcements perfectly elucidated why, after years of thundering against drugmakers, Congress and the administration have now focused on regulating the deal-makers known as pharmacy benefit managers, or PBMs. Sen. Bernie Sanders? health committee grilled a panel of PBM and pharmaceutical executives Wednesday in preparation for a vote on PBM legislation, expected Thursday.

The three biggest PBMs ? OptumRx, CVS Caremark, and Express Scripts ? control about 80% of prescription drug sales in America and are the most profitable parts of the health conglomerates in which they?re nestled. CVS Health, the fourth-largest U.S. corporation by revenue on Fortune?s list, owns CVS Caremark and the insurer Aetna; UnitedHealth Group, a close fifth, owns Optum; and Cigna, ranking 12th, owns Express Scripts. While serving as middlemen among drugmakers, insurers, and pharmacies, the three corporations also own the highest-grossing specialty drug and mail-order pharmacies.

?John D. Rockefeller would be happy to be alive today,? said David Balto, a former Federal Trade Commission attorney who represents clients suing PBMs. ?He could own a PBM and monopolize economic power in ways he never imagined.?

Drug manufacturers claim that exorbitant PBM demands for rebates force them to set high list prices to earn a profit. Independent pharmacists say PBMs are driving them out of business. Physicians blame them for unpredictable, clinically invalid prescribing decisions. And patients complain that PBMs? choices drain their pocketbooks.

With PBMs driving prices, competition has had the opposite effect from what economic theory predicted Medicare patients would spend out-of-pocket on drugs, one large study showed. Over a five-year period, patients were paying 50% more for branded drugs that had competitors than for those that didn?t.

All this makes the PBMs ripe targets for politicians of both parties. Yet the complexity and obscurity of their role in the drug marketplace have skeptics wondering whether legislation advancing in the House and Senate will actually help patients or lower prices at the pharmacy counter.

?We may try to make things better and actually make things worse,? Sen. Rand Paul (R-Ky.) said at Wednesday?s hearing.

The PBMs pass along most of their rebates to health plans, which will bear a larger share of patient drug costs in coming years under Medicare changes that are part of the 2022 Inflation Reduction Act. It?s likely that pressure on insurers will be passed along to PBMs and result in even more aggressive limits on physician prescription decisions, said Troyen Brennan, an adjunct Harvard University professor who was chief medical officer for CVS Health from 2008 to 2022.

Several congressional bills target drug company rebates to PBMs and what?s known as ?spread pricing? ? the extra money PBMs collect from insurers over what they pay pharmacies for drugs.

But those aren?t the big PBM revenue sources anymore, Brennan said. PBMs today mostly make money by owning mail-order and specialty pharmacies and from the government?s 340B program, created to help hospitals that treat a disproportionately elderly and poor population. Medicare requires drugmakers to provide big discounts to participating hospitals and the growing rosters of affiliated physician groups they own, and some of those discounts end up with PBMs.

Employers and the federal government decide where most of the rebate money goes, PBM leaders testified Wednesday ? and health plans decide what out-of-pocket costs their covered members will pay.

In other words, drug companies blame PBMs for high drug counter prices, PBMs blame insurers, and insurers blame the drug companies, all part of a health care system that hinges on an unspoken bargain: Make life comfortable for some ? mostly the upper and middle classes ? at the expense of lower-income and poorly insured people who get what they get.


 PBMs? extraction of money from patients in the name of ?copayments? at the pharmacy counter ?reintroduces medical underwriting? that was stripped away by the Affordable Care Act, Craig Garthwaite, a health care researcher at Northwestern?s Kellogg School of Management, told a Senate panel last year. Insurers can no longer pick and choose whom to insure, as they could before the landmark 2010 health law. But they are finding ways to make the sickest pay.

?People with expensive conditions are paying more for insurance so healthy people can pay less,? he said.

PBMs Evolve From Minnows to Whales

In 1967, a year before the first PBM was founded, spending on prescription drugs outside of a hospital in the U.S. totaled around $3.3 billion, compared with more than $600 billion in net payments last year. By 2005, when Medicare expanded to include coverage of outpatient drugs, government and private insurers depended on PBMs? negotiating power to keep rising drug prices in check.

The Federal Trade Commission and Justice Department allowed the largest PBMs to gobble up competitors and merge with insurers during the Bush and Obama administrations on the grounds that bolstering their powers might rein in prices. The FTC fought state investigations of anti-competitive behavior, saying that pressure on PBMs would benefit consumers.

The FTC under President Joe Biden has switched course, at least partly because of the arrival of Chair Lina Khan, a vigorous proponent of antitrust policy who launched an investigation of the PBMs last June.

It came partly at the request of independent pharmacists, who rely on PBM reimbursements for the drugs they purchase and provide consumers. Thousands of pharmacists complained to the FTC that PBMs force them to accept unfairly low reimbursements ? then slam them with opaque rules requiring them to pay back some of the money months later. Pharmacists returned $12.6 billion to PBMs in 2021, according to a recent Medicare Payment Advisory Commission report.

During a recent week, said Ashley Seyfarth, who owns Kare Drug in Aztec, New Mexico, a PBM reclaimed money from one prescription because the paperwork was faxed. It clawed back cash from another sale because Kare had kept the drug on the shelf an extra day, beyond the PBM?s time limit, to accommodate a patient delayed getting to the store.

And her reimbursements are ?beyond low,? Seyfarth said. She laughed when asked whether contract terms with the PBMs were negotiable. ?You aren?t negotiating anything,? she said. ?It?s take it or leave it.?

PBMs ?have the right to audit whether contract terms are agreed to,? Angela Banks, vice president of policy at the Pharmaceutical Care Management Association, the PBM trade group, said at a recent conference. ?A lot of the complaints about PBMs come from two parties from whom we are extracting money: manufacturers and pharmacists.?

PBM pricing decisions are often murky. According to a recent study, in 2018 Medicare spent $2.6 billion more through PBMs for a year?s worth of 184 generic drugs than they would have cost at Costco. Doctors and hospitals find PBM formularies baffling, with dozens of variations depending on a patient?s health plan.

When Philadelphia-area internist Amy Davis writes a prescription, she has no idea what the pharmacy will bill her patients, she said, or whether a PBM has decided the drug needs prior authorization. Sometimes she doesn?t find out until a patient returns months later saying they skipped the drug because it was too expensive.

?We physicians are completely in the dark,? she said. ?And it?s designed that way.?

The PBMs? growing use of proprietary pharmacies, including mail-order operations, can interfere with the care of patients like Jasmine St. Clair, a 45-year-old restaurant manager and mother of six in Mount Juliet, Tennessee.

In October 2021, St. Clair?s treatment for a rare, non-smoking-related lung cancer was delayed three weeks after PBM giant Express Scripts insisted her prescription be filled by Accredo, the mail-order pharmacy it owns.

In the meantime, her fatigue and lower-back and neck pain became so bad ?I couldn?t pick up my daughter, who was 2,? St. Clair said. ?And I was really getting scared.?

After St. Clair started the four-pills-twice-a-day regimen, her tumor rapidly shrank. But in January, her husband?s insurance changed and the medications didn?t arrive on time. When she called Accredo to see what was wrong, ?they said, ?You owe $8,000. Would you like to pay by card???

The pharmacy attached to her oncology practice straightened out the payment issue and ensured her continued use of the drug, St. Clair said. Her oncologist, Johnetta Blakely, said these are daily occurrences in her practice.

?The problem with the PBMs and the specialty pharmacies they own is that they are so complicated and intertwined it?s hard to figure out what the heck they are doing,? Blakely said. ?All this bureaucratic stuff is a distraction and takes away from things I could be doing, like asking Jasmine about her kids.?

What?s the Remedy?

Bipartisan House and Senate bills would require PBMs to reimburse pharmacies serving Medicaid patients based on an authorized price list, rather than using standards that allegedly allow PBMs to lowball pharmacies. The Congressional Budget Office has estimated the bills would save the federal government $1 billion over 10 years. Another Senate bill would require PBMs to report more of their earnings to the FTC, and would ban deceptive and unfair fees.

But PBMs have shown themselves adept at finding ways around regulation. A federal rule scheduled to take effect next year would curtail PBM ?clawbacks? on independent pharmacies. But PBM contracts sent out to pharmacies in recent weeks get around that by lowering reimbursement fees and putting a percentage of their payments to pharmacies into a kind of escrow, said Douglas Hoey, CEO of the National Community Pharmacists Association.

When the Trump administration considered banning brand-name drug rebates in 2017, PBMs set up companies in Ireland and Switzerland to take over the negotiations and purchases. Doing so offered a tax advantage and allowed the PBMs to avoid scrutiny of the quantity and nature of those deals. Recently, Express Scripts set up another company to purchase generic drugs, in the Cayman Islands.

And PBMs appear adept at moving money from one pocket to another. ?Yesterday?s rebates are today?s fees and potentially tomorrow?s something else,? said John O?Brien, CEO of the pharmaceutical industry-funded research group, the National Pharmaceutical Council.

Every arrangement that PBMs make with manufacturers, employers, and insurers is secret and proprietary, said Barak Richman, a Duke University Law School professor. This makes it nearly impossible to examine what kind of deals PBMs are making.

Antitrust law could be brought to bear on the PBMs, Richman said. And the Biden administration has shown an eagerness to possibly reverse mergers that have increased PBM clout. The Justice Department has taken similar steps.

But federal officials will have to move fast to slow the PBMs. Insurers that don?t have PBMs as part of their business have been shrinking in recent years because of the growing clout and buying power of the companies.

?I predict that any health insurer that doesn?t have a PBM is going to disappear in 10 years,? said Neeraj Sood, a professor at the University of Southern California Sol Price School of Public Policy. ?Otherwise, there is no way to compete with the big three.?

";s:14:"date_timestamp";i:1683816223;}i:4;a:12:{s:5:"title";s:75:"Drive-Thru Baby Showers Serve Express Needs of Pregnant Veterans in Atlanta";s:4:"link";s:104:"https://northdenvernews.com/drive-thru-baby-showers-serve-express-needs-of-pregnant-veterans-in-atlanta/";s:2:"dc";a:1:{s:7:"creator";s:12:"James Python";}s:7:"pubdate";s:31:"Thu, 11 May 2023 13:42:18 +0000";s:8:"category";s:6:"Latest";s:4:"guid";s:104:"https://northdenvernews.com/drive-thru-baby-showers-serve-express-needs-of-pregnant-veterans-in-atlanta/";s:11:"description";s:1518:"
Jess Mador, WABE When 28-year-old Navy veteran Carisma Carter pulled her car up to the front of the Atlanta VA Clinic, her seat was pushed far back from the steering wheel to make room for her big belly. Carter was 8 months pregnant. ?I?m having two boys, twins. It?s my first pregnancy,? she said. Carter […]";s:7:"content";a:1:{s:7:"encoded";s:11611:"

Jess Mador, WABE

When 28-year-old Navy veteran Carisma Carter pulled her car up to the front of the Atlanta VA Clinic, her seat was pushed far back from the steering wheel to make room for her big belly. Carter was 8 months pregnant.

?I?m having two boys, twins. It?s my first pregnancy,? she said.

Carter knows the pregnancy risks she could face as a Black woman, especially in Georgia, where data shows Black women are more than twice as likely as white women to die during or within a year after a pregnancy.

?I take care of my body during the pregnancy, but, yeah, I?m very aware,? Carter said. ?And I just try to stay positive.?

In 2021, women made up about 17% of the U.S. military?s active-duty force. And women are the fastest-growing group of veterans in the country, according to the Department of Veterans Affairs.

A recent report from Rand Corp. outlines some of the ways the health needs of women differ from men?s, including pregnancy and childbirth. And health researchers have said women veterans may be at heightened risk for pregnancy complications, compared with their civilian counterparts.

A few years ago, the Atlanta VA Clinic got creative with its outreach to pregnant patients. It began throwing surprise baby showers for small groups of patients. The goal is to cement relationships with the clinical staff, make sure pregnant veterans get to all their regular and specialist appointments, and help ensure pregnant people have the supplies they need as they near delivery. A trained maternity care coordinator manages each pregnant veteran?s care.

After the covid-19 pandemic emerged, the VA transformed the showers into low-contact ?drive-thru? events, which occur about every three months, and serve roughly 20 pregnant veterans each time.

At a shower in February, volunteers set up in front of the main entrance of the Atlanta VA. The building is concrete, beige, and bland. But the volunteers created a celebratory atmosphere by decorating a folding table and stacking it high with free diaper bags and other baby supplies.

A car pulled up to the table and a volunteer with a clipboard began hyping up the small crowd, which then burst into applause and cheers.

?Thank you for your service!? they called out. ?Congratulations!?

The pregnant veteran behind the wheel looked surprised at first. Then she broke into a big smile. She rolled down her car window.

Volunteers and VA staff members clustered around the car and offered her a tiara of green, white, and pink flowers.

?Would you like to wear it?? one asked. ?Stunning! Remind us what you?re having??

?I?m having a girl,? the woman said.

While they chatted through the open window about her due date and health, other volunteers rushed forward with supplies. Some piled boxes of diapers into the back seat. The final, parting gesture was a $100 gift card.

Kathleen O?Loughlin, who manages the women veterans program at the Atlanta VA, said the events offer ?last-minute baby needs.?

?Because we know there?s a lot,? she said.

O?Loughlin said the health center can?t invite every pregnant veteran to these group baby showers, so they focus on women with higher-risk pregnancies, including veterans carrying multiples or those who have a disability related to their military service.

?Now, a lot of the women have different musculoskeletal issues because of their service, [or] a lot of service-connected disabilities that civilian women aren?t exposed to because they don?t have those same job responsibilities,? O?Loughlin said. ?This is an extra set of eyeballs on them. Are you making sure you?re taking your blood pressure medicines? Are you getting all of your appointments, are you meeting with your doctors??

U.S. maternal mortality rates increased again during the pandemic years of 2020 and 2021, according to the Centers for Disease Control and Prevention.

Physical and psychological injuries linked to military service can increase the risk of poor maternal outcomes, according to Jamya Pittman, an internist and the medical director for the women veterans program in Atlanta.

?A lot of our women veterans have the diagnoses of anxiety, depression. They may also have PTSD, in addition to a myriad of other diagnoses like hypertension and diabetes,? Pittman said. ?We also know that pregnancy in itself can be a stressor on the body.?

The Atlanta VA designed the baby showers to boost veterans? well-being, she explained. Program volunteers are predominantly also women veterans.

?This visible showing of support, this community engagement, this celebration,? she said, ?is our way of helping to decrease stress and allow the woman veteran to know that she has a partner in her health care and with the arrival of the baby.?

Nationally, the Department of Veterans Affairs is focusing on women?s health at all life stages.

The Atlanta women veterans program serves more than 24,000 veterans in the region, and about 9% of them are pregnant at any time.

Two years ago, Congress passed bipartisan legislation mandating a national study of pregnancy outcomes among veterans, including any racial disparities.

?There has never been a comprehensive evaluation of how our nation?s growing maternal mortality crisis is impacting our women Veterans, even though they may be at higher risk due to their service,? wrote co-sponsor Sen. Tammy Duckworth (D-Ill.) on the day the bill was introduced.

The law, called the Protecting Moms Who Served Act, also provided $15 million to support maternity care coordination programs at VA facilities.

The Atlanta VA is using some of its share of that money to make sure pregnant veterans receive ongoing medical care for a full year after giving birth.

Carter, the Navy veteran who stopped by the baby shower, said she appreciated the outreach from the VA.

?Just checking on the women, supporting them, making sure that they have everything that they need for the baby,? she said, ?because a lot of people don?t have that support, they don?t have family, they?re doing this on their own.?

Carter gave birth to her twins on Feb. 25. She and the babies are doing well, she said. The women veterans program?s maternity care coverage continues for 12 months after the twins? birth.

This article is from a partnership that includes WABE, NPR, and KFF Health News.

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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This story can be republished for free (details).

";}s:7:"post-id";s:5:"53339";s:7:"summary";s:1518:"
Jess Mador, WABE When 28-year-old Navy veteran Carisma Carter pulled her car up to the front of the Atlanta VA Clinic, her seat was pushed far back from the steering wheel to make room for her big belly. Carter was 8 months pregnant. ?I?m having two boys, twins. It?s my first pregnancy,? she said. Carter […]";s:12:"atom_content";s:11611:"

Jess Mador, WABE

When 28-year-old Navy veteran Carisma Carter pulled her car up to the front of the Atlanta VA Clinic, her seat was pushed far back from the steering wheel to make room for her big belly. Carter was 8 months pregnant.

?I?m having two boys, twins. It?s my first pregnancy,? she said.

Carter knows the pregnancy risks she could face as a Black woman, especially in Georgia, where data shows Black women are more than twice as likely as white women to die during or within a year after a pregnancy.

?I take care of my body during the pregnancy, but, yeah, I?m very aware,? Carter said. ?And I just try to stay positive.?

In 2021, women made up about 17% of the U.S. military?s active-duty force. And women are the fastest-growing group of veterans in the country, according to the Department of Veterans Affairs.

A recent report from Rand Corp. outlines some of the ways the health needs of women differ from men?s, including pregnancy and childbirth. And health researchers have said women veterans may be at heightened risk for pregnancy complications, compared with their civilian counterparts.

A few years ago, the Atlanta VA Clinic got creative with its outreach to pregnant patients. It began throwing surprise baby showers for small groups of patients. The goal is to cement relationships with the clinical staff, make sure pregnant veterans get to all their regular and specialist appointments, and help ensure pregnant people have the supplies they need as they near delivery. A trained maternity care coordinator manages each pregnant veteran?s care.

After the covid-19 pandemic emerged, the VA transformed the showers into low-contact ?drive-thru? events, which occur about every three months, and serve roughly 20 pregnant veterans each time.

At a shower in February, volunteers set up in front of the main entrance of the Atlanta VA. The building is concrete, beige, and bland. But the volunteers created a celebratory atmosphere by decorating a folding table and stacking it high with free diaper bags and other baby supplies.

A car pulled up to the table and a volunteer with a clipboard began hyping up the small crowd, which then burst into applause and cheers.

?Thank you for your service!? they called out. ?Congratulations!?

The pregnant veteran behind the wheel looked surprised at first. Then she broke into a big smile. She rolled down her car window.

Volunteers and VA staff members clustered around the car and offered her a tiara of green, white, and pink flowers.

?Would you like to wear it?? one asked. ?Stunning! Remind us what you?re having??

?I?m having a girl,? the woman said.

While they chatted through the open window about her due date and health, other volunteers rushed forward with supplies. Some piled boxes of diapers into the back seat. The final, parting gesture was a $100 gift card.

Kathleen O?Loughlin, who manages the women veterans program at the Atlanta VA, said the events offer ?last-minute baby needs.?

?Because we know there?s a lot,? she said.

O?Loughlin said the health center can?t invite every pregnant veteran to these group baby showers, so they focus on women with higher-risk pregnancies, including veterans carrying multiples or those who have a disability related to their military service.

?Now, a lot of the women have different musculoskeletal issues because of their service, [or] a lot of service-connected disabilities that civilian women aren?t exposed to because they don?t have those same job responsibilities,? O?Loughlin said. ?This is an extra set of eyeballs on them. Are you making sure you?re taking your blood pressure medicines? Are you getting all of your appointments, are you meeting with your doctors??

U.S. maternal mortality rates increased again during the pandemic years of 2020 and 2021, according to the Centers for Disease Control and Prevention.

Physical and psychological injuries linked to military service can increase the risk of poor maternal outcomes, according to Jamya Pittman, an internist and the medical director for the women veterans program in Atlanta.

?A lot of our women veterans have the diagnoses of anxiety, depression. They may also have PTSD, in addition to a myriad of other diagnoses like hypertension and diabetes,? Pittman said. ?We also know that pregnancy in itself can be a stressor on the body.?

The Atlanta VA designed the baby showers to boost veterans? well-being, she explained. Program volunteers are predominantly also women veterans.

?This visible showing of support, this community engagement, this celebration,? she said, ?is our way of helping to decrease stress and allow the woman veteran to know that she has a partner in her health care and with the arrival of the baby.?

Nationally, the Department of Veterans Affairs is focusing on women?s health at all life stages.

The Atlanta women veterans program serves more than 24,000 veterans in the region, and about 9% of them are pregnant at any time.

Two years ago, Congress passed bipartisan legislation mandating a national study of pregnancy outcomes among veterans, including any racial disparities.

?There has never been a comprehensive evaluation of how our nation?s growing maternal mortality crisis is impacting our women Veterans, even though they may be at higher risk due to their service,? wrote co-sponsor Sen. Tammy Duckworth (D-Ill.) on the day the bill was introduced.

The law, called the Protecting Moms Who Served Act, also provided $15 million to support maternity care coordination programs at VA facilities.

The Atlanta VA is using some of its share of that money to make sure pregnant veterans receive ongoing medical care for a full year after giving birth.

Carter, the Navy veteran who stopped by the baby shower, said she appreciated the outreach from the VA.

?Just checking on the women, supporting them, making sure that they have everything that they need for the baby,? she said, ?because a lot of people don?t have that support, they don?t have family, they?re doing this on their own.?

Carter gave birth to her twins on Feb. 25. She and the babies are doing well, she said. The women veterans program?s maternity care coverage continues for 12 months after the twins? birth.

This article is from a partnership that includes WABE, NPR, and KFF Health News.

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.

USE OUR CONTENT

This story can be republished for free (details).

";s:14:"date_timestamp";i:1683812538;}i:5;a:12:{s:5:"title";s:47:"How End of COVID-19 Emergency Impacts Americans";s:4:"link";s:76:"https://northdenvernews.com/how-end-of-covid-19-emergency-impacts-americans/";s:2:"dc";a:1:{s:7:"creator";s:12:"James Python";}s:7:"pubdate";s:31:"Thu, 11 May 2023 13:39:06 +0000";s:8:"category";s:6:"Health";s:4:"guid";s:76:"https://northdenvernews.com/how-end-of-covid-19-emergency-impacts-americans/";s:11:"description";s:335:"At the height of the pandemic, Mount Sinai South Nassau hospital in Oceanside, New York, had more than 400 COVID-19 patients, many of whom were very sick. These days, that number is less than five, with no patients in the intensive care unit, according to Dr. Aaron Glatt, the hospital?s epidemiologist. Those numbers are why […]";s:7:"content";a:1:{s:7:"encoded";s:11601:"

At the height of the pandemic, Mount Sinai South Nassau hospital in Oceanside, New York, had more than 400 COVID-19 patients, many of whom were very sick. These days, that number is less than five, with no patients in the intensive care unit, according to Dr. Aaron Glatt, the hospital?s epidemiologist.

Those numbers are why Glatt is OK with the federal government?s decision to end the COVID-19 public health emergency. But he also wants the public to understand what that means.

?People have to realize that the benefits that come along with being a public health emergency will go away. And some of the free things that were given out by the government ? without concern about financial reimbursement are going to stop. That’s number one,? says Glatt, who also serves as chair of the hospital?s Department of Medicine and chief of infectious diseases.

?Number two is that allowing an emergency situation to occur freed up some of the regulatory restrictions that normally would be present, and those will now go back into play,? he says.

Nurses with the Mount Sinai South Nassau Vaxmobile administer the COVID-19 vaccine at a school in Freeport, New York, May 14, 2021.

Nurses with the Mount Sinai South Nassau Vaxmobile administer the COVID-19 vaccine at a school in Freeport, New York, May 14, 2021.

After more than three years, more than 1 million U.S. deaths, and 104.5 million documented infections, the COVID-19 public health emergency comes to an end on May 11.

?I think the biggest implication of it is symbolic,? says Jen Kates, a senior vice president at the Kaiser Family Foundation, a nonprofit that focuses on health care research. ?It really is a marker saying, ?We have this important declaration that has come to an end,? and it’s symbolizing a move from this emergency state that allowed for a lot of flexibilities to a different place.?

The pandemic reached its peak between July 2020 to July 2021. The highest hospitalization rates were recorded in December 2020 and January 2021.

What’s changing

Americans will feel the end of the COVID-19 emergency in different ways.

?The age of the free COVID test is over,? says Boris Lushniak, a former acting U.S. surgeon general (2013-2014) who now leads the University of Maryland?s School of Public Health. ?Things that people will notice, for the most part, is going to be that something that was taken for granted for the last two and a half years in the midst of this pandemic, that we kind of got used to, is now going to become more complicated.?

Convention attendees verify proof of COVID-19 vaccination and/or negative tests outside the San Diego Convention Center at Comic-Con International, in California, July 21, 2022.

Convention attendees verify proof of COVID-19 vaccination and/or negative tests outside the San Diego Convention Center at Comic-Con International, in California, July 21, 2022.

During the pandemic, the federal government mailed more than 70 million free COVID-19 tests to people?s homes.

Going forward, at-home COVID-19 tests could become more expensive, according to the Kaiser Family Foundation, and people with private insurance and traditional Medicare will no longer be guaranteed to get them for free, athough private insurers might elect to cover the costs of testing.

More than 81% of the U.S. population, almost 268 million people, has had at least one shot of the COVID-19 vaccine.

Vaccines will continue to be free until the stockpiles purchased by the federal government run out, which experts say will probably be by the end of the year. After that, vaccines will continue to be free for most people with public and private insurance. However, the uninsured and the underinsured face losing easy access to COVID-19 vaccines.

?During COVID, we had probably the closest the United States has ever gotten to universal [health] coverage, and we’re going back to where things generally always are ? where people who have insurance have access to coverage and services, and people who don’t often are left out,? Kates says.

President Joe Biden receives an updated COVID-19 vaccine onstage in an auditorium on the White House campus in Washington, October 25, 2022.

President Joe Biden receives an updated COVID-19 vaccine onstage in an auditorium on the White House campus in Washington, October 25, 2022.

Medication used to treat COVID-19 also will be free for as long as the federal government supply lasts, which is probably until the fall, according to Kates. Congress has not authorized the funding needed for the federal government to continue to purchase more vaccines and treatments. Private insurance companies were never required to waive costs for COVID-19 treatment.

?Still need to be vigilant?

The expiring PHE isn?t the only COVID-19-related emergency measure currently in effect. The emergency measures that allow for the use of the COVID-19 vaccines and treatments will continue beyond May 11.

?People need to be reassured that the fact that the public health emergency status is going away is a positive thing, not a negative thing. It doesn’t mean that we’re ignoring this problem, that it?s done with,? Glatt says. ?A tremendous amount of public health work will still go on and, in general, the American public is going to be well taken care of going forward regarding COVID.?

Although Lushniak agrees that the PHE should be rescinded, he worries the public will assume that COVID-19 is a thing of the past, even though COVID-19 remained the fourth-leading cause of death in the United States in 2022, behind heart disease, cancer and unintentional injury. Currently, 150 people in the U.S. die from coronavirus disease each day.

?The reality is it’s still not over, and we still need to be vigilant,? Lushniak says. ?If you’re not feeling well, stay away from large crowds. This whole idea of disease spread still remains out there. And there are people who are at higher risk around us, so let’s be caring towards others.?

Rules for telemedicine appointments are also changing. During the pandemic emergency, doctors were allowed to prescribe controlled substances during online medical visits. After May 11, people will have to see their doctors in person to get a prescription for those.

A lab technician tests wastewater samples from around the United States for the coronavirus disease (COVID-19) at the Biobot Analytics, in Cambridge, Massachusetts, February 22, 2022.

A lab technician tests wastewater samples from around the United States for the coronavirus disease (COVID-19) at the Biobot Analytics, in Cambridge, Massachusetts, February 22, 2022.

The end of the PHE means that states will no longer be required to report COVID-19 infections to federal authorities.

However, the Centers for Disease Control and Prevention usually has individual agreements with each state regarding reporting incidences of infectious diseases, and all hospitals are required to report COVID-19 admissions through April 2024.

Other methods the CDC will use to track future infections include monitoring COVID-19 hospital emergency room visits and by testing wastewater for evidence of the virus that causes COVID-19.

?It’s not like everything is going to go by the wayside,? Lushniak says, ?but certainly the data will be less vibrant.”

";}s:7:"post-id";s:5:"53338";s:7:"summary";s:335:"At the height of the pandemic, Mount Sinai South Nassau hospital in Oceanside, New York, had more than 400 COVID-19 patients, many of whom were very sick. These days, that number is less than five, with no patients in the intensive care unit, according to Dr. Aaron Glatt, the hospital?s epidemiologist. Those numbers are why […]";s:12:"atom_content";s:11601:"

At the height of the pandemic, Mount Sinai South Nassau hospital in Oceanside, New York, had more than 400 COVID-19 patients, many of whom were very sick. These days, that number is less than five, with no patients in the intensive care unit, according to Dr. Aaron Glatt, the hospital?s epidemiologist.

Those numbers are why Glatt is OK with the federal government?s decision to end the COVID-19 public health emergency. But he also wants the public to understand what that means.

?People have to realize that the benefits that come along with being a public health emergency will go away. And some of the free things that were given out by the government ? without concern about financial reimbursement are going to stop. That’s number one,? says Glatt, who also serves as chair of the hospital?s Department of Medicine and chief of infectious diseases.

?Number two is that allowing an emergency situation to occur freed up some of the regulatory restrictions that normally would be present, and those will now go back into play,? he says.

Nurses with the Mount Sinai South Nassau Vaxmobile administer the COVID-19 vaccine at a school in Freeport, New York, May 14, 2021.

Nurses with the Mount Sinai South Nassau Vaxmobile administer the COVID-19 vaccine at a school in Freeport, New York, May 14, 2021.

After more than three years, more than 1 million U.S. deaths, and 104.5 million documented infections, the COVID-19 public health emergency comes to an end on May 11.

?I think the biggest implication of it is symbolic,? says Jen Kates, a senior vice president at the Kaiser Family Foundation, a nonprofit that focuses on health care research. ?It really is a marker saying, ?We have this important declaration that has come to an end,? and it’s symbolizing a move from this emergency state that allowed for a lot of flexibilities to a different place.?

The pandemic reached its peak between July 2020 to July 2021. The highest hospitalization rates were recorded in December 2020 and January 2021.

What’s changing

Americans will feel the end of the COVID-19 emergency in different ways.

?The age of the free COVID test is over,? says Boris Lushniak, a former acting U.S. surgeon general (2013-2014) who now leads the University of Maryland?s School of Public Health. ?Things that people will notice, for the most part, is going to be that something that was taken for granted for the last two and a half years in the midst of this pandemic, that we kind of got used to, is now going to become more complicated.?

Convention attendees verify proof of COVID-19 vaccination and/or negative tests outside the San Diego Convention Center at Comic-Con International, in California, July 21, 2022.

Convention attendees verify proof of COVID-19 vaccination and/or negative tests outside the San Diego Convention Center at Comic-Con International, in California, July 21, 2022.

During the pandemic, the federal government mailed more than 70 million free COVID-19 tests to people?s homes.

Going forward, at-home COVID-19 tests could become more expensive, according to the Kaiser Family Foundation, and people with private insurance and traditional Medicare will no longer be guaranteed to get them for free, athough private insurers might elect to cover the costs of testing.

More than 81% of the U.S. population, almost 268 million people, has had at least one shot of the COVID-19 vaccine.

Vaccines will continue to be free until the stockpiles purchased by the federal government run out, which experts say will probably be by the end of the year. After that, vaccines will continue to be free for most people with public and private insurance. However, the uninsured and the underinsured face losing easy access to COVID-19 vaccines.

?During COVID, we had probably the closest the United States has ever gotten to universal [health] coverage, and we’re going back to where things generally always are ? where people who have insurance have access to coverage and services, and people who don’t often are left out,? Kates says.

President Joe Biden receives an updated COVID-19 vaccine onstage in an auditorium on the White House campus in Washington, October 25, 2022.

President Joe Biden receives an updated COVID-19 vaccine onstage in an auditorium on the White House campus in Washington, October 25, 2022.

Medication used to treat COVID-19 also will be free for as long as the federal government supply lasts, which is probably until the fall, according to Kates. Congress has not authorized the funding needed for the federal government to continue to purchase more vaccines and treatments. Private insurance companies were never required to waive costs for COVID-19 treatment.

?Still need to be vigilant?

The expiring PHE isn?t the only COVID-19-related emergency measure currently in effect. The emergency measures that allow for the use of the COVID-19 vaccines and treatments will continue beyond May 11.

?People need to be reassured that the fact that the public health emergency status is going away is a positive thing, not a negative thing. It doesn’t mean that we’re ignoring this problem, that it?s done with,? Glatt says. ?A tremendous amount of public health work will still go on and, in general, the American public is going to be well taken care of going forward regarding COVID.?

Although Lushniak agrees that the PHE should be rescinded, he worries the public will assume that COVID-19 is a thing of the past, even though COVID-19 remained the fourth-leading cause of death in the United States in 2022, behind heart disease, cancer and unintentional injury. Currently, 150 people in the U.S. die from coronavirus disease each day.

?The reality is it’s still not over, and we still need to be vigilant,? Lushniak says. ?If you’re not feeling well, stay away from large crowds. This whole idea of disease spread still remains out there. And there are people who are at higher risk around us, so let’s be caring towards others.?

Rules for telemedicine appointments are also changing. During the pandemic emergency, doctors were allowed to prescribe controlled substances during online medical visits. After May 11, people will have to see their doctors in person to get a prescription for those.

A lab technician tests wastewater samples from around the United States for the coronavirus disease (COVID-19) at the Biobot Analytics, in Cambridge, Massachusetts, February 22, 2022.

A lab technician tests wastewater samples from around the United States for the coronavirus disease (COVID-19) at the Biobot Analytics, in Cambridge, Massachusetts, February 22, 2022.

The end of the PHE means that states will no longer be required to report COVID-19 infections to federal authorities.

However, the Centers for Disease Control and Prevention usually has individual agreements with each state regarding reporting incidences of infectious diseases, and all hospitals are required to report COVID-19 admissions through April 2024.

Other methods the CDC will use to track future infections include monitoring COVID-19 hospital emergency room visits and by testing wastewater for evidence of the virus that causes COVID-19.

?It’s not like everything is going to go by the wayside,? Lushniak says, ?but certainly the data will be less vibrant.”

";s:14:"date_timestamp";i:1683812346;}i:6;a:12:{s:5:"title";s:58:"Beneficiarios de Medi-Cal: cómo verificar si eres elegible";s:4:"link";s:86:"https://northdenvernews.com/beneficiarios-de-medi-cal-como-verificar-si-eres-elegible/";s:2:"dc";a:1:{s:7:"creator";s:12:"James Python";}s:7:"pubdate";s:31:"Wed, 10 May 2023 19:18:59 +0000";s:8:"category";s:6:"Latest";s:4:"guid";s:86:"https://northdenvernews.com/beneficiarios-de-medi-cal-como-verificar-si-eres-elegible/";s:11:"description";s:1686:"
Si estás inscrito en Medi-Cal, como más de un tercio de los californianos, asegúrate de que el condado donde vives sepa cómo contactarte, o podrías perder tu cobertura médica sin necesidad. Es probable que en las próximas semanas escuches y veas mensajes públicos instándote a actualizar tu información de contacto. Hazles caso. En algún momento […]";s:7:"content";a:1:{s:7:"encoded";s:15140:"

Si estás inscrito en Medi-Cal, como más de un tercio de los californianos, asegúrate de que el condado donde vives sepa cómo contactarte, o podrías perder tu cobertura médica sin necesidad.

Es probable que en las próximas semanas escuches y veas mensajes públicos instándote a actualizar tu información de contacto. Hazles caso.

En algún momento entre ahora y la próxima primavera, es probable que recibas correspondencia de la agencia que administra Medi-Cal en tu condado para dejarte saber si todavía eres elegible para el seguro de salud, o para pedirte más información acerca de tu situación laboral, ingresos y cuántas personas componen tu núcleo familiar.

Lo más probable es que recibas una solicitud de información en un sobre de color amarillo brillante con un formulario de unas 20 páginas, unas seis semanas antes de que empiece tu mes de renovación.

Manténte alerta: Medi-Cal está advirtiendo sobre estafadores que han contactado a los afiliados y solicitado una cuota para ayudarles a renovar la cobertura. No caigas en esa trampa. No se requiere ningún pago para renovarla.

Pero asegúrate de abrir la correspondencia y responder a cualquier solicitud oficial de información personal. Y ten en cuenta que la actualización de tu información podría dejarte fuera de Medi-Cal, si tus ingresos han aumentado o si tienes acceso a otro seguro.

Si necesitas ayuda, especialmente con el intimidante formulario de renovación, sigue leyendo.

Medi-Cal, la versión de Medicaid en California, puso en marcha una iniciativa de 14 meses para reexaminar la elegibilidad de sus casi 15.8 millones de miembros. Esta medida forma parte de la ?reducción? masiva que están emprendiendo todos los programas estatales de Medicaid después de tres ańos de pandemia durante los cuales sus listas de afiliados aumentaron. Los estados habían acordado no expulsar a nadie salvo en casos como fraude, fallecimiento o mudarse de estado, a cambio de financiación adicional federal.

Medicaid reanudó el 1 de abril las comprobaciones anuales de elegibilidad que habían sido la norma antes de la pandemia. Es la mayor reorganización en la cobertura sanitaria estadounidense desde la Ley de Cuidado de Salud a Bajo Precio (ACA), aunque con recortes  que van en sentido contrario: es probable que entre 8 y 24 millones de personas queden excluidas de Medicaid en todo el país, incluidos entre 2 y 3 millones en California.

Para reducir al mínimo el número de afiliados que se den de baja innecesariamente, el Departamento de Servicios de Atención de Salud de California, que gestiona Medi-Cal, ha puesto en marcha una campańa publicitaria y de divulgación de $25 millones que enviará notificaciones en 19 idiomas.

El departamento está recabando la ayuda de casi todos los que tienen contacto con los beneficiarios de Medi-Cal: oficinas del condado, planes de salud, proveedores médicos, grupos de defensoría y voluntarios. Y consiguió $146 millones en fondos suplementarios para ayudar a los condados a hacer frente al número sin precedentes de renovaciones.

Pero a algunos defensores de los pacientes, ejecutivos de planes de salud y administradores de clínicas comunitarias les preocupa que no sea suficiente para ayudar a todos los afiliados que podrían perder la cobertura si no se les puede localizar o no responden, especialmente personas que no tienen un domicilio fijo, las que viven en la calle, o las que tienen barreras de idioma o culturales.

Menos de dos meses antes del inicio de los ajustes, varios condados, entre ellos Fresno y Sacramento, informaron de la escasez de personal y de la necesidad de formar a trabajadores que cumplieran con los requisitos.

Laura Sheckler, directora adjunta de políticas de la Asociación de Atención Primaria de California, que representa a cerca de 1,300 clínicas comunitarias en todo el estado, dijo que los casi $60 millones en fondos estatales destinados a ?navegadores? para ayudar a los afiliados de Medi-Cal no es suficiente para proporcionar toda la ayuda que se necesita. La asociación ha pedido a los legisladores otros $60 millones.

Algunos afiliados de Medi-Cal ya saben a qué atenerse. Anthony Kelley, padre soltero de 53 ańos, es uno de ellos. Kelley, que vive con su hijo de 14 ańos, Nicholas, en Pacifica, California, perdió temporalmente su trabajo como conductor para una empresa de hormigón en los primeros días de la pandemia y se inscribió en Medi-Cal.

Recuperó su trabajo un mes después, junto con el acceso a la cobertura médica patrocinada por su empleador, pero ha permanecido en Medi-Cal durante los últimos tres ańos. Su hijo ha estado en Medi-Cal desde que nació.

Cuando el condado de San Mateo envió a Kelley un formulario de renovación, llamó y le dijeron que sus $58,000 de ingresos anuales probablemente significaban que él y su hijo perderían la cobertura de Medi-Cal. Ahora está esperando que eso suceda.

?Es un fastidio para mi hijo?, dijo Kelley, quien agregó que teme que Nicholas pueda perder a sus médicos. ?Pero ya lidiaremos con eso?.

Si tienes ansiedad o dudas sobre lo que debes hacer, no te preocupes. Hay ayuda disponible.

Puedes llamar o acudir a una oficina local de Medi-Cal para actualizar tus datos personales o solicitar ayuda. El Departamento de Servicios de Atención de Salud (www.dhcs.ca.gov) tiene una lista en su sitio web de todas las agencias de Medi-Cal de los condados, con direcciones, números de teléfono y enlaces. También puedes llamar al teléfono de ayuda de Medi-Cal (800-541-5555).

Si quieres evitar las largas filas o los tiempos de espera por teléfono, considera la posibilidad de abrir una cuenta en www.benefitscal.com o www.mybenefitscalwin.org. Esto te permitirá actualizar tu información personal y financiera en línea, y encontrar tu fecha de renovación.

Otro gran recurso es la Alianza de Consumidores de Salud (888-804-3536 o www.healthconsumer.org), que puede ayudarte con las complejidades de la renovación, o impugnar una decisión de cancelación que consideres injustificada.

Las clínicas comunitarias, que atienden a casi un tercio de los afiliados a Medi-Cal, suelen contar con asesores que pueden ayudarte a llenar formularios y responder a tus preguntas. L.A. Care, el mayor plan de salud de Medi-Cal, tiene 11 centros en el condado de Los Ángeles que ofrecen ayuda a cualquiera que la necesite, no solo a sus afiliados.

El condado de Fresno cuenta con 14 centros de este tipo. Consulta con tu plan de salud para obtener recursos similares.

En virtud de una ley estatal, la SB260, si se te da de baja de Medi-Cal pero tus ingresos son lo suficientemente bajos como para tener derecho a un subsidio a través de Covered California, el mercado de seguros del estado, se te inscribirá automáticamente en un plan que el mercado considere la mejor relación calidad-precio. Una vez notificada la selección del plan, tendrás 30 días para aceptarlo, elegir otro plan o rechazar la cobertura.

?Esto no tiene por qué ser un desastre para los beneficiarios de Medi-Cal?, indicó David Kane, abogado del Western Center on Law & Poverty.

Esta historia fue producida por KHN, que publica California Healthline, un servicio editorialmente independiente de la California Health Care Foundation.

";}s:7:"post-id";s:5:"53320";s:7:"summary";s:1686:"
Si estás inscrito en Medi-Cal, como más de un tercio de los californianos, asegúrate de que el condado donde vives sepa cómo contactarte, o podrías perder tu cobertura médica sin necesidad. Es probable que en las próximas semanas escuches y veas mensajes públicos instándote a actualizar tu información de contacto. Hazles caso. En algún momento […]";s:12:"atom_content";s:15140:"

Si estás inscrito en Medi-Cal, como más de un tercio de los californianos, asegúrate de que el condado donde vives sepa cómo contactarte, o podrías perder tu cobertura médica sin necesidad.

Es probable que en las próximas semanas escuches y veas mensajes públicos instándote a actualizar tu información de contacto. Hazles caso.

En algún momento entre ahora y la próxima primavera, es probable que recibas correspondencia de la agencia que administra Medi-Cal en tu condado para dejarte saber si todavía eres elegible para el seguro de salud, o para pedirte más información acerca de tu situación laboral, ingresos y cuántas personas componen tu núcleo familiar.

Lo más probable es que recibas una solicitud de información en un sobre de color amarillo brillante con un formulario de unas 20 páginas, unas seis semanas antes de que empiece tu mes de renovación.

Manténte alerta: Medi-Cal está advirtiendo sobre estafadores que han contactado a los afiliados y solicitado una cuota para ayudarles a renovar la cobertura. No caigas en esa trampa. No se requiere ningún pago para renovarla.

Pero asegúrate de abrir la correspondencia y responder a cualquier solicitud oficial de información personal. Y ten en cuenta que la actualización de tu información podría dejarte fuera de Medi-Cal, si tus ingresos han aumentado o si tienes acceso a otro seguro.

Si necesitas ayuda, especialmente con el intimidante formulario de renovación, sigue leyendo.

Medi-Cal, la versión de Medicaid en California, puso en marcha una iniciativa de 14 meses para reexaminar la elegibilidad de sus casi 15.8 millones de miembros. Esta medida forma parte de la ?reducción? masiva que están emprendiendo todos los programas estatales de Medicaid después de tres ańos de pandemia durante los cuales sus listas de afiliados aumentaron. Los estados habían acordado no expulsar a nadie salvo en casos como fraude, fallecimiento o mudarse de estado, a cambio de financiación adicional federal.

Medicaid reanudó el 1 de abril las comprobaciones anuales de elegibilidad que habían sido la norma antes de la pandemia. Es la mayor reorganización en la cobertura sanitaria estadounidense desde la Ley de Cuidado de Salud a Bajo Precio (ACA), aunque con recortes  que van en sentido contrario: es probable que entre 8 y 24 millones de personas queden excluidas de Medicaid en todo el país, incluidos entre 2 y 3 millones en California.

Para reducir al mínimo el número de afiliados que se den de baja innecesariamente, el Departamento de Servicios de Atención de Salud de California, que gestiona Medi-Cal, ha puesto en marcha una campańa publicitaria y de divulgación de $25 millones que enviará notificaciones en 19 idiomas.

El departamento está recabando la ayuda de casi todos los que tienen contacto con los beneficiarios de Medi-Cal: oficinas del condado, planes de salud, proveedores médicos, grupos de defensoría y voluntarios. Y consiguió $146 millones en fondos suplementarios para ayudar a los condados a hacer frente al número sin precedentes de renovaciones.

Pero a algunos defensores de los pacientes, ejecutivos de planes de salud y administradores de clínicas comunitarias les preocupa que no sea suficiente para ayudar a todos los afiliados que podrían perder la cobertura si no se les puede localizar o no responden, especialmente personas que no tienen un domicilio fijo, las que viven en la calle, o las que tienen barreras de idioma o culturales.

Menos de dos meses antes del inicio de los ajustes, varios condados, entre ellos Fresno y Sacramento, informaron de la escasez de personal y de la necesidad de formar a trabajadores que cumplieran con los requisitos.

Laura Sheckler, directora adjunta de políticas de la Asociación de Atención Primaria de California, que representa a cerca de 1,300 clínicas comunitarias en todo el estado, dijo que los casi $60 millones en fondos estatales destinados a ?navegadores? para ayudar a los afiliados de Medi-Cal no es suficiente para proporcionar toda la ayuda que se necesita. La asociación ha pedido a los legisladores otros $60 millones.

Algunos afiliados de Medi-Cal ya saben a qué atenerse. Anthony Kelley, padre soltero de 53 ańos, es uno de ellos. Kelley, que vive con su hijo de 14 ańos, Nicholas, en Pacifica, California, perdió temporalmente su trabajo como conductor para una empresa de hormigón en los primeros días de la pandemia y se inscribió en Medi-Cal.

Recuperó su trabajo un mes después, junto con el acceso a la cobertura médica patrocinada por su empleador, pero ha permanecido en Medi-Cal durante los últimos tres ańos. Su hijo ha estado en Medi-Cal desde que nació.

Cuando el condado de San Mateo envió a Kelley un formulario de renovación, llamó y le dijeron que sus $58,000 de ingresos anuales probablemente significaban que él y su hijo perderían la cobertura de Medi-Cal. Ahora está esperando que eso suceda.

?Es un fastidio para mi hijo?, dijo Kelley, quien agregó que teme que Nicholas pueda perder a sus médicos. ?Pero ya lidiaremos con eso?.

Si tienes ansiedad o dudas sobre lo que debes hacer, no te preocupes. Hay ayuda disponible.

Puedes llamar o acudir a una oficina local de Medi-Cal para actualizar tus datos personales o solicitar ayuda. El Departamento de Servicios de Atención de Salud (www.dhcs.ca.gov) tiene una lista en su sitio web de todas las agencias de Medi-Cal de los condados, con direcciones, números de teléfono y enlaces. También puedes llamar al teléfono de ayuda de Medi-Cal (800-541-5555).

Si quieres evitar las largas filas o los tiempos de espera por teléfono, considera la posibilidad de abrir una cuenta en www.benefitscal.com o www.mybenefitscalwin.org. Esto te permitirá actualizar tu información personal y financiera en línea, y encontrar tu fecha de renovación.

Otro gran recurso es la Alianza de Consumidores de Salud (888-804-3536 o www.healthconsumer.org), que puede ayudarte con las complejidades de la renovación, o impugnar una decisión de cancelación que consideres injustificada.

Las clínicas comunitarias, que atienden a casi un tercio de los afiliados a Medi-Cal, suelen contar con asesores que pueden ayudarte a llenar formularios y responder a tus preguntas. L.A. Care, el mayor plan de salud de Medi-Cal, tiene 11 centros en el condado de Los Ángeles que ofrecen ayuda a cualquiera que la necesite, no solo a sus afiliados.

El condado de Fresno cuenta con 14 centros de este tipo. Consulta con tu plan de salud para obtener recursos similares.

En virtud de una ley estatal, la SB260, si se te da de baja de Medi-Cal pero tus ingresos son lo suficientemente bajos como para tener derecho a un subsidio a través de Covered California, el mercado de seguros del estado, se te inscribirá automáticamente en un plan que el mercado considere la mejor relación calidad-precio. Una vez notificada la selección del plan, tendrás 30 días para aceptarlo, elegir otro plan o rechazar la cobertura.

?Esto no tiene por qué ser un desastre para los beneficiarios de Medi-Cal?, indicó David Kane, abogado del Western Center on Law & Poverty.

Esta historia fue producida por KHN, que publica California Healthline, un servicio editorialmente independiente de la California Health Care Foundation.

";s:14:"date_timestamp";i:1683746339;}i:7;a:12:{s:5:"title";s:66:"California Confronts Overdose Epidemic Among Former Prison Inmates";s:4:"link";s:95:"https://northdenvernews.com/california-confronts-overdose-epidemic-among-former-prison-inmates/";s:2:"dc";a:1:{s:7:"creator";s:12:"James Python";}s:7:"pubdate";s:31:"Wed, 10 May 2023 13:13:10 +0000";s:8:"category";s:6:"Latest";s:4:"guid";s:95:"https://northdenvernews.com/california-confronts-overdose-epidemic-among-former-prison-inmates/";s:11:"description";s:323:"Michael Vera walked into a bedroom of a residential drug treatment program in Los Angeles in March to find its occupant slumped over on his bed and struggling to breathe, a homemade straw on the floor beside him and tinfoil with what appeared to be drug residue under his body. The 35-year-old overdose victim had […]";s:7:"content";a:1:{s:7:"encoded";s:31304:"

Michael Vera walked into a bedroom of a residential drug treatment program in Los Angeles in March to find its occupant slumped over on his bed and struggling to breathe, a homemade straw on the floor beside him and tinfoil with what appeared to be drug residue under his body.

The 35-year-old overdose victim had been out of custody less than 48 hours, in the midst of a frequently fatal danger zone: Individuals newly released from prison are 40 times as likely to die of opioid overdoses as members of the general population, researchers say.

But he was one of the lucky ones, because Vera was among tens of thousands of California inmates to receive training in overdose prevention and resuscitation when he was released from state prison in 2020. He was given two doses of Narcan to take with him, part of California prisons? attempt to arm every departing inmate with overdose-reversal medication.

Vera and his roommate quickly summoned staff members. Paramedics administered two jolts of Narcan, a brand-name version of the drug naloxone. That stabilized the patient enough to get him to a hospital, where he soon recovered.

More than 80% of inmates released in California between April 2020 and June 2022 departed with antidote kits and the training that goes with them, according to a January study by corrections officials. Acceptance has continued to grow, with 95% of departing inmates accepting Narcan in July 2022, the most recent month with data.

Now corrections officials are trying to determine whether the kits actually save lives by examining overdose rates among formerly incarcerated people. They are still gathering data and have no timeline for results, though their report calls the evaluation effort ?a critical priority.? Officials are also looking at whether the program can help address health inequity issues, since overdose death rates are higher in lower-income areas, where parolees often live, and occur disproportionately among racial minorities and people with disabilities.

At the same time, California Gov. Gavin Newsom, a Democrat, is looking to cut the cost and boost the supply of opioid antidotes by having the state produce them itself. Currently, federal grants and legal settlements with opioid vendors fund most of the Narcan for departing inmates, but officials said the state did have to buy 1,180 kits for $62.40 each.

In 2020, California began offering kits containing two doses of Narcan and information on how to use it to every departing prison inmate. ?Education and Narcan is key. It?s not a perfect solution, but it?s a damn good one,? said Mark Malone, director of administration at Fred Brown Recovery Services. (Alessandra Bergamin / KFF Health News)
Narcan, a common form of the antidote naloxone, is kept in the kitchen first-aid kit at Fred Brown Recovery Services. At the instruction of a 911 operator, staff rushed to retrieve Narcan from the box amid a potentially fatal overdose. (Alessandra Bergamin / KFF Health News)

?This is an extremely serious problem,? said Lynn Wenger of the nonprofit research institute RTI International. ?As people leave jail and prison, their tolerance for opioids is very low and the stress of release is high.?

Wenger is the lead author of a 2019 study of a naloxone distribution program at the San Francisco County Jail, where over a four-year period nearly one-third of inmates who were equipped with the drug upon release reported reversing an overdose.

California officials estimate that some two-thirds of inmates in the state have a substance abuse problem, fed by smuggled contraband. That statistic tracks with national estimates. A new program to administer anti-craving medications like methadone to incarcerated drug users has brought inmate overdose deaths down substantially over the past several years.

But parolee overdoses remain a huge problem.

The California report, quoting various studies, says people just released from incarceration are 40 times as likely to die of opioid overdoses as members of the general population, though estimates vary. Massachusetts put the death toll at 120 times as high, while a study using Washington state prison data put the risk at 12.7 times as high in the first two weeks. Research in Georgia, Maryland, Michigan, New Mexico, North Carolina, and Cook County (Chicago) all found significant connections.

Globally, overdoses are the top cause of death among people recently released from custody.

?It?s just so scary what?s going on here, and we?re seeing it,? said Mark Malone, director of administration at Fred Brown Recovery Services, a 40-year-old nonprofit in the Los Angeles neighborhood of San Pedro. That?s where Vera was getting addiction treatment when he helped save the overdose victim.

With quick thinking, roommates Michael Vera and Agustin Pargas intervened amid a potentially fatal overdose. ?It made me feel good to be able to save somebody,? Vera said. ?He has a second chance now.? (Alessandra Bergamin / KFF Health News)

Research shows that formerly incarcerated drug users are especially vulnerable because their tolerance for opioids fades while they are behind bars and their social networks and medical care are disrupted, often including any substance abuse treatment they were receiving in prison. And if they use drugs once released, they often do so in solitude, where they are less likely to be found quickly if they overdose.

California offers departing inmates a kit containing two doses of Narcan, along with instructions on how to recognize and prevent overdoses, perform CPR, and administer the antidote.

Demian Johnson, who spent 35 years in prison for a second-degree murder he committed when he was 18 before being paroled in 2018, now helps formerly incarcerated people and others with substance abuse problems at Five Keys Schools and Programs, a San Francisco Bay Area nonprofit. He says two of his friends died soon after they were released from years of incarceration.

?It?s not hard for me to figure out why so many are succumbing to these really, really potent drugs,? said Johnson, noting that what inmates obtain in prison is likely to be much less pure than what they would find outside.

One of Johnson?s buddies died alone of fentanyl within a year of leaving prison.

?He had nobody to save him, to bring him back or to issue him some Narcan,? Johnson said.

When Michael Vera was released from prison in 2020, he was shown a training video and given two doses of Narcan to take with him. (Alessandra Bergamin/KFF Health News) (Alessandra Bergamin / KFF Health News)
At Fred Brown Recovery Services, a residential drug treatment program in San Pedro, California, Narcan is available in emergency boxes throughout the house. Because of increased overdoses in the last year, the treatment program has increased training and availability of Narcan. (Alessandra Bergamin / KFF Health News)

Wenger says the California program is likely having benefits beyond helping those recently paroled: They can use the Narcan to save others, too.

?They are often released to neighborhoods where they are likely to encounter someone who is experiencing an opioid overdose & will have the tools to reverse an overdose,? she said in an email.

That was the case with Vera, who said he was particularly glad to be able to help someone because he lost a 21-year-old niece and 24-year-old nephew to overdoses around the time he was released.

Vera said the paramedics told him they were just in time. ?If we wouldn?t have found him, they don?t know what his outcome would have been ? but it would have been bad,? Vera said. ?He has a second chance now.?

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

";}s:7:"post-id";s:5:"53311";s:7:"summary";s:323:"Michael Vera walked into a bedroom of a residential drug treatment program in Los Angeles in March to find its occupant slumped over on his bed and struggling to breathe, a homemade straw on the floor beside him and tinfoil with what appeared to be drug residue under his body. The 35-year-old overdose victim had […]";s:12:"atom_content";s:31304:"

Michael Vera walked into a bedroom of a residential drug treatment program in Los Angeles in March to find its occupant slumped over on his bed and struggling to breathe, a homemade straw on the floor beside him and tinfoil with what appeared to be drug residue under his body.

The 35-year-old overdose victim had been out of custody less than 48 hours, in the midst of a frequently fatal danger zone: Individuals newly released from prison are 40 times as likely to die of opioid overdoses as members of the general population, researchers say.

But he was one of the lucky ones, because Vera was among tens of thousands of California inmates to receive training in overdose prevention and resuscitation when he was released from state prison in 2020. He was given two doses of Narcan to take with him, part of California prisons? attempt to arm every departing inmate with overdose-reversal medication.

Vera and his roommate quickly summoned staff members. Paramedics administered two jolts of Narcan, a brand-name version of the drug naloxone. That stabilized the patient enough to get him to a hospital, where he soon recovered.

More than 80% of inmates released in California between April 2020 and June 2022 departed with antidote kits and the training that goes with them, according to a January study by corrections officials. Acceptance has continued to grow, with 95% of departing inmates accepting Narcan in July 2022, the most recent month with data.

Now corrections officials are trying to determine whether the kits actually save lives by examining overdose rates among formerly incarcerated people. They are still gathering data and have no timeline for results, though their report calls the evaluation effort ?a critical priority.? Officials are also looking at whether the program can help address health inequity issues, since overdose death rates are higher in lower-income areas, where parolees often live, and occur disproportionately among racial minorities and people with disabilities.

At the same time, California Gov. Gavin Newsom, a Democrat, is looking to cut the cost and boost the supply of opioid antidotes by having the state produce them itself. Currently, federal grants and legal settlements with opioid vendors fund most of the Narcan for departing inmates, but officials said the state did have to buy 1,180 kits for $62.40 each.

In 2020, California began offering kits containing two doses of Narcan and information on how to use it to every departing prison inmate. ?Education and Narcan is key. It?s not a perfect solution, but it?s a damn good one,? said Mark Malone, director of administration at Fred Brown Recovery Services. (Alessandra Bergamin / KFF Health News)
Narcan, a common form of the antidote naloxone, is kept in the kitchen first-aid kit at Fred Brown Recovery Services. At the instruction of a 911 operator, staff rushed to retrieve Narcan from the box amid a potentially fatal overdose. (Alessandra Bergamin / KFF Health News)

?This is an extremely serious problem,? said Lynn Wenger of the nonprofit research institute RTI International. ?As people leave jail and prison, their tolerance for opioids is very low and the stress of release is high.?

Wenger is the lead author of a 2019 study of a naloxone distribution program at the San Francisco County Jail, where over a four-year period nearly one-third of inmates who were equipped with the drug upon release reported reversing an overdose.

California officials estimate that some two-thirds of inmates in the state have a substance abuse problem, fed by smuggled contraband. That statistic tracks with national estimates. A new program to administer anti-craving medications like methadone to incarcerated drug users has brought inmate overdose deaths down substantially over the past several years.

But parolee overdoses remain a huge problem.

The California report, quoting various studies, says people just released from incarceration are 40 times as likely to die of opioid overdoses as members of the general population, though estimates vary. Massachusetts put the death toll at 120 times as high, while a study using Washington state prison data put the risk at 12.7 times as high in the first two weeks. Research in Georgia, Maryland, Michigan, New Mexico, North Carolina, and Cook County (Chicago) all found significant connections.

Globally, overdoses are the top cause of death among people recently released from custody.

?It?s just so scary what?s going on here, and we?re seeing it,? said Mark Malone, director of administration at Fred Brown Recovery Services, a 40-year-old nonprofit in the Los Angeles neighborhood of San Pedro. That?s where Vera was getting addiction treatment when he helped save the overdose victim.

With quick thinking, roommates Michael Vera and Agustin Pargas intervened amid a potentially fatal overdose. ?It made me feel good to be able to save somebody,? Vera said. ?He has a second chance now.? (Alessandra Bergamin / KFF Health News)

Research shows that formerly incarcerated drug users are especially vulnerable because their tolerance for opioids fades while they are behind bars and their social networks and medical care are disrupted, often including any substance abuse treatment they were receiving in prison. And if they use drugs once released, they often do so in solitude, where they are less likely to be found quickly if they overdose.

California offers departing inmates a kit containing two doses of Narcan, along with instructions on how to recognize and prevent overdoses, perform CPR, and administer the antidote.

Demian Johnson, who spent 35 years in prison for a second-degree murder he committed when he was 18 before being paroled in 2018, now helps formerly incarcerated people and others with substance abuse problems at Five Keys Schools and Programs, a San Francisco Bay Area nonprofit. He says two of his friends died soon after they were released from years of incarceration.

?It?s not hard for me to figure out why so many are succumbing to these really, really potent drugs,? said Johnson, noting that what inmates obtain in prison is likely to be much less pure than what they would find outside.

One of Johnson?s buddies died alone of fentanyl within a year of leaving prison.

?He had nobody to save him, to bring him back or to issue him some Narcan,? Johnson said.

When Michael Vera was released from prison in 2020, he was shown a training video and given two doses of Narcan to take with him. (Alessandra Bergamin/KFF Health News) (Alessandra Bergamin / KFF Health News)
At Fred Brown Recovery Services, a residential drug treatment program in San Pedro, California, Narcan is available in emergency boxes throughout the house. Because of increased overdoses in the last year, the treatment program has increased training and availability of Narcan. (Alessandra Bergamin / KFF Health News)

Wenger says the California program is likely having benefits beyond helping those recently paroled: They can use the Narcan to save others, too.

?They are often released to neighborhoods where they are likely to encounter someone who is experiencing an opioid overdose & will have the tools to reverse an overdose,? she said in an email.

That was the case with Vera, who said he was particularly glad to be able to help someone because he lost a 21-year-old niece and 24-year-old nephew to overdoses around the time he was released.

Vera said the paramedics told him they were just in time. ?If we wouldn?t have found him, they don?t know what his outcome would have been ? but it would have been bad,? Vera said. ?He has a second chance now.?

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

";s:14:"date_timestamp";i:1683724390;}i:8;a:12:{s:5:"title";s:78:"An Outdated Tracking System Is a Key Factor in Texas? Foster Care Shortcomings";s:4:"link";s:106:"https://northdenvernews.com/an-outdated-tracking-system-is-a-key-factor-in-texas-foster-care-shortcomings/";s:2:"dc";a:1:{s:7:"creator";s:12:"James Python";}s:7:"pubdate";s:31:"Wed, 10 May 2023 12:12:22 +0000";s:8:"category";s:6:"Latest";s:4:"guid";s:106:"https://northdenvernews.com/an-outdated-tracking-system-is-a-key-factor-in-texas-foster-care-shortcomings/";s:11:"description";s:1669:"
The decades-old system Texas foster care officials use to track and monitor the health records of the nearly 20,000 children in their custody is both outdated and unreliable ? so much so, advocates say, that children have been harmed or put at risk. And those deficiencies persist despite a 2015 order by a federal judge […]";s:7:"content";a:1:{s:7:"encoded";s:16830:"

The decades-old system Texas foster care officials use to track and monitor the health records of the nearly 20,000 children in their custody is both outdated and unreliable ? so much so, advocates say, that children have been harmed or put at risk. And those deficiencies persist despite a 2015 order by a federal judge that state leaders fix the system?s deficiencies.

?The frustration with IMPACT is well known,? said Texas state Rep. Gene Wu, a Democrat from Houston, referring to the aging software.

That frustration, he added, is felt widely, from caseworkers to the court system, and boils down to a simple reality: IMPACT, Information Management Protecting Adults and Children in Texas, has been in place since 1996. It was designed to be a secure location for foster children?s records, including their health records and histories of neglect and abuse. But it doesn?t allow such information to be easily added by or shared among state and local health agencies, Medicaid, and even health care providers for the foster children in Texas? care. Without that ability, children?s medical needs are getting lost in transit. After all, foster kids tend to move from place to place, home to home, and doctor to doctor.

A report released this year by court-appointed monitors is full of harrowing stories and frightening missteps. For instance, in January 2022, a residential treatment center lost track of a 16-year-old boy?s medications. The supply ran out but the center ?didn?t realize it.? The boy, who had a history of suicidal ideation, had to undergo an emergency psychiatric consult.

The report also told the story of a foster child who had to stay in a Dallas hotel because caseworkers were unable to find her a family. But no one knew she had prescription drugs in her backpack. When she was left alone in her room, she swallowed a handful of pills. She was taken to a behavioral hospital. As of last September, she was in juvenile detention.

Such accounts, and the concerns they trigger about the state?s broken foster care system, have begun to find traction this legislative session.

The state?s Department of Family and Protective Services, for instance, which oversees the system, has been called in for a series of status hearings regarding its overall progress. Those involved say lasting improvement has to start with modernizing DFPS? technological infrastructure, but whether their pleas will be met with action is unclear.

Making matters more frustrating for caseworkers is that the federal government in 2015 introduced a new set of regulatory requirements. States could use them to build a framework and become part of a national network that, from the federal view, would help states better track foster kids and their health care needs. Texas, however, is one of four states that has so far opted against using it.

The state now finds itself in the unprecedented situation of having a budget surplus of $32.7 billion, and DFPS is bidding to snag some of that windfall. During an appropriations meeting in February, commissioner Stephanie Muth said that priorities for any such allocation would include building community-based care teams and increasing pay to boost employee retention. The department isn?t planning to replace or make sweeping changes to IMPACT anytime soon.

That?s despite the fact that IMPACT is older than Google ? and has had far fewer updates.

Marissa Gonzales, DFPS media relations director, said that when states were given the option to adopt the new federal standards ? which incorporated modern technology to enable data to be shared between systems ? the agency opted out because they found the requirements ?quite restrictive.? On the table now, however, is a federal offer to cover half the cost of transitioning, she said, adding that the agency is ?talking to other states about their experiences, and evaluating our own needs, before deciding next steps.?

According to a report by think tank Texas 2036 and the Texas Alliance of Child and Family Services, transitioning to the new program would cost the state $80 million. It said the state had already spent more than $80 million since 2015 to maintain its current system.

One of the biggest concerns of caseworkers is that IMPACT isn?t capable of supporting data-sharing, also known as interoperability, and flagging potential problems, such as when doctors separately prescribe medications that are dangerous when taken together. This is critical, because foster children are prescribed psychotropic drugs to treat mental health disorders at more than four times the rate of other children on Medicaid.

But without such a safety net, the responsibility falls to the caseworker.

?You wouldn?t really expect a CPS worker to have advanced knowledge of psychotropic medications? and which ones children can and cannot take together safely, said Tara Green, co-founder and executive director of the Foster Care Advocacy Center in Houston. But caseworkers have saved children?s lives by catching dangerous medication pairings, she said.

On several occasions, Green said, a caseworker has raised a concern about a child?s medications and a psychiatrist has confirmed that if the issue wasn?t caught then, ?this kid would have had a heart attack in the next week or so.?

Scores of children in the past few years have died while in the state?s care, with most of the deaths attributed to preexisting medical conditions ? disorders that, more often than not, require specialized care and treatments.

Asked during a House committee hearing about the timing of a modernization project, Muth seemed to suggest it would be a longer-range fix. ?It would not be a process that takes a biennium or two, and you?d have to plan for that,? she said. ?So, I still think we?re talking about down the road.?

But Wu told KFF Health News that putting off even starting such an upgrade will make things worse. The system will ?probably already be out-of-date? by the time it?s ready, he said. That?s why ?it always feels like we?re in a catch-up mode,? he added.

As it stands, caseworkers have heavy client loads and spend much of their day driving to visits with children who are scattered across counties. But IMPACT isn?t accessible on their mobile devices. That means they often end up transferring paper notes into the program when they return to the office. On top of that, it takes several steps to make a single entry, and the system is prone to freezing.

?All the data that we?re relying on to tell us about the lives of these kids, it has to be taken with a grain of salt,? said Meredith Parekh, the supervising attorney of Disability Rights Texas? foster care team. ?Your data is only as good as the ability of the caseworker to keep up with all of that, and they?re trying to juggle so many things.?

Texas? foster system has been under intense pressure since a federal lawsuit was filed against it in 2011 for ?leaving many thousands of children to be harmed while in the state?s care,? the complaint reads. U.S. District Judge Janis Graham Jack wrote in a scathing 260-page 2015 ruling that the system ?shocks the conscience.? More recently, during a January status hearing, Jack scolded the foster care agency, saying children ?come into your care with great needs. I just don?t want them going out of your care with even greater needs, which is what has been happening.?

As part of her ruling, Jack ordered a list of corrections the state agency must make, including hiring more caseworkers to reduce caseloads, stopping the placing of children in foster group homes that lack 24-hour supervision, and tracking child-on-child abuse.

In the eight years since, some progress has been made. For instance, according to the state, caseloads have been reduced, from a daily average of 17 children per caseworker in 2015 ? which exceeded the national recommendation of 12 to 15 children per worker ? to a daily average of 11 at the beginning of 2023.

But caseworkers say updating the foster care system?s technology would provide overall support for the care children receive, rather than placing band-aids on issues.

The new records system would ?make it easier to track everything about that kid,? said Hope Osborn, the policy and advocacy manager at Texas 2036, since a variety of agencies would have access to that child?s data, and the ?more eyes on that kid, the better.?

";}s:7:"post-id";s:5:"53308";s:7:"summary";s:1669:"
The decades-old system Texas foster care officials use to track and monitor the health records of the nearly 20,000 children in their custody is both outdated and unreliable ? so much so, advocates say, that children have been harmed or put at risk. And those deficiencies persist despite a 2015 order by a federal judge […]";s:12:"atom_content";s:16830:"

The decades-old system Texas foster care officials use to track and monitor the health records of the nearly 20,000 children in their custody is both outdated and unreliable ? so much so, advocates say, that children have been harmed or put at risk. And those deficiencies persist despite a 2015 order by a federal judge that state leaders fix the system?s deficiencies.

?The frustration with IMPACT is well known,? said Texas state Rep. Gene Wu, a Democrat from Houston, referring to the aging software.

That frustration, he added, is felt widely, from caseworkers to the court system, and boils down to a simple reality: IMPACT, Information Management Protecting Adults and Children in Texas, has been in place since 1996. It was designed to be a secure location for foster children?s records, including their health records and histories of neglect and abuse. But it doesn?t allow such information to be easily added by or shared among state and local health agencies, Medicaid, and even health care providers for the foster children in Texas? care. Without that ability, children?s medical needs are getting lost in transit. After all, foster kids tend to move from place to place, home to home, and doctor to doctor.

A report released this year by court-appointed monitors is full of harrowing stories and frightening missteps. For instance, in January 2022, a residential treatment center lost track of a 16-year-old boy?s medications. The supply ran out but the center ?didn?t realize it.? The boy, who had a history of suicidal ideation, had to undergo an emergency psychiatric consult.

The report also told the story of a foster child who had to stay in a Dallas hotel because caseworkers were unable to find her a family. But no one knew she had prescription drugs in her backpack. When she was left alone in her room, she swallowed a handful of pills. She was taken to a behavioral hospital. As of last September, she was in juvenile detention.

Such accounts, and the concerns they trigger about the state?s broken foster care system, have begun to find traction this legislative session.

The state?s Department of Family and Protective Services, for instance, which oversees the system, has been called in for a series of status hearings regarding its overall progress. Those involved say lasting improvement has to start with modernizing DFPS? technological infrastructure, but whether their pleas will be met with action is unclear.

Making matters more frustrating for caseworkers is that the federal government in 2015 introduced a new set of regulatory requirements. States could use them to build a framework and become part of a national network that, from the federal view, would help states better track foster kids and their health care needs. Texas, however, is one of four states that has so far opted against using it.

The state now finds itself in the unprecedented situation of having a budget surplus of $32.7 billion, and DFPS is bidding to snag some of that windfall. During an appropriations meeting in February, commissioner Stephanie Muth said that priorities for any such allocation would include building community-based care teams and increasing pay to boost employee retention. The department isn?t planning to replace or make sweeping changes to IMPACT anytime soon.

That?s despite the fact that IMPACT is older than Google ? and has had far fewer updates.

Marissa Gonzales, DFPS media relations director, said that when states were given the option to adopt the new federal standards ? which incorporated modern technology to enable data to be shared between systems ? the agency opted out because they found the requirements ?quite restrictive.? On the table now, however, is a federal offer to cover half the cost of transitioning, she said, adding that the agency is ?talking to other states about their experiences, and evaluating our own needs, before deciding next steps.?

According to a report by think tank Texas 2036 and the Texas Alliance of Child and Family Services, transitioning to the new program would cost the state $80 million. It said the state had already spent more than $80 million since 2015 to maintain its current system.

One of the biggest concerns of caseworkers is that IMPACT isn?t capable of supporting data-sharing, also known as interoperability, and flagging potential problems, such as when doctors separately prescribe medications that are dangerous when taken together. This is critical, because foster children are prescribed psychotropic drugs to treat mental health disorders at more than four times the rate of other children on Medicaid.

But without such a safety net, the responsibility falls to the caseworker.

?You wouldn?t really expect a CPS worker to have advanced knowledge of psychotropic medications? and which ones children can and cannot take together safely, said Tara Green, co-founder and executive director of the Foster Care Advocacy Center in Houston. But caseworkers have saved children?s lives by catching dangerous medication pairings, she said.

On several occasions, Green said, a caseworker has raised a concern about a child?s medications and a psychiatrist has confirmed that if the issue wasn?t caught then, ?this kid would have had a heart attack in the next week or so.?

Scores of children in the past few years have died while in the state?s care, with most of the deaths attributed to preexisting medical conditions ? disorders that, more often than not, require specialized care and treatments.

Asked during a House committee hearing about the timing of a modernization project, Muth seemed to suggest it would be a longer-range fix. ?It would not be a process that takes a biennium or two, and you?d have to plan for that,? she said. ?So, I still think we?re talking about down the road.?

But Wu told KFF Health News that putting off even starting such an upgrade will make things worse. The system will ?probably already be out-of-date? by the time it?s ready, he said. That?s why ?it always feels like we?re in a catch-up mode,? he added.

As it stands, caseworkers have heavy client loads and spend much of their day driving to visits with children who are scattered across counties. But IMPACT isn?t accessible on their mobile devices. That means they often end up transferring paper notes into the program when they return to the office. On top of that, it takes several steps to make a single entry, and the system is prone to freezing.

?All the data that we?re relying on to tell us about the lives of these kids, it has to be taken with a grain of salt,? said Meredith Parekh, the supervising attorney of Disability Rights Texas? foster care team. ?Your data is only as good as the ability of the caseworker to keep up with all of that, and they?re trying to juggle so many things.?

Texas? foster system has been under intense pressure since a federal lawsuit was filed against it in 2011 for ?leaving many thousands of children to be harmed while in the state?s care,? the complaint reads. U.S. District Judge Janis Graham Jack wrote in a scathing 260-page 2015 ruling that the system ?shocks the conscience.? More recently, during a January status hearing, Jack scolded the foster care agency, saying children ?come into your care with great needs. I just don?t want them going out of your care with even greater needs, which is what has been happening.?

As part of her ruling, Jack ordered a list of corrections the state agency must make, including hiring more caseworkers to reduce caseloads, stopping the placing of children in foster group homes that lack 24-hour supervision, and tracking child-on-child abuse.

In the eight years since, some progress has been made. For instance, according to the state, caseloads have been reduced, from a daily average of 17 children per caseworker in 2015 ? which exceeded the national recommendation of 12 to 15 children per worker ? to a daily average of 11 at the beginning of 2023.

But caseworkers say updating the foster care system?s technology would provide overall support for the care children receive, rather than placing band-aids on issues.

The new records system would ?make it easier to track everything about that kid,? said Hope Osborn, the policy and advocacy manager at Texas 2036, since a variety of agencies would have access to that child?s data, and the ?more eyes on that kid, the better.?

";s:14:"date_timestamp";i:1683720742;}i:9;a:12:{s:5:"title";s:86:"Republicans Vow Not to Cut Veterans? Benefits. But the Legislation Suggests Otherwise.";s:4:"link";s:112:"https://northdenvernews.com/republicans-vow-not-to-cut-veterans-benefits-but-the-legislation-suggests-otherwise/";s:2:"dc";a:1:{s:7:"creator";s:12:"James Python";}s:7:"pubdate";s:31:"Tue, 09 May 2023 20:56:10 +0000";s:8:"category";s:6:"Latest";s:4:"guid";s:112:"https://northdenvernews.com/republicans-vow-not-to-cut-veterans-benefits-but-the-legislation-suggests-otherwise/";s:11:"description";s:344:"Addressing the impact of the House GOP debt-ceiling bill on veterans? programs,?I?m dead serious that we?re not cutting veterans, and I mean it.? Rep. Mike Bost (R-Ill.), chair of the House Committee on Veterans? Affairs, in a speech on the House floor, April 26. House Republicans have set themselves a tough, if not impossible, task […]";s:7:"content";a:1:{s:7:"encoded";s:22789:"

Addressing the impact of the House GOP debt-ceiling bill on veterans? programs,?I?m dead serious that we?re not cutting veterans, and I mean it.?

Rep. Mike Bost (R-Ill.), chair of the House Committee on Veterans? Affairs, in a speech on the House floor, April 26.

House Republicans have set themselves a tough, if not impossible, task in attempting to use a standoff over the nation?s debt limit to cut federal spending to what it was in 2022.

Retrenching to those budget levels would require cutting 8% or 9% from the discretionary program side of the ledger, which excludes entitlement programs such as Social Security and Medicare. Spending on those programs is required by law. Other spending is dictated by congressional appropriations annually. The latter is up for debate here.

Nevertheless, House Republicans tried to thread the needle with the Limit, Save, Grow Act, which narrowly passed the House on April 26. Its backers say the measure would address the debt ceiling while implementing ?commonsense spending reforms.? The House GOP leadership promised to spare programs that are popular with Republican voters, such as the defense budget and veterans? health services.

Democrats pounced on these possible cuts, especially those that would affect veterans. Their talking points appeared to infuriate Rep. Mike Bost (R-Ill.), chairman of the House Committee on Veterans? Affairs. On the House floor, he drew a line in the sand.

?I?m dead serious that we?re not cutting veterans, and I mean it,? Bost said. ?The White House and Democrats know that we can get our fiscal house in order while ensuring our service members and veterans are taken care of, and yet, with no regard for the impact of their words, they continue to speak lies about how House Republicans are cutting veterans? benefits.?

(Credit: C-SPAN)

With such an unequivocal statement, we wondered whether Bost was correct. Can the GOP plan dramatically reduce federal spending without taking away funding for veterans? programs?

To understand this fully, two things need to be examined: the budget projections that suggest the GOP plan would result in trims to veterans? programs, and what is spelled out in the legislation.

Digging Into the Numbers

Democrats and agencies within the Biden administration, such as the Department of Veterans Affairs, looked at the GOP bill and did their own math to determine budgetary estimates.

Because the bill is mostly a list of general spending categories, the estimates reflect uniform cuts to discretionary spending. And, because there is no specific language in the House-passed measure to exempt support for veterans? programs, the VA assumed a full, 22% cut for fiscal year 2024 compared with 2023 funding and estimated reductions as high as $29.7 billion.

That could translate to 13 million fewer health care appointments for veterans and significant cuts to benefit payments, staffing, and clinic construction, according to the agency.

Bost?s communications director, Kathleen McCarthy, said, however, that Democrats are knowingly making a bogus assumption that cuts will be applied evenly, and pointed to public statements by Republican leaders who have insisted veterans will be spared.

?We make sure that our veterans and our service members are taken care of,? House Speaker Kevin McCarthy said in a speech at the New York Stock Exchange last month.

?We will provide for our national defense, take care of veterans, and secure our border ? all while reducing overall spending,? House Appropriations Committee Chairwoman Kay Granger (R-Texas) said when Republicans unveiled their plan.

But delivering on that promise would necessitate even deeper cuts to other programs.

Of the $1.7 trillion discretionary budget spent in 2022, a Congressional Budget Office analysis released in March found that $113 billion went to certain veterans? benefits and $751 billion covered defense.

Shielding defense and veterans? programs would force Republicans to concentrate all the cuts on the remaining discretionary budget, which the Center on Budget and Policy Priorities found would amount to 23% cuts, an amount similar to the administration?s estimate.

Why This Debate Matters

Veterans? funding has emerged as one of the most hotly contested issues in the debt discussion.

The White House tweeted about Republican cuts to veterans, prompting an angry response from Sen. Tom Cotton (R-Ark.), a veteran of the wars in Iraq and Afghanistan. Sen. Roger Marshall (R-Kan.) echoed Bost?s claim in a hearing Thursday, accusing Democrats of ?lies.? Sen. Alex Padilla (D-Calif.) shot back that House Republicans voted down Democratic amendments that would have explicitly exempted veterans.

The GOP also could face opposition from within its ranks. To achieve their goals without affecting veterans, House Republicans would have to find other reductions supported by nearly the entire caucus. Opposition from five or more members would doom the legislation.

The situation is particularly dicey because certain Republicans oppose cutting some of the programs likely to be targeted ? such as projects in their districts ? and other Republicans favor even deeper cuts.

More than 20 veterans? groups have signed a letter opposing the GOP plan.

The nation?s largest veterans? organizations have said they will not take a position on the legislation to avoid the appearance of partisanship. But representatives for some of those groups said although they believe Republican leaders genuinely want to protect veterans, they understand it is hard for such a narrowly divided body to make guarantees.

?Mike Bost and the leaders may not want to cut veterans, but they may have to acquiesce to one or two or three or more of their members to get the thing done,? said Patrick Murray, director of national legislative service for the Veterans of Foreign Wars, referring to raising the debt ceiling while reducing spending.

Though other large veterans? groups declined to comment on the record, representatives highlighted possible cuts to programs they consider worthwhile that some lawmakers have declared unnecessary or wasteful.

?We?ve heard people say they?re not going to cut spending, but then we?ve heard people say they?re going to cut wasteful spending,? Murray said. ?Well, that?s subjective.?

Another Potential Land Mine

Veterans? organizations are also worried about a possible rollback of the landmark ? and expensive ? Honoring Our PACT Act, which provides for the care and remediation for veterans exposed to toxic substances overseas. The law did not take effect until this year.

Republican lawmakers maintain that they can make the numbers work to preserve the law.

But the House-passed debt-ceiling measure does specifically mandate one significant cut, as Rep. Rosa DeLauro (D-Conn.), the top Democrat on the House Appropriations Committee, pointed out. The GOP bill rescinds any unspent funding passed in bills on covid-19 relief, including veterans? funding. When Bost wrote to the VA at the end of March asking about unspent covid money, his office estimated some $4.5 billion was up for grabs.

DeLauro, in denouncing the GOP bill and apparently using more recent numbers, said the rescission would be closer to $2 billion.

?That is a straight-up, ?we?re-taking-that-back? cut,? said Murray.

Bost?s office stuck to its side of the line in the sand, suggesting the money, once rescinded, could be repurposed for different veterans? programs, but noted that would be up to appropriators.

Our Ruling

Bost claimed that Republicans were not cutting veterans? benefits even as the text of their bill to raise the nation?s debt ceiling would roll back all discretionary spending.

Drafting a slimmed-down budget that spares veterans is no easy task. Most notably, the VA represents one of the largest pieces of the pie in terms of discretionary spending, and, in the House-passed Limit, Save, Grow Act, no language was included to specifically protect it.

The House GOP plan does include a specific budget rescission for unspent covid relief funds. That translates to $2 billion coming from the VA. While Congress could restore that money in the future ? and it is a relatively small portion of the VA budget ? it would result in a reduction in spending for veterans as the proposal stands.

House Republicans like Bost have said repeatedly they intend to protect this key constituency. But so far, such protections are not evident on paper.

We rate Bost?s statement as Mostly False.

Speaker Kevin McCarthy?s Speech at the New York Stock Exchange, April 17, 2023

Statement by House Appropriations Chairwoman Kay Granger on the Limit, Save, Grow Act, April 26, 2023

?Putting the Limit, Save, Grow Act in Context,? Committee for a Responsible Federal Budget, April 25, 2023

Letter to House Democrats from Veterans Affairs Secretary Denis McDonough, March 21, 2023

Statement by Rep. Rosa DeLauro (D-Conn.) on spending for veterans, April 26, 2023

Analysis of Rescissions in the Default on America Act, House Appropriations Committee estimate of veterans? cuts

American Rescue Plan Act, March 11, 2021 (veterans? appropriations on Page 110)

Limit, Save, Grow Act, sponsored by Rep. Jodey C. Arrington (R-Texas), engrossed April 26, 2023

MAX Information and Reports (Executive, Legislative, and Judicial Users): FY 2023-SF 133 Reports on Budget Execution and Budgetary Resources, April 20, 2023

?How Much Has the U.S. Government Spent This Year?? U.S. Department of Treasury, accessed May 1, 2023

?Discretionary Spending in Fiscal Year 2022: An Infographic,? Congressional Budget Office, March 28, 2023

Letter from veterans? service organizations to members of Congress, April 25, 2023

?Many Dissatisfied With the Government?s Spending Priorities,? poll by AP-NORC, March 29, 2023

?House Republicans? Pledge to Cut Appropriated Programs to 2022 Level Would Have Severe Effects, Particularly for Non-Defense Programs,? Center on Budget and Policy Priorities, March 25, 2023

?VFW Asks Speaker of the House to Honor the Promises of the PACT Act? (letter), April 25, 2023

Background email discussion with office of Rep. Mike Bost (R-Ill.), April 28, 2023

Email exchanges with Democratic staff of House Appropriations Committee, April 28, 2023

Telephone interview with Patrick Murray, director of national legislative service for the Veterans of Foreign Wars, April 28, 2023

House floor speech regarding veterans? programs by Rep. Mike Bost (R-Ill.), C-SPAN, April 26, 2023

";}s:7:"post-id";s:5:"53278";s:7:"summary";s:344:"Addressing the impact of the House GOP debt-ceiling bill on veterans? programs,?I?m dead serious that we?re not cutting veterans, and I mean it.? Rep. Mike Bost (R-Ill.), chair of the House Committee on Veterans? Affairs, in a speech on the House floor, April 26. House Republicans have set themselves a tough, if not impossible, task […]";s:12:"atom_content";s:22789:"

Addressing the impact of the House GOP debt-ceiling bill on veterans? programs,?I?m dead serious that we?re not cutting veterans, and I mean it.?

Rep. Mike Bost (R-Ill.), chair of the House Committee on Veterans? Affairs, in a speech on the House floor, April 26.

House Republicans have set themselves a tough, if not impossible, task in attempting to use a standoff over the nation?s debt limit to cut federal spending to what it was in 2022.

Retrenching to those budget levels would require cutting 8% or 9% from the discretionary program side of the ledger, which excludes entitlement programs such as Social Security and Medicare. Spending on those programs is required by law. Other spending is dictated by congressional appropriations annually. The latter is up for debate here.

Nevertheless, House Republicans tried to thread the needle with the Limit, Save, Grow Act, which narrowly passed the House on April 26. Its backers say the measure would address the debt ceiling while implementing ?commonsense spending reforms.? The House GOP leadership promised to spare programs that are popular with Republican voters, such as the defense budget and veterans? health services.

Democrats pounced on these possible cuts, especially those that would affect veterans. Their talking points appeared to infuriate Rep. Mike Bost (R-Ill.), chairman of the House Committee on Veterans? Affairs. On the House floor, he drew a line in the sand.

?I?m dead serious that we?re not cutting veterans, and I mean it,? Bost said. ?The White House and Democrats know that we can get our fiscal house in order while ensuring our service members and veterans are taken care of, and yet, with no regard for the impact of their words, they continue to speak lies about how House Republicans are cutting veterans? benefits.?

(Credit: C-SPAN)

With such an unequivocal statement, we wondered whether Bost was correct. Can the GOP plan dramatically reduce federal spending without taking away funding for veterans? programs?

To understand this fully, two things need to be examined: the budget projections that suggest the GOP plan would result in trims to veterans? programs, and what is spelled out in the legislation.

Digging Into the Numbers

Democrats and agencies within the Biden administration, such as the Department of Veterans Affairs, looked at the GOP bill and did their own math to determine budgetary estimates.

Because the bill is mostly a list of general spending categories, the estimates reflect uniform cuts to discretionary spending. And, because there is no specific language in the House-passed measure to exempt support for veterans? programs, the VA assumed a full, 22% cut for fiscal year 2024 compared with 2023 funding and estimated reductions as high as $29.7 billion.

That could translate to 13 million fewer health care appointments for veterans and significant cuts to benefit payments, staffing, and clinic construction, according to the agency.

Bost?s communications director, Kathleen McCarthy, said, however, that Democrats are knowingly making a bogus assumption that cuts will be applied evenly, and pointed to public statements by Republican leaders who have insisted veterans will be spared.

?We make sure that our veterans and our service members are taken care of,? House Speaker Kevin McCarthy said in a speech at the New York Stock Exchange last month.

?We will provide for our national defense, take care of veterans, and secure our border ? all while reducing overall spending,? House Appropriations Committee Chairwoman Kay Granger (R-Texas) said when Republicans unveiled their plan.

But delivering on that promise would necessitate even deeper cuts to other programs.

Of the $1.7 trillion discretionary budget spent in 2022, a Congressional Budget Office analysis released in March found that $113 billion went to certain veterans? benefits and $751 billion covered defense.

Shielding defense and veterans? programs would force Republicans to concentrate all the cuts on the remaining discretionary budget, which the Center on Budget and Policy Priorities found would amount to 23% cuts, an amount similar to the administration?s estimate.

Why This Debate Matters

Veterans? funding has emerged as one of the most hotly contested issues in the debt discussion.

The White House tweeted about Republican cuts to veterans, prompting an angry response from Sen. Tom Cotton (R-Ark.), a veteran of the wars in Iraq and Afghanistan. Sen. Roger Marshall (R-Kan.) echoed Bost?s claim in a hearing Thursday, accusing Democrats of ?lies.? Sen. Alex Padilla (D-Calif.) shot back that House Republicans voted down Democratic amendments that would have explicitly exempted veterans.

The GOP also could face opposition from within its ranks. To achieve their goals without affecting veterans, House Republicans would have to find other reductions supported by nearly the entire caucus. Opposition from five or more members would doom the legislation.

The situation is particularly dicey because certain Republicans oppose cutting some of the programs likely to be targeted ? such as projects in their districts ? and other Republicans favor even deeper cuts.

More than 20 veterans? groups have signed a letter opposing the GOP plan.

The nation?s largest veterans? organizations have said they will not take a position on the legislation to avoid the appearance of partisanship. But representatives for some of those groups said although they believe Republican leaders genuinely want to protect veterans, they understand it is hard for such a narrowly divided body to make guarantees.

?Mike Bost and the leaders may not want to cut veterans, but they may have to acquiesce to one or two or three or more of their members to get the thing done,? said Patrick Murray, director of national legislative service for the Veterans of Foreign Wars, referring to raising the debt ceiling while reducing spending.

Though other large veterans? groups declined to comment on the record, representatives highlighted possible cuts to programs they consider worthwhile that some lawmakers have declared unnecessary or wasteful.

?We?ve heard people say they?re not going to cut spending, but then we?ve heard people say they?re going to cut wasteful spending,? Murray said. ?Well, that?s subjective.?

Another Potential Land Mine

Veterans? organizations are also worried about a possible rollback of the landmark ? and expensive ? Honoring Our PACT Act, which provides for the care and remediation for veterans exposed to toxic substances overseas. The law did not take effect until this year.

Republican lawmakers maintain that they can make the numbers work to preserve the law.

But the House-passed debt-ceiling measure does specifically mandate one significant cut, as Rep. Rosa DeLauro (D-Conn.), the top Democrat on the House Appropriations Committee, pointed out. The GOP bill rescinds any unspent funding passed in bills on covid-19 relief, including veterans? funding. When Bost wrote to the VA at the end of March asking about unspent covid money, his office estimated some $4.5 billion was up for grabs.

DeLauro, in denouncing the GOP bill and apparently using more recent numbers, said the rescission would be closer to $2 billion.

?That is a straight-up, ?we?re-taking-that-back? cut,? said Murray.

Bost?s office stuck to its side of the line in the sand, suggesting the money, once rescinded, could be repurposed for different veterans? programs, but noted that would be up to appropriators.

Our Ruling

Bost claimed that Republicans were not cutting veterans? benefits even as the text of their bill to raise the nation?s debt ceiling would roll back all discretionary spending.

Drafting a slimmed-down budget that spares veterans is no easy task. Most notably, the VA represents one of the largest pieces of the pie in terms of discretionary spending, and, in the House-passed Limit, Save, Grow Act, no language was included to specifically protect it.

The House GOP plan does include a specific budget rescission for unspent covid relief funds. That translates to $2 billion coming from the VA. While Congress could restore that money in the future ? and it is a relatively small portion of the VA budget ? it would result in a reduction in spending for veterans as the proposal stands.

House Republicans like Bost have said repeatedly they intend to protect this key constituency. But so far, such protections are not evident on paper.

We rate Bost?s statement as Mostly False.

Speaker Kevin McCarthy?s Speech at the New York Stock Exchange, April 17, 2023

Statement by House Appropriations Chairwoman Kay Granger on the Limit, Save, Grow Act, April 26, 2023

?Putting the Limit, Save, Grow Act in Context,? Committee for a Responsible Federal Budget, April 25, 2023

Letter to House Democrats from Veterans Affairs Secretary Denis McDonough, March 21, 2023

Statement by Rep. Rosa DeLauro (D-Conn.) on spending for veterans, April 26, 2023

Analysis of Rescissions in the Default on America Act, House Appropriations Committee estimate of veterans? cuts

American Rescue Plan Act, March 11, 2021 (veterans? appropriations on Page 110)

Limit, Save, Grow Act, sponsored by Rep. Jodey C. Arrington (R-Texas), engrossed April 26, 2023

MAX Information and Reports (Executive, Legislative, and Judicial Users): FY 2023-SF 133 Reports on Budget Execution and Budgetary Resources, April 20, 2023

?How Much Has the U.S. Government Spent This Year?? U.S. Department of Treasury, accessed May 1, 2023

?Discretionary Spending in Fiscal Year 2022: An Infographic,? Congressional Budget Office, March 28, 2023

Letter from veterans? service organizations to members of Congress, April 25, 2023

?Many Dissatisfied With the Government?s Spending Priorities,? poll by AP-NORC, March 29, 2023

?House Republicans? Pledge to Cut Appropriated Programs to 2022 Level Would Have Severe Effects, Particularly for Non-Defense Programs,? Center on Budget and Policy Priorities, March 25, 2023

?VFW Asks Speaker of the House to Honor the Promises of the PACT Act? (letter), April 25, 2023

Background email discussion with office of Rep. Mike Bost (R-Ill.), April 28, 2023

Email exchanges with Democratic staff of House Appropriations Committee, April 28, 2023

Telephone interview with Patrick Murray, director of national legislative service for the Veterans of Foreign Wars, April 28, 2023

House floor speech regarding veterans? programs by Rep. Mike Bost (R-Ill.), C-SPAN, April 26, 2023

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